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Suganuma E, Miura M, Koyama Y, Kobayashi T, Kaneko T, Hokosaki T, Numano F, Furuno K, Shiono J, Fuse S, Fukazawa R, Mitani Y. Regression effect of renin-angiotensin-aldosterone system inhibitors on Kawasaki disease patients with coronary artery aneurysm: a prospective, observational study. Eur J Pediatr 2024:10.1007/s00431-024-05765-3. [PMID: 39240388 DOI: 10.1007/s00431-024-05765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE This study is to investigate whether angiotensin type 1 receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEis) can regress coronary artery aneurysm (CAA) in patients with Kawasaki disease (KD). METHODS This multicenter, prospective, observational study was conducted at 53 institutions throughout Japan. We enrolled patients who were diagnosed with KD after January 2015 and had a medium or large CAA (maximum luminal diameter ≥ 4 mm or z score ≥ + 5) 30 days or later after KD onset. RESULTS Of the 209 patients, 47 (22%) were taking ARBs/ ACEis. Compared with those in the non-ARB/ACEi group, the baseline CAA diameter was significantly greater (6.7 mm vs. 5.5 mm, p < 0.01), and bilateral CAA (70% vs. 59%, p = 0.01) and giant CAA (32% vs. 20%, p = 0.08) were more frequently observed in the ARB/ACEi group. Although the overall regression rates did not differ between the groups (67% vs. 65%), the regression rates of giant CAA were approximately 1.6 times greater in the ARB/ACEi group than in the non-ARB/ACEi group (36% vs. 23%). Multivariate Cox regression analysis after adjustment for other clinical variables suggested that ARBs/ACEis may be a factor in CAA regression (hazard ratio [HR]: 1.5, 95% confidence interval [CI]: 0.91-2.46). CONCLUSIONS Although ARBs/ ACEis were used more frequently in patients with severe CAA, these patients had similar CAA regression rates to patients not taking ARBs/ACEis. ARBs/ACEis may be beneficial agents aimed at inducing CAA regression in KD patients. WHAT IS KNOWN • Large CAAs are less likely to regress and are always at risk of life-threatening cardiac events. • Moderate CAA, age less than 1 year, and female sex have been reported to be factors that promote the regression of CAA. WHAT IS NEW • Although ARBs/ACEis were used more frequently in patients with severe CAA, these patients had a similar rate of CAA regression to patients who did not take ARBs/ACEis. • The regression rates of giant CAA were approximately 1.6 times greater in the ARB/ACEi group than in the non-ARB/ACEi group.
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Affiliation(s)
- Eisuke Suganuma
- Division of Infectious Diseases and Immunology and Allergy, Saitama Children's Medical Center, Saitama, Japan
| | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, 2-18-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Yutaro Koyama
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, 2-18-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-18-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Tatsunori Hokosaki
- Department of Pediatric Cardiology, Yokohama City University Hospital, Kanagawa, Japan
| | - Fujito Numano
- Department of Pediatrics, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Kenji Furuno
- Department of General Pediatrics and Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Junko Shiono
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Shigeto Fuse
- Department of Clinical Laboratory, NTT EAST Medical Center Sapporo, Hokkaido, Japan
| | - Ryuji Fukazawa
- Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
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Kuo HC, Lin MC, Kao CC, Weng KP, Ding Y, Chen CJ, Jan SL, Chien KJ, Ko CH, Lin CY, Lei WT, Chang LS, Guo MMH, Yang KD, Sylvester KG, Han Z, Whitin JC, Tian L, Chubb H, Ceresnak SR, McElhinney D, Cohen HJ, Ling XB. EFFICACY OF INTRAVENOUS IMMUNOGLOBULIN ALONE ON CORONARY ARTERY LESION REDUCTION IN KAWASAKI DISEASE. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.11.24310310. [PMID: 39040184 PMCID: PMC11261943 DOI: 10.1101/2024.07.11.24310310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Background Though Aspirin and intravenous immunoglobulin (IVIG) remain the standard treatments for Kawasaki Disease (KD) to minimize coronary artery damage, the duration and dosage of aspirin are inconsistent across hospitals. However, the lack of multi-center randomized trials prevents definitive answers to the impact of high-dose aspirin. Methods This clinical trial was structured as a prospective, evaluator-blinded, multi-center randomized controlled trial with two parallel arms, aiming to assess the effectiveness of IVIG as a standalone primary therapy of KD in comparison to the combination of IVIG with high-dose aspirin therapy. KD patients were enrolled between September, 2016 and August, 2019. A final cohort of 134 patients were randomly assigned to the standard and test groups with 69 and 65 patients, respectively. The Standard group received IVIG (2 g/kg) along with aspirin (80-100 mg/kg/day) until fever subsided for 48 hours. The test group received IVIG (2 g/kg) alone. Following the initial treatment, both groups received a daily aspirin dose (3-5 mg/kg) for six weeks. The primary outcome measure was the occurrence of coronary artery lesions (CAL) at the 6-8 weeks mark. The secondary outcome is IVIG resistance. Results The overall rate of CAL in test group decreased from 10.8% at diagnosis to 1.5% and 3.1% at 6 weeks and 6 months, respectively. The CAL rate of standard group declined from 13.0% to 2.9% and 1.4%, with no statistically significant difference (P>0.1) in the frequency of CAL between the two groups. Furthermore, no statistically significant differences were found for treatment (P>0.1) and prevention (P>0.1) effect between the two groups. Conclusions This marks the first prospective multi-center randomized controlled trial comparing the standard treatment of KD using IVIG plus high-dose aspirin against IVIG alone. Our analysis indicates that addition of high-dose aspirin during initial IVIG treatment is neither statistically significant nor clinically meaningful for CAL reduction. Registration URL: http://www.clinicaltrials.gov ; identifier: NCT02951234. What is New? This study represents the first multi-center randomized controlled trial investigating the efficacy of high-dose aspirin or intravenous immunoglobulin (IVIG) during the acute stage of KD. This study assessed the impact of discontinuing high-dose aspirin (80-100 mg/kg/day) on the occurrence of CAL during the acute phase treatment of Kawasaki Disease.No significant differences were observed between high-dose aspirin plus IVIG treatment and IVIG alone treatment in terms of the frequency of abnormal coronary artery abnormalities. Additionally, our analysis revealed no statistically significant differences in either the treatment effect (the number of cases successfully treated) or prevention effect (the prevention of new cases) between these two treatments. What Are the Clinical Implications? Comparison analysis indicated the non-inferiority between two groups with or without high-dose aspirin.Administering the standard 2 g/kg/day IVIG without high-dose aspirin (80-100 mg/kg/day) during the acute phase therapy for KD does not increase the risk of coronary artery lesions, which are a primary cause of morbidity and mortality in KD patients.Addition of high-dose aspirin during initial IVIG treatment is not statistically significant or clinically meaningful.
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Lombardi Pereira AP, Aubuchon E, Moreira DP, Lane M, Carvalho TT, Mesquita TRR, Lee Y, Crother TR, Porritt RA, Verri WA, Noval Rivas M, Arditi M. Long-term cardiovascular inflammation and fibrosis in a murine model of vasculitis induced by Lactobacillus casei cell wall extract. Front Immunol 2024; 15:1411979. [PMID: 38989288 PMCID: PMC11234797 DOI: 10.3389/fimmu.2024.1411979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Background Kawasaki disease (KD), an acute febrile illness and systemic vasculitis, is the leading cause of acquired heart disease in children in industrialized countries. KD leads to the development of coronary artery aneurysms (CAA) in affected children, which may persist for months and even years after the acute phase of the disease. There is an unmet need to characterize the immune and pathological mechanisms of the long-term complications of KD. Methods We examined cardiovascular complications in the Lactobacillus casei cell wall extract (LCWE) mouse model of KD-like vasculitis over 4 months. The long-term immune, pathological, and functional changes occurring in cardiovascular lesions were characterized by histological examination, flow cytometric analysis, immunofluorescent staining of cardiovascular tissues, and transthoracic echocardiogram. Results CAA and abdominal aorta dilations were detected up to 16 weeks following LCWE injection and initiation of acute vasculitis. We observed alterations in the composition of circulating immune cell profiles, such as increased monocyte frequencies in the acute phase of the disease and higher counts of neutrophils. We determined a positive correlation between circulating neutrophil and inflammatory monocyte counts and the severity of cardiovascular lesions early after LCWE injection. LCWE-induced KD-like vasculitis was associated with myocarditis and myocardial dysfunction, characterized by diminished ejection fraction and left ventricular remodeling, which worsened over time. We observed extensive fibrosis within the inflamed cardiac tissue early in the disease and myocardial fibrosis in later stages. Conclusion Our findings indicate that increased circulating neutrophil counts in the acute phase are a reliable predictor of cardiovascular inflammation severity in LCWE-injected mice. Furthermore, long-term cardiac complications stemming from inflammatory cell infiltrations in the aortic root and coronary arteries, myocardial dysfunction, and myocardial fibrosis persist over long periods and are still detected up to 16 weeks after LCWE injection.
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Affiliation(s)
- Ana Paula Lombardi Pereira
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Londrina State University, Londrina, Brazil
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Emily Aubuchon
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Debbie P. Moreira
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Malcolm Lane
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Thacyana T. Carvalho
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | | | - Youngho Lee
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Timothy R. Crother
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Rebecca A. Porritt
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Waldiceu A. Verri
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Londrina State University, Londrina, Brazil
| | - Magali Noval Rivas
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Moshe Arditi
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Guerin Children’s at Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Infectious and Immunologic Diseases Research Center (IIDRC), Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Liu J, Su D, Qin S, Ye B, Wang B, Pang Y. Evaluation of the Association Between Coronary Artery Aneurysms and Concomitant Infection in Patients With Kawasaki Disease. Clin Pediatr (Phila) 2024; 63:785-797. [PMID: 37642409 DOI: 10.1177/00099228231196526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
We analyzed the relationship between recovery from coronary artery aneurysms (CAAs) and concurrent infections in patients with Kawasaki disease (KD). The estimated median time of aneurysm persistence between patients with and without infections was compared using Kaplan-Meier survival analyses. Risk factors associated with persistent CAAs at 2 years were identified using multivariable analyses. Co-infection was confirmed in 20.5% (106/518) of patients diagnosed with KD. No significant differences regarding treatment or coronary artery outcome were identified between patients with and without infections. The estimated median time of aneurysm persistence was higher in the co-infected group (9 vs. 6 months). A maximum Z-score ≥ 4.00 at 1 month had 78% sensitivity and 83% specificity in predicting CAAs without recovery within 1 year of onset, whereas the predictability was higher within 2 years of onset, with a Z-score ≥ 4.88 (sensitivity, 92%; specificity, 91%). Concomitant infections did not affect the response to treatment or coronary artery outcomes in patients with KD.
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Affiliation(s)
- Jie Liu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Danyan Su
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Suyuan Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Ye
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baofeng Wang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Li M, Zheng Z, Yi Q. The landscape of hot topics and research frontiers in Kawasaki disease: Scientometric analysis. Heliyon 2024; 10:e29680. [PMID: 38660261 PMCID: PMC11040120 DOI: 10.1016/j.heliyon.2024.e29680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose Kawasaki disease(KD) is a vascular inflammatory disease that was first identified in 1967. Numerous studies have been conducted on KD and have yielded valuable recent insights. This current bibliometric analysis aimed to determine the intellectual landscape of research interest in KD. Methods Publications were collected from the Web of Science Core Collection. Bibliometric tools such as CiteSpace and VOSviewer were utilized to analyze the research focus, emerging trends, frontiers, and hot topics in this specific field. Results A total of 6122 articles on KD were retrieved. Pediatric Cardiology, Pediatrics International, and Pediatric Infections Disease Journal were the three most productive journals reporting KD development. The University of California San Diego was the most productive institution, with 230 publications. The USA was the most productive country, with 1661 articles in KD. SARS-CoV-2, diagnostic serum biomarkers, and risk factor prediction models for coronary arterial lesions and subtypes of KD are popular topics in KD research. Factors that induce smooth muscle cell transition to myofibroblastic cell, potentially halting the subacute/chronic vasculitis process and endothelial dysfunction in macrophage activation syndrome associated with KD were the frontiers in the study of KD. Conclusion KD has attracted widespread attention worldwide that has continued to increase since 1974. The most productive institution and country are the University of California San Diego and the USA, respectively. SARS-CoV-2, serum biomarkers, and prediction models are hot topics in this field.
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Affiliation(s)
- Mengling Li
- National Clinical Key Cardiovascular Specialty, Key Laboratory of Children's Important Organ Development and Diseases of Chongqing Municipal Health Commission, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Department of Pediatrics, Sichuan Mianyang 404 Hospital, Mianyang, 621000, China
| | - Zaiyong Zheng
- Nucleic Acid Medicine of Luzhou Key Laboratory,Luzhou, 646000, China
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Qijian Yi
- National Clinical Key Cardiovascular Specialty, Key Laboratory of Children's Important Organ Development and Diseases of Chongqing Municipal Health Commission, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
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He Y, Shao S, Qiao Y, Zhang N, Gong X, Hua Y, Zhou K, Li Y, Liu X, Wang C. Using nomogram scores to predict the early regression of coronary artery aneurysms of Kawasaki disease. Cardiol Young 2024; 34:348-355. [PMID: 37424509 DOI: 10.1017/s1047951123001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Coronary artery aneurysms have been considered the most serious complication of Kawasaki disease. However, some coronary artery aneurysms do regress. Therefore, the ability to predict the expected time of coronary artery aneurysm regression is critical. Herein, we have created a nomogram prediction system to determine the early regression (<1 month) among patients with small to medium coronary artery aneurysms. METHODS Seventy-six Kawasaki disease patients identified with coronary artery aneurysms during the acute or subacute phase were included. All the patients who met inclusion criteria demonstrated regression of coronary artery aneurysms within the first-year post Kawasaki disease diagnosis. The clinical and laboratory parameters were compared between the groups of coronary artery aneurysms regression duration within and beyond 1 month. Multivariate logistic regression analysis was used to identify the independent parameters for early regression based on the results from the univariable analysis. Then nomogram prediction systems were established with associated receiver operating characteristic curves. RESULTS Among the 76 included patients, 40 cases recovered within 1 month. Haemoglobin, globulin, activated partial thromboplastin time, the number of lesions, location of the aneurysm, and coronary artery aneurysm size were identified as independent factors for early regression of coronary artery aneurysms in Kawasaki disease patients. The predictive nomogram models revealed a high efficacy in predicting early regression of coronary artery aneurysms. CONCLUSION The size of coronary artery aneurysms, the number of lesions, and the location of aneurysms presented better predictive value for predicting coronary artery aneurysms regression. The nomogram system created from the identified risk factors successfully predicted early coronary artery aneurysm regression.
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Affiliation(s)
- Yunru He
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuran Shao
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanni Qiao
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics, Affiliated People's Hospital of Chongqing Three Gorges Medical College, Wanzhou, Chongqing, China
| | - Nanjun Zhang
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xue Gong
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoliang Liu
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Galeotti C, Bajolle F, Belot A, Biscardi S, Bosdure E, Bourrat E, Cimaz R, Darbon R, Dusser P, Fain O, Hentgen V, Lambert V, Lefevre-Utile A, Marsaud C, Meinzer U, Morin L, Piram M, Richer O, Stephan JL, Urbina D, Kone-Paut I. French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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Affiliation(s)
- C Galeotti
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - F Bajolle
- M3C-Necker-Enfants-Malades, hôpital Necker-Enfants-Malades, université de Paris Cité, Paris, France
| | - A Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - S Biscardi
- Service des urgences pédiatriques, centre hospitalier intercommunal de Créteil, Créteil, France
| | - E Bosdure
- Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 13385 Marseille cedex 5, France
| | - E Bourrat
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - R Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - R Darbon
- Association France vascularites, Blaisy-Bas, France
| | - P Dusser
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - O Fain
- Service de médecine interne, hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Hentgen
- Service de pédiatrie, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), centre hospitalier de Versailles, Le Chesnay, France
| | - V Lambert
- Service de radiologie pédiatrique, Institut mutualiste Montsouris, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - A Lefevre-Utile
- Service de pédiatrie générale et des urgences pédiatriques, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - C Marsaud
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - U Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Morin
- Service de réanimation pédiatrique et néonatale, DMU 3 santé de l'enfant et adolescent, hôpital Bicêtre, université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - M Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, Quebec, Canada
| | - O Richer
- Service des urgences pédiatriques, hôpital universitaire de Pellegrin, Bordeaux, France
| | - J-L Stephan
- Service de pédiatrie, CHU Saint-Étienne, Saint-Étienne, France
| | - D Urbina
- Service d'accueil des urgences pédiatriques, hôpital Nord, AP-HM, 13005 Marseille, France
| | - I Kone-Paut
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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Cannon L, Campbell MJ, Wu EY. Multisystemic Inflammatory Syndrome in Children and Kawasaki Disease: Parallels in Pathogenesis and Treatment. Curr Allergy Asthma Rep 2023:10.1007/s11882-023-01083-0. [PMID: 37171672 PMCID: PMC10176315 DOI: 10.1007/s11882-023-01083-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE OF REVIEW Since it first appeared, multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been compared to Kawasaki disease (KD). Although there were early parallels between MIS-C and KD, key differences emerged over time. Here, we aim to compare the pathogenesis, clinical presentation, treatment, and outcomes of MIS-C and KD. RECENT FINDINGS In this article, we review and compare MIS-C and KD, highlighting differentiating features. We discuss the epidemiological and immunological factors along with clinical and laboratory features which discern MIS-C from KD. We also compare treatment and our understanding of long-term outcomes. Though parallels exist between MIS-C and KD, distinguishing the two is important for clinical management of patients, counseling about natural history, and determining long-term monitoring. While both MIS-C and KD are characterized by profound inflammation and inflammatory vasculopathy, further study is needed to determine whether they are distinct immunopathogenic disorders.
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Affiliation(s)
- Laura Cannon
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Jay Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Eveline Y Wu
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, 030 MacNider Hall, CB #7231 Chapel Hill, NC, 27599-7231, Chapel Hill, USA.
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Kato T, Miura M, Kobayashi T, Kaneko T, Fukushima N, Suda K, Maeda J, Shimoyama S, Shiono J, Hirono K, Ikeda K, Sato S, Numano F, Mitani Y, Waki K, Ayusawa M, Fukazawa R, Fuse S, Fukazawa R, Fuse S, Hamaoka K, Hirono K, Kato T, Kato H, Kobayashi T, Saji T, Suda K, Waki K, Yamagishi H, Fukushima N, Tomotsune M, Yoshida M, Kaneko T, Toyono M, Furuno K, Shimoyama S, Iwashima S, Moritou Y, Kamada M, Takeda A, Shiono J, Sano T, Omori D, Fukasawa Y, Mii S, Nomura Y, Nakamura T, Maeda J, Ishii M, Ogata S, Kitagawa A, Yamamoto M, Ikeda K, Yamamura K, Mitani Y, Masuda H, Kaneko M, Kawamura Y, Komori A, Ayusawa M, Sato S, Numano F, Suzuki H, Watanabe K, Hayashi M, Watanabe M, Kuraishi K, Nishihara E, Katayama H, Okumura K, Takahashi T, Horita N, Matsuzaki S, Motoki N, Akazawa Y, Aso K, Nagumo K, Takatuki S, Suganuma E, Matsuda S, Hayabuchi Y, Doi S, Honda T, Terai M, Miyamoto T. Analysis of Coronary Arterial Aneurysm Regression in Patients With Kawasaki Disease by Aneurysm Severity: Factors Associated With Regression. J Am Heart Assoc 2023; 12:e022417. [PMID: 36718857 PMCID: PMC9973627 DOI: 10.1161/jaha.121.022417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Coronary arterial aneurysms (CAAs) associated with Kawasaki disease (KD) significantly affect prognosis. However, the clinical course of CAAs and factors associated with CAA regression have not been well analyzed. Methods and Results The cohort of the Z-Score 2nd Project Stage study, a multicenter, retrospective, cohort study involving 44 institutions in Japan including 1006 patients with KD, was examined. CAAs were classified by the z score of their internal diameter in the acute phase: small (z<5), medium (5≤z<10), and large (z≥10). The lower limit of small CAA was based on the Japanese Ministry of Health, Labour and Welfare criteria. In the right coronary artery, the CAA regression rates 10 years after diagnosis were 95.5% for small, 83.2% for medium, and 36.3% for large. In the proximal left anterior descending artery, the regression rates 10 years after diagnosis were 95.3% for small, 80.1% for medium, and 28.8% for large. Cox regression analysis showed that diagnosis under the age of 1 year and onset of KD in 2010 to 2012 for the right coronary artery and the left anterior descending artery, and female for the right coronary artery were significantly associated with a high regression rate, whereas large CAAs for the right coronary artery and the left anterior descending artery were significantly associated with a low regression rate. Conclusions The current study, the largest Japanese study of its kind, found that small aneurysm, recent onset, and diagnosis under the age of 1 year predict regression, and that even giant aneurysms could regress. These data may contribute to long-term management of coronary aneurysms. Registration URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000010606.
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Affiliation(s)
- Taichi Kato
- Department of PediatricsNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Masaru Miura
- Department of CardiologyTokyo Metropolitan Children’s Medical CenterTokyoJapan,Clinical Research Support CenterTokyo Metropolitan Children’s Medical CenterTokyoJapan
| | - Tohru Kobayashi
- Department of Data Science Clinical Research CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Tetsuji Kaneko
- Clinical Research Support CenterTokyo Metropolitan Children’s Medical CenterTokyoJapan
| | - Naoya Fukushima
- Department of CardiologyTokyo Metropolitan Children’s Medical CenterTokyoJapan
| | - Kenji Suda
- Department of Pediatrics and Child HealthKurume University School of MedicineFukuokaJapan
| | - Jun Maeda
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Shinya Shimoyama
- Department of PediatricsGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Junko Shiono
- Department of Pediatric CardiologyIbaraki Children’s HospitalIbarakiJapan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of MedicineUniversity of ToyamaToyamaJapan
| | - Kazuyuki Ikeda
- Department of Pediatrics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Seiichi Sato
- Department of PediatricsNiigata City General HospitalNiigataJapan
| | - Fujito Numano
- Department of PediatricsNiigata UniversityNiigataJapan
| | - Yoshihide Mitani
- Department of PediatricsMie University Graduate School of MedicineTsuMieJapan
| | - Kenji Waki
- Department of PediatricsKurashiki Central HospitalOkayamaJapan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | | | - Shigeto Fuse
- Department of PediatricsNTT Medical Center SapporoSapporoHokkaidoJapan
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Differences in Sensitivity Between the Japanese and Z Score Criteria for Detecting Coronary Artery Abnormalities Resulting from Kawasaki Disease. Pediatr Cardiol 2023; 44:153-160. [PMID: 36121493 DOI: 10.1007/s00246-022-03008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
No studies have assessed differences between the Japanese and Z score criteria in the echocardiographic detection sensitivity of coronary artery (CA) abnormalities using large-scale data containing samples from multiple facilities engaged in daily clinical practices of Kawasaki disease (KD). We analyzed data from the 25th Japanese nationwide KD survey, which identified 30,415 patients from 1357 hospitals throughout Japan during 2017-2018. Hospitals were classified according to their use of Z score criteria. We assessed differences in hospital and patient background factors and compared the prevalence of CA abnormalities among groups using the Z score criteria. Multivariable logistic regression analyses were performed to evaluate differences in the detection sensitivity for CA abnormalities. The Z score criteria were more likely to be utilized in larger hospitals with more pediatricians and cardiologists. Even after controlling for potential confounders, detection sensitivities by the Z score criteria were significantly higher than by the Japanese criteria in patients with CA dilatations (adjusted odds ratio (95% confidence interval) 1.77 (1.56-2.01)) and aneurysms (1.62 (1.17-2.24)). No significant difference was found in patients with giant CA aneurysms. Compared with the Japanese criteria, the Z score criteria were significantly more sensitive for detecting patients with CA dilatations regardless of age, and for those with CA aneurysms only in patients aged ≤ 1 year. Our results indicate that differences in the detection sensitivity for CA abnormalities between the Z score and the Japanese criteria were dependent on the CA size and patient age.
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Peng Y, Yi Q. Incidence and timing of coronary thrombosis in Kawasaki disease patients with giant coronary artery aneurysm. Thromb Res 2023; 221:30-34. [PMID: 36455387 DOI: 10.1016/j.thromres.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Coronary thrombosis is a common cardiovascular complication of Kawasaki disease (KD), which seriously affects the long-term therapeutic effect of KD. The purpose was to determine the incidence and timing of coronary thrombosis and to identify risk factors for coronary thrombosis in KD with giant coronary artery aneurysm (GCAA). METHODS AND RESULTS A total of 94 consecutive KD patients with GCAA from Children's Hospital Affiliated to Chongqing Medical University were enrolled retrospectively. The cumulative incidence of coronary thrombosis in KD patients with GCAA was 59 % (n = 54). Coronary thrombosis mainly occurred in the acute phase (n = 41/54, 76 %), with a median time of 16 days after onset. Cox regression analysis was used to identify risk factors for coronary thrombosis. Cox regression analysis indicated that male (hazard ratios, 1.87; 95 % CI, 1.01-3.44; P = 0.43), left anterior descending artery (LAD) involvement (hazard ratios, 3.75; 95 % CI, 1.85-7.39; P < 0.001), coronary absolute diameter ≥ 8 mm (hazard ratios, 2.93; 95 % CI, 1.36-6.29; P = 0.006) constituted a higher risk of coronary thrombosis after adjusting for confounders. Kaplan-Meier method showed the cumulative incidence for coronary thrombosis in KD patients with GCAA was 79 %, 92 %, and 88 % in male, LAD involvement, coronary absolute diameter > 8 mm, respectively. CONCLUSIONS Male, LAD involvement, and coronary absolute diameter ≥ 8 mm were associated with a high incidence of coronary thrombosis. Based on the analysis of the incidence, time and risk factors of coronary thrombosis in different periods, this study may provide an essential reference for thromboprophylaxis management of KD with GCAA.
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Affiliation(s)
- Yue Peng
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, People's Republic of China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, People's Republic of China.
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12
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Huang H, Jiang J, Shi X, Qin J, Dong J, Xu L, Huang C, Liu Y, Zheng Y, Hou M, Shen Q, Zeng B, Qian G, Yang F, Lv H. Nomogram to predict risk of resistance to intravenous immunoglobulin in children hospitalized with Kawasaki disease in Eastern China. Ann Med 2022; 54:442-453. [PMID: 35099338 PMCID: PMC8812733 DOI: 10.1080/07853890.2022.2031273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aimed to develop a nomogram to predict risk of resistance to intravenous immunoglobulin (IVIG) in children with Kawasaki disease in eastern China. METHODS We retrospectively analysed the data of children with Kawasaki disease who received IVIG during hospitalisation at Soochow University Affiliated Children's Hospital. IVIG resistance was defined as recrudescent or persistent fever ≥36 h after the end of the IVIG infusion. Baseline variables were analysed using least absolute shrinkage and selection operator (LASSO) to identify the predictors of IVIG resistance, which were then used to construct a predictive nomogram. Calibration curve and area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of the model. The predictive nomogram was validated on test sets of external data and prospective data. RESULTS Between January 2015 and December 2020, 1293 Kawasaki disease patients were hospitalized in Soochow University Affiliated Children's Hospital. Among them, 72 (5.57%) showed IVIG resistance. LASSO identified haemoglobin, percentage of neutrophils, C-reactive protein level, platelet count, serum albumin, serum sodium, serum alkaline phosphatase, coronary artery damage, and complete Kawasaki disease as risk factors for IVIG resistance. The nomogram constructed using these factors showed satisfactory discriminatory power (AUC, 0.75), and sensitivity (0.74) and specificity (0.64). In the external data and prospective data, the AUC was 0.66 and 0.83, respectively, the sensitivity was 0.86 and 1, respectively, and the specificity was 0.49 and 0.60, respectively. CONCLUSIONS The predictive nomogram constructed using nine factors associated with IVIG resistance in children with Kawasaki disease could be a useful tool for identifying patients likely to show IVIG resistance. This nomogram may help reduce the risk of coronary artery lesions.Key MessagesNone of the IVIG resistance scoring systems has shown consistently good performance in previous studies. Tools to predict the risk of IVIG resistance in eastern China are lacking.In our series, haemoglobin level, percentage of neutrophils, platelet count, coronary artery damage, incomplete Kawasaki disease, and CRP, serum albumin, serum sodium, and serum alkaline phosphatase levels were risk factors of IVIG resistance in hospitalized children in the eastern China cities of Suzhou and Fuzhou.We propose an easy-to-use nomogram to predict the risk factors of IVIG resistance in hospitalized children.
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Affiliation(s)
- Hongbiao Huang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China.,Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, P.R. China
| | - Jiaqi Jiang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Xiaosong Shi
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, P.R. China
| | - Jie Qin
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Jinfeng Dong
- Department of Hematology and Rheumatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Lei Xu
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Chengcheng Huang
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Ying Liu
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Yiming Zheng
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Miao Hou
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Qin Shen
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Bihe Zeng
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Guanghui Qian
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
| | - Fang Yang
- Department of Pediatrics, Fujian Provincial Hospital, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, P.R. China
| | - Haitao Lv
- Department of Pediatrics, Institute of Pediatric Research, Children's Hospital of Soochow University, P.R. China
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13
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Yang Y, Hu X. The Predictive Values of MMP-9, PLTs, ESR, and CRP Levels in Kawasaki Disease with Cardiovascular Injury. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6913315. [PMID: 36159562 PMCID: PMC9492360 DOI: 10.1155/2022/6913315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the levels of matrix metalloproteinase-9 (MMP-9), platelets (PLTs), C reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and their predictive values in Kawasaki disease (KD) with cardiovascular injury. Methods 128 children were diagnosed with KD in the Lanzhou University Second Hospital. 75 patients had coronary artery lesion (CAL), while 53 patients did not. The levels of MMP-9, PLTs, and CRP and ESR in the two groups were determined. The area under the curve (AUC) of the receiver-operating characteristic (ROC) curve and the Youden index (YI) were used to evaluate the efficacy of MMP-9, PLTs, ESR, and CRP for predicting CALs in KD. Results The mean age of the patients was 2.7 ± 2.03 years (range, 2 months to 11 years). There were 87 boys (67.97%) and 41 girls (32.03%). In contrast to the NCAL group, the CAL group had obviously higher levels of MMP-9, PLTs, and CRP and an obviously higher ESR (P < 0.05). MMP-9 showed a linear positive correlation with ESR (P < 0.05) and CRP (P < 0.05). The AUC of the combined detection of the four indicators was 0.877, the sensitivity was 85.07% and the specificity was 78.95%. Conclusion MMP-9, PLTs, ESR, and CRP are important indicators for a CAL in KD. The efficacy of the combined detection of MMP-9, PLTs, ESR and CRP is better than that of any single indicator for predicting a CAL in KD.
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Affiliation(s)
- Yinan Yang
- Department of Pediatrics, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaobin Hu
- Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
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Masuda H, Ae R, Koshimizu TA, Kosami K, Makino N, Matsubara Y, Sasahara T, Nakamura Y. Serum alanine aminotransferase level and intravenous immunoglobulin resistance in patients with kawasaki disease. Clin Rheumatol 2022; 41:3125-3133. [PMID: 35798922 DOI: 10.1007/s10067-022-06278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/12/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES Serum alanine aminotransferase (ALT) elevation is considered a risk factor for resistance to initial intravenous immunoglobulin (IVIG) treatment in patients with Kawasaki disease (KD). However, serum ALT levels change dramatically during acute KD illness. We tested the hypothesis that risk assessment for initial IVIG resistance based on serum ALT elevation may differ by examination day after KD onset. METHODS We analyzed 18,492 population-based patients who developed KD throughout Japan. First, we epidemiologically evaluated the serum ALT variation at 1‒10 days after disease onset. Second, we conducted multivariable logistic regression to determine the association between serum ALT level and initial IVIG resistance according to timing of initial hospital visit by stratifying the patients into an early group (1‒5 days after onset) and a late group (6‒10 days after onset). RESULTS Serum ALT rapidly increased after KD onset, peaked at day 4 of illness, and then declined regardless of IVIG responsiveness. The adjusted odds ratio (OR) increased with increasing serum ALT in the early group (adjusted OR [95% CI]: 1.44 [1.25-1.66], 1.94 [1.65-2.28], and 2.22 [1.99-2.48] for serum ALT 50-99, 100-199, and ≥ 200 IU/L, respectively; reference ALT level: 1-49 IU/L). No significant association was observed in the late group. CONCLUSIONS The findings indicate that risk assessment for initial IVIG resistance based on serum ALT level may only be reliable for patients with KD who visit hospitals during early illness, specifically 1-5 days after disease onset. Key Points Serum alanine aminotransferase level differed markedly according to examination days after Kawasaki disease onset. Serum alanine aminotransferase level declined toward normal range after day 5 of illness regardless of intravenous immunoglobulin responsiveness. Elevated serum alanine aminotransferase level was no longer a significant risk factor for initial intravenous immunoglobulin resistance when measured on delayed hospital visits. Risk assessment for initial intravenous immunoglobulin resistance based on serum alanine aminotransferase level may only be reliable for patients who visit hospitals during early illness, specifically 1-5 days after disease onset.
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Affiliation(s)
- Hiroya Masuda
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
| | - Taka-Aki Koshimizu
- Division of Molecular Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Nobuko Makino
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Yuri Matsubara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Teppei Sasahara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
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Abstract
BACKGROUND Coronary artery aneurysms are well-described in Kawasaki disease and the Multisystem Inflammatory Syndrome in Children and are graded using Z scores. Three Z score systems (Boston, Montreal, and DC) are widely used in North America. The recent Pediatric Heart Network Z score system is derived from the largest diverse sample to-date. The impact of Z score system on the rate of coronary dilation and management was assessed in a large real-world dataset. METHODS Using a combined dataset of patients with acute Kawasaki disease from the Children's Hospital at Montefiore and the National Heart, Lung, and Blood Institute Kawasaki Disease Study, coronary Z scores and the rate of coronary lesions (Z ≥ 2.0) and aneurysms (Z ≥ 2.5) were determined using four Z score systems. Agreement among Z scores and the effect on Kawasaki management were assessed. RESULTS Of 333 patients analysed, 136 were from Montefiore and 197 from the Kawasaki Disease Study. Age, sex, body surface area, and rate of coronary lesions did not differ between the samples. Among the four Z score systems, the rate of acute coronary lesions varied from 24 to 55%. The mean left anterior descending Z scores from Pediatric Heart Network and Boston had a large uniform discrepancy of 1.3. Differences in Z scores among the four systems may change anticoagulation management in up to 22% of a Kawasaki population. CONCLUSIONS Choice of Z score system alone may impact Kawasaki disease diagnosis and management. Further research is necessary to determine the ideal coronary Z score system.
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Ranjan P, Ro R, Lerakis S. Multislice Computed Tomography (MSCT) and Cardiovascular Magnetic Resonance (CMR) Imaging for Coronary and Structural Heart Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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17
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Liu J, Huang Y, Chen C, Su D, Qin S, Pang Y. Risk Factors for Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Abnormalities in a Chinese Pediatric Population With Kawasaki Disease: A Retrospective Cohort Study. Front Pediatr 2022; 10:812644. [PMID: 35515347 PMCID: PMC9067160 DOI: 10.3389/fped.2022.812644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 12/19/2022] Open
Abstract
Background The factors predicting high-risk Kawasaki disease (KD) remain unclear. Therefore, we aimed to determine the risk factors for resistance to intravenous immunoglobulin (IVIG) treatment and coronary artery aneurysm (CAA) development in a Chinese pediatric population with high-risk KD. Methods We compared the performances of 11 scoring systems that have been reported to predict IVIG resistance among patients with KD hospitalized from January 2013 through August 2021. Patients were risk-stratified based on the optimal scoring system. The association of baseline characteristics with IVIG treatment resistance and CAA development was investigated within the high-risk group of KD. Results In total, 346 pediatric patients with KD were included, of whom 63 (18.2%) presented with IVIG resistance. The Kobayashi score and five Chinese scoring system scores (Tang et al., Yang et al., Lan et al., Liping et al., and Wu et al.) were significantly higher in the IVIG non-responsive KD group than in the IVIG responsive KD group, and the results of the receiver operating characteristic (ROC) curves analysis were observed to be highest in the Xie Liping scoring system for IVIG resistance (area under the curve, 0.650). Especially, 87 (25.1%) patients comprised the high-risk KD group based on this optimal scoring system (≥5 points). IVIG resistance was significantly associated with the total bilirubin-to-albumin ratio (B/A ratio) [odds ratio, 7.427; 95% confidence interval (CI): 1.022-53.951]. The area under the ROC was 0.703 (95% CI: 0.586-0.821), and the cutoff point was 0.383, which indicated a sensitivity and specificity for predicting treatment resistance of 58% and 80%, respectively. The serum albumin level (odds ratio, 1.401; 95% CI: 1.049-1.869) and Z score of the left main coronary artery (odds ratio, 9.023; 95% CI: 1.070-76.112) were independent predictors of CAA development. Conclusions In the Chinese pediatric population with KD, the Xie Liping scoring system is the most appropriate method for identifying high-risk patients, and IVIG resistance could be predicted based on the B/A ratio. Serum albumin level and Z score of the left main coronary artery at baseline were warning indicators for CAA development. More intensified or adjunctive therapies and close follow-up should be considered for high-risk patients with these risk factors.
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Affiliation(s)
| | | | | | | | | | - Yusheng Pang
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Lee JJY, Lin E, Widdifield J, Mahood Q, McCrindle BW, Yeung RSM, Feldman BM. The Long-term Cardiac and Noncardiac Prognosis of Kawasaki Disease: A Systematic Review. Pediatrics 2022; 149:184739. [PMID: 35118494 DOI: 10.1542/peds.2021-052567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CONTEXT It is uncertain if children with Kawasaki Disease (KD) are at risk for non-cardiac diseases and if children with KD but without coronary artery aneurysms (CAA) are at risk for long-term cardiac complications. OBJECTIVE To determine the long-term mortality and prognosis of children after KD. DATA SOURCES Medline, Embase, and the Cochrane Central Register. STUDY SELECTION Controlled trials and observational studies were included if they included children with KD and reported mortality, major adverse cardiovascular events (MACE), chronic cardiac or other disease over an average follow-up of ≥1 year. DATA EXTRACTION Data extracted included sample size, age at diagnosis, the proportion with coronary artery aneurysms (CAA), follow-up duration, and outcome(s). RESULTS Seventy-four studies were included. Thirty-six studies reported mortality, 55 reported a cardiac outcome, and 12 reported a noncardiac outcome. Survival ranged from 92% to 99% at 10 years, 85% to 99% at 20 years, and 88% to 94% at 30 years. MACE-free survival, mostly studied in those with CAA, varied from 66% to 91% at 10 years, 29% to 74% at 20 years, and 36% to 96% at 30 years. Seven of 10 studies reported an increased risk in early atherosclerosis. All 6 included studies demonstrated an increased risk in allergic diseases. LIMITATIONS Our study may have missed associated chronic comorbidities because short-term studies were excluded. The majority of outcomes were evaluated in East-Asian patients, which may limit generalizability. Studies frequently excluded patients without CAA and did not compare outcomes to a comparison group. CONCLUSIONS Studies demonstrate >90% survival up to 30 years follow-up. MACE is observed in children with CAA, but is not well studied in those without CAA.
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Affiliation(s)
- Jennifer J Y Lee
- Department of Pediatrics.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Ethan Lin
- University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Widdifield
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Quenby Mahood
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Brian W McCrindle
- Department of Pediatrics.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Rae S M Yeung
- Department of Pediatrics.,Institute of Medical Science.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Brian M Feldman
- Department of Pediatrics.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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19
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Xia Y, Qiu H, Wen Z, Shi H, Yu H, Li J, Zhang Q, Wang J, Rong X, Wu R, Chu M. Albumin level and progression of coronary artery lesions in Kawasaki disease: A retrospective cohort study. Front Pediatr 2022; 10:947059. [PMID: 36186633 PMCID: PMC9516112 DOI: 10.3389/fped.2022.947059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Albumin (ALB) level is closely associated with the occurrence of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in Kawasaki disease (KD). The association between ALB level and CALs progression, is critical to the prognosis of KD patients. But little is known about it. This study aims to investigate the effect of the ALB level on CALs progression in KD patients. METHODS A total of 3,479 KD patients from 1 January 2005 to 30 November 2020, in Wenzhou, China were recruited. A total of 319 KD patients who had CALs and ALB data, and finish the follow-up as requested were enrolled in this study. They were classified into the low ALB group and the normal ALB group, divided by 30 g/L. CALs outcomes were classified into two categories according to the CALs changes from the time that CALs were detected within 48 h before or after IVIG treatment to 1 month after disease onset: progressed and no progressed. Multiple logistic regression models were used to assess the independent effect of ALB level on CALs progression among KD patients. Stratified analysis was performed to verify the ALB level on CALs progression among patients in different subgroups. RESULTS Higher proportion of IVIG resistance (P < 0.001), receiving non-standard therapy (P < 0.001), and receiving delayed IVIG treatment (P = 0.020) were detected in patients with lower ALB level. Patients with lower ALB level had higher C-reactive protein (CRP) level (P = 0.097) and white blood cell count (WBC) (P = 0.036). After adjustment for confounders, patients with lower ALB level had higher odds of CALs progression; the adjusted odds ratio (OR) was 3.89 (95% CI: 1.68, 9.02). Similar results were found using stratification analysis and sensitivity analysis. Male gender and age over 36 months, as covariates in multiple logistic regression models, were also associated with CALs progression. CONCLUSION Low ALB level is identified as an independent risk factor for CALs progression in KD patients. Male gender and age over 36 months are also proved to be risk factors for CALs progression. Further investments are required to explore its mechanisms.
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Affiliation(s)
- Yuhan Xia
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Huixian Qiu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Zhengwang Wen
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Hongying Shi
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China.,Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Huan Yu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Jie Li
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Qihao Zhang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Jianjie Wang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Xing Rong
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Rongzhou Wu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
| | - Maoping Chu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Zhejiang, China
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20
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Dahdah N, Kung SC, Friedman KG, Marelli A, Gordon JB, Belay ED, Baker AL, Kazi DS, White PH, Tremoulet AH. Falling Through the Cracks: The Current Gap in the Health Care Transition of Patients With Kawasaki Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2021; 10:e023310. [PMID: 34632822 PMCID: PMC8751858 DOI: 10.1161/jaha.121.023310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Health care transition (HCT) is a period of high vulnerability for patients with chronic childhood diseases, particularly when patients shift from a pediatric to an adult care setting. An increasing number of patients with Kawasaki disease (KD) who develop medium and large coronary artery aneurysms (classified by the American Heart Association according to maximal internal coronary artery diameter Z‐scores ≥5 and ≥10, respectively) are becoming adults and thus undergoing an HCT. However, a poor transition to an adult provider represents a risk of loss to follow‐up, which can result in increasing morbidity and mortality. Methods and Results This scientific statement provides a summary of available literature and expert opinion pertaining to KD and HCT of children as they reach adulthood. The statement reviews the existing life‐long risks for patients with KD, explains current guidelines for long‐term care of patients with KD, and offers guidance on assessment and preparation of patients with KD for HCT. The key element to a successful HCT, enabling successful transition outcomes, is having a structured intervention that incorporates the components of planning, transfer, and integration into adult care. This structured intervention can be accomplished by using the Six Core Elements approach that is recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians. Conclusions Formal HCT programs for patients with KD who develop aneurysms should be established to ensure a smooth transition with uninterrupted medical care as these youths become adults.
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21
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Masuda H, Ae R, Koshimizu TA, Matsumura M, Kosami K, Hayashida K, Makino N, Matsubara Y, Sasahara T, Nakamura Y. Serum sodium level associated with coronary artery lesions in patients with Kawasaki disease. Clin Rheumatol 2021; 41:137-145. [PMID: 34363547 DOI: 10.1007/s10067-021-05881-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/OBJECTIVES Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) identified after acute Kawasaki disease (KD). However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. We hypothesized the association of serum sodium level with CAL complications differs between infants and older patients with KD. METHODS We analyzed 21,610 population-based patients who developed KD throughout Japan during 2013-2014. We performed multivariable logistic regression analyses to evaluate the association between serum sodium and CAL complications. Additionally, we stratified the serum sodium distribution associated with CAL complications by infants and older patients. RESULTS CALs were identified in 158 (3.6%) infants and 302 (1.8%) older patients. Infants were more likely to develop CALs when within the normal sodium range compared with older patients (75% vs. 29%), whereas most older patients developed CALs with a sodium level lower than the reference interval. Serum sodium ≤ 130 mEq/L indicated significantly higher risk for development of CALs in both groups (adjusted odds ratio [95% confidence intervals] = 3.21 [1.65-6.25] in infants and 1.74 [1.18-2.57] in older patients). CONCLUSIONS Serum sodium distribution associated with CAL complications differed greatly between infants and older patients. Older patients developed CALs with sodium levels lower than the reference interval; however, among infants, hyponatremia was not necessarily a risk factor for developing coronary artery lesion. When considering risk assessments for CALs using serum sodium levels, infants with KD should be distinguished from older patients. Key Points • Hyponatremia is a potential risk factor for the development of coronary artery lesions (CALs) among patients with Kawasaki disease. • However, the serum sodium distribution corresponding to the reference intervals differs between infants (< 1 year of age) and older children. • Most infants developed CALs within the normal sodium range, whereas older patients developed at a range lower than the reference interval. • These findings highlight that when considering risk assessments for CALs using serum sodium levels, infants should be distinguished from older patients.
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Affiliation(s)
- Hiroya Masuda
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.,Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.
| | - Taka-Aki Koshimizu
- Division of Molecular Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masami Matsumura
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Kanako Hayashida
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan.,Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Nobuko Makino
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Yuri Matsubara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Teppei Sasahara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke Tochigi, 329-0498, Japan
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22
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Takikawa H, Ae R, Matsubara Y, Matsubara D, Makino N, Kosami K, Kuwabara M, Sasahara T, Nakamura Y. Bacille Calmette-Guérin inoculation site changes and cardiac complications in patients with Kawasaki disease. Arch Dis Child 2021; 106:669-673. [PMID: 33303488 DOI: 10.1136/archdischild-2020-319543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether redness and crusting at the bacille Calmette-Guérin inoculation site (BCGitis), identified during acute illness owing to Kawasaki disease (KD), is an independent risk factor for development of cardiac complications. DESIGN Retrospective cohort study using data from the nationwide KD survey in Japan. SETTING Survey respondents included hospitals specialising in paediatrics and hospitals with ≥100 beds and a paediatric department throughout Japan. PATIENTS We included 17 181 patients with KD across Japan during 2005-2006. MAIN OUTCOME MEASURES BCGitis and cardiac complications resulting from KD. RESULTS BCGitis was identified in 7549 (44%) patients with KD. Compared with patients without BCGitis, those with BCGitis were younger, more likely to be male, less likely to have recurrent status and visited a hospital and underwent initial intravenous immunoglobulin (IVIG) treatment earlier after KD onset. In the unadjusted model, patients with BCGitis were significantly less likely to have cardiac complications (crude OR 0.81, 95% CI 0.71 to 0.92). However, after including treatment factors (days of illness at initial IVIG and treatment responsiveness) in the adjusted model, the association was no longer significant (adjusted OR 0.89, 95% CI 0.77 to 1.03), indicating that BCGitis was not an independent factor associated with cardiac complication and might be confounded by treatment factors. CONCLUSIONS BCGitis was identified in comparatively early illness stages of KD. Our findings indicated that BCGitis was not an independent factor associated with developing cardiac complications but was confounded by prompt initial IVIG administration, which might result in successful treatment and prevention of cardiac complications.
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Affiliation(s)
- Haruki Takikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuri Matsubara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Daisuke Matsubara
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Nobuko Makino
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masanari Kuwabara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Teppei Sasahara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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23
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Abstract
BACKGROUND Some patients with Kawasaki disease (KD) have siblings who developed the same disease. Using a large-scale epidemiologic dataset, the present study aimed to determine the clinical characteristics of this population. METHODS We analyzed 89,725 patients diagnosed with KD during 2011-2018 who were registered in the nationwide Japanese KD survey database. Multivariable logistic regression analyses were performed to determine factors associated with sibling history of KD. RESULTS Of the 89,725 patients, 1777 (2%) had sibling history of KD. Annual prevalence ranged from 1.5% to 2.3% during the study period and showed a tendency toward an increasing trend. Patients with recurrent KD and parental history of KD were significantly associated with sibling history of KD (adjusted odds ratio [95% confidence interval] = 2.15 [1.82-2.54] and 2.64 [2.02-3.47], respectively). Although patients with a sibling history of KD were significantly associated with initial intravenous immunoglobulin treatment resistance (1.14 [1.02-1.28]), no significant association was found between sibling history and coronary artery abnormality development. Among patients with a sibling history of KD, male patients were less likely to have recurrent KD than female patients (0.68 [0.49-0.96]). CONCLUSIONS The significant association between sibling history and parental history may indicate genetic susceptibility to KD onset. Among those with a sibling history, recurrent KD was more likely to occur in female patients. Further studies focusing on this population may contribute toward identification of the cause of KD onset.
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24
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Coronary arterial abnormalities detected in children over 10 years following initial Kawasaki disease using cardiac computed tomography. Cardiol Young 2021; 31:998-1002. [PMID: 33504398 DOI: 10.1017/s1047951121000020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether Kawasaki disease predisposes to premature atherosclerosis and to assess status of coronary artery abnormalities at least 10 years after diagnosis. MATERIAL AND METHODS A prospective study was carried out on 21 patients who were diagnosed with Kawasaki disease at least 10 years back and are on regular follow-up. The study was conducted on 128 Slice Dual Source computed tomography scanner with electrocardiography-triggered radiation optimised protocols for assessment of coronary artery abnormalities and calcifications. RESULTS Study cohort had 21 subjects - 15 males and 6 females (age range: 11-23 years; mean: 15.76 + 3.72 years). Mean age at time of diagnosis was 3.21 + 2.48 years. Mean time interval from diagnosis of Kawasaki disease to computed tomography coronary angiography was 12.59 + 2.89 years. Four children had evidence of coronary artery abnormalities on transthoracic echocardiography at time of diagnosis. Of these, two had persistent abnormalities on computed tomography coronary angiography. One subject (4.76%) had coronary calcification that was localised to abnormal coronary artery segment. Four coronary artery abnormalities (one saccular; three fusiform aneurysms) were noted in two subjects. CONCLUSION Prevalence of coronary artery calcification is low and, if present, is localised to abnormal segments. This calcification is likely dystrophic rather than atherosclerotic. It appears that coronary artery abnormalities can persist for several years after acute episode of Kawasaki disease. Periodic follow-up by computed tomography coronary angiography is now a feasible non-invasive imaging modality for long term surveillance of patients with Kawasaki disease who had coronary artery abnormalities at time of diagnosis.
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25
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Ae R, Maddox RA, Abrams JY, Schonberger LB, Nakamura Y, Kuwabara M, Makino N, Kosami K, Matsubara Y, Matsubara D, Sasahara T, Belay ED. Kawasaki Disease With Coronary Artery Lesions Detected at Initial Echocardiography. J Am Heart Assoc 2021; 10:e019853. [PMID: 33787310 PMCID: PMC8174370 DOI: 10.1161/jaha.120.019853] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Detection of coronary artery lesions (CALs) at initial echocardiography can aid in diagnosing Kawasaki disease (KD) and inform primary adjunctive treatments. We aimed to characterize patients with KD with CALs detected at initial echocardiography. Methods and Results We analyzed data from the nationwide Japanese KD survey that contained information on 103 222 population‐based patients diagnosed with KD across Japan during 2011 to 2018. Patients with CALs detected at initial echocardiography were assessed by age, day of illness, and number of principal KD signs (≥3). Multivariable logistic regression analysis was performed to evaluate factors independently associated with CAL detection. Overall, 3707 (3.6%) patients had CALs detected at initial echocardiography. Patients aged <12 and ≥60 months were associated with CAL detection (adjusted odds ratio [95% CI], 1.28 [1.18‒1.39] and 1.32 [1.20‒1.45], respectively; reference, 12‒59 months). Patients with delayed hospital visits were increasingly at higher risk for CAL detection (days 7‒8, 1.84 [1.63‒2.08]; days 9–10, 4.30 [3.58–5.15]; and days ≥11, 9.12 [7.63‒10.90]; reference, days 1–4). Patients with 3 or 4 principal KD signs were independently associated with CAL detection (1.75 [1.63‒1.88]). These patients were significantly more likely to be aged <12 months but were not associated with delayed hospital visit. Younger patients visited at earlier days of illness. Conclusions Timely diagnosis could be beneficial for patients with KD. However, even when the hospital visit occurred early in the course of illness, patients with 3 or 4 principal KD signs, especially younger patients, were at higher risk of CAL detection at initial echocardiography.
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Affiliation(s)
- Ryusuke Ae
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA.,Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Ryan A Maddox
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Joseph Y Abrams
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Lawrence B Schonberger
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Yosikazu Nakamura
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Masanari Kuwabara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Nobuko Makino
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Koki Kosami
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Yuri Matsubara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | | | - Teppei Sasahara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Ermias D Belay
- Division of High‒Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
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Yao Q, Hu XH, He LL. Cardiac magnetic resonance feature tracking of the right ventricle in convalescent Kawasaki disease in a large single center. Clin Cardiol 2020; 44:108-115. [PMID: 33179816 PMCID: PMC7803351 DOI: 10.1002/clc.23512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background The changes in right ventricular (RV) contractility of Kawasaki disease (KD) still remain unclear. Hypothesis We aimed to determine whether RV systolic dysfunction can be detected by cardiac magnetic resonance (CMR) feature tracking and to find its association with coronary artery lesions (aneurysm, thrombosis and stenosis). Methods Peak systolic myocardial longitudinal, radial and circumferential strain and the strain rate (RVSL, RVSR, RVSC, RVSRL, RVSRR and RVSRC) in the global RV and three levels (basal, middle and apical) were measured in 66 patients with convalescent KD. A total of 20 controls were included. Comparisons were made with controls and among KD subgroups divided with coronary artery lesions. Results RVSC (−10.575% vs. −10.760%), RVSL (−18.150% vs. −18.712%) and RVSRC (−0.815/s vs. −0.924/s) were slightly lower in KD group without significant difference. All the strain and strain rate presented lowest in the basal level. In subgroup comparison, lower RVSL and RVSRL were observed in the giant coronary artery aneurysm (CAA) group; RVSR (15.844% vs. 16.897%), RVSRR (1.245/s vs. 1.322/s) and RVSRC (−0.715/s vs. −0.895/s) were lower in thrombosed group; RVSRL (−1.27/s vs. −1.503/s) were lower in stenosis group. All the comparison in subgroups did not reach significant difference. From the analysis of receiver operating characteristic curve, RVSRL had a better ability to identify KD with giant CAA and stenosis. For the identification of thrombosis, RVSRC had a better ability. Conclusions Lower strain and strain rates of RV were detected in convalescent KD. More pronounced in those with persisting coronary artery lesions.
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Affiliation(s)
- Qiong Yao
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, China
| | - Xi-Hong Hu
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, China
| | - Li-Li He
- Department of Ultrasound, Children's Hospital of Fudan University, Shanghai, China
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Ae R, Makino N, Kosami K, Kuwabara M, Matsubara Y, Nakamura Y. Epidemiology, Treatments, and Cardiac Complications in Patients with Kawasaki Disease: The Nationwide Survey in Japan, 2017-2018. J Pediatr 2020; 225:23-29.e2. [PMID: 32454114 DOI: 10.1016/j.jpeds.2020.05.034] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To report the epidemiologic characteristics, treatments, and cardiac complications of Kawasaki disease, using data from the nationwide survey in Japan. STUDY DESIGN The nationwide Kawasaki disease survey in Japan has been conducted biennially since 1970. The most recent survey was completed in 2019, obtaining information for patients who developed Kawasaki disease during 2017-2018. Survey respondents were hospitals specializing in pediatrics and those with ≥100 beds and a pediatric department throughout Japan, where patients with Kawasaki disease were eventually hospitalized. RESULTS The survey identified 32 528 patients with Kawasaki disease, which consisted of 15 164 (46.6%) in 2017 and 17 364 (53.4%) in 2018. The highest annual incidence rate was recorded in 2018 (359 per 100 000 children aged 0-4 years). After 1982, patients with ≤4 principal Kawasaki disease signs gradually increased, resulting in 6847 (21.1%) patients diagnosed during 2017-2018. Among the 30 784 patients receiving initial intravenous immunoglobulin administration, 6061 (19.7%) did not respond. Within 30 days of Kawasaki disease onset, 9.0% of patients were diagnosed with cardiac complications, and 2.6% of patients developed cardiac sequelae after the acute illness. CONCLUSIONS The annual number of patients developing Kawasaki disease in Japan increased from 1970 through 2018, whereas the proportion of patients with Kawasaki disease with cardiac complications decreased in the most recent 2 decades. Early diagnosis of Kawasaki disease as well as advances in initial treatments could explain these findings.
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Affiliation(s)
- Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
| | - Nobuko Makino
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Masanari Kuwabara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Yuri Matsubara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
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Shenoy B, Singh S, Ahmed MZ, Pal P, Balan S, Viswanathan V, Bhattad S, Rao AP, Chaudhuri M, Shastri DD, Soans ST. Indian Academy of Pediatrics Position Paper on Kawasaki Disease. Indian Pediatr 2020. [PMID: 32471961 DOI: 10.1007/s13312-020-2033-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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29
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Ae R, Abrams JY, Maddox RA, Schonberger LB, Nakamura Y, Kuwabara M, Makino N, Matsubara Y, Kosami K, Sasahara T, Belay ED. Corticosteroids Added to Initial Intravenous Immunoglobulin Treatment for the Prevention of Coronary Artery Abnormalities in High-Risk Patients With Kawasaki Disease. J Am Heart Assoc 2020; 9:e015308. [PMID: 32811256 PMCID: PMC7660775 DOI: 10.1161/jaha.119.015308] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Randomized controlled trials previously provided different conclusions about the superiority of adding corticosteroids to initial intravenous immunoglobulin treatment for the prevention of coronary artery abnormalities in patients with Kawasaki disease (KD). To further assess this issue, we analyzed large-scale data from nationwide KD surveys in Japan, where combination treatment (corticosteroids added to initial standard intravenous immunoglobulin treatment) has become commonly used for patients at high risk for KD. METHODS AND RESULTS Standard intravenous immunoglobulin treatment and combination treatment were compared using data from time periods with and without combination treatment. Outcome measures were coronary artery abnormalities and initial intravenous immunoglobulin treatment failure. Hospitals where ≥20% of patients received combination treatment were identified, and treatment and control groups were selected via matching by age, sex, illness day at initial treatment, and KD recurrence. Matched group selection and subsequent analyses were conducted 1000 times to minimize sampling bias and potential confounders (bootstrapping). From 115 hospitals, 1593 patients with KD in the treatment group and 1593 controls were selected for each of the 1000 sample iterations. The median proportion of patients who developed coronary artery abnormalities among the treatment group and controls were 4.6% (95% CI, 3.8%-5.8%) and 8.8% (95% CI, 7.5%-10.0%), respectively: an estimated risk ratio of 0.53 (0.41-0.67). A median of 14.1% (95% CI, 12.4%-15.9%) of the patients in the treatment group and 21.7% (95% CI, 19.8%-23.4%) in the controls had treatment failure: an estimated risk ratio of 0.65 (0.56-0.75). CONCLUSIONS Combination treatment reduced coronary artery abnormality risk by an estimated 47% and treatment failure by 35%. Multiple-dose corticosteroids may provide benefit in selected patients at high risk for KD.
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Affiliation(s)
- Ryusuke Ae
- Division of High-Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA.,Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Joseph Y Abrams
- Division of High-Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Ryan A Maddox
- Division of High-Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Lawrence B Schonberger
- Division of High-Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
| | - Yosikazu Nakamura
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Masanari Kuwabara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Nobuko Makino
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Yuri Matsubara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Koki Kosami
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Teppei Sasahara
- Division of Public Health Center for Community Medicine Jichi Medical University Tochigi Japan
| | - Ermias D Belay
- Division of High-Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA
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Ae R, Abrams JY, Maddox RA, Schonberger LB, Nakamura Y, Kuwabara M, Makino N, Matsubara Y, Matsubara D, Kosami K, Sasahara T, Belay ED. Outcomes in Kawasaki disease patients with coronary artery abnormalities at admission. Am Heart J 2020; 225:120-128. [PMID: 32497905 DOI: 10.1016/j.ahj.2020.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies demonstrated that coronary artery lesions (CALs) resulting from Kawasaki disease (KD) can improve over time. However, limited information is available on sub-acute outcomes of CALs detected at admission during KD illness. METHODS The nationwide Japanese KD survey contained substantial information on KD patients with CALs detected at admission and who received standard IVIG treatment within 10 days of disease onset. Coronary outcomes were evaluated by changes in CALs from admission to the first assessment at 30 days from disease onset in three categories: improved, unchanged, and progressed. Ordinal logistic regression analysis was performed to evaluate factors associated with the outcomes. RESULTS Of 2024 patients with CALs detected at admission, improved, unchanged, and progressed outcomes were found in 1548 (76.5%), 390 (19.3%), and 86 (4.2%), respectively. Over 80% of patients with coronary artery (CA) dilatations had improved outcome. Independent factors associated with worse outcomes were larger-size CALs (adjusted ORs [95% CIs]: CA aneurysm = 5.13 [3.65-7.22] and giant CA aneurysms = 7.49 [3.56-15.72] compared with CA dilatation, respectively), age ≥ 60 months (1.45 [1.08-1.94] compared with 12-59 months), recurrent KD (1.57 [1.07-2.29]), parental history of KD (2.23 [1.02-4.85]), and delayed admission (8-10 days from disease onset: 1.76 [1.21-2.57] compared with 1-4 days). CONCLUSIONS KD patients with larger CALs, ≥60 months old, and with recurrent status or parental history may require more rigorous treatment. In addition, delayed admission may result in worse coronary outcome, indicating that prompt diagnosis and treatment are required.
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Distinguishing Kawasaki Disease from Febrile Infectious Disease Using Gene Pair Signatures. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6539398. [PMID: 32420360 PMCID: PMC7201505 DOI: 10.1155/2020/6539398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022]
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis of childhood with prolonged fever, and the diagnosis of KD is mainly based on clinical criteria, which is prone to misdiagnosis with other febrile infectious (FI) diseases. Currently, there remain no effective molecular markers for KD diagnosis. In this study, we aimed to use a relative-expression-based method k-TSP and resampling framework to identify robust gene pair signatures to distinguish KD from bacterial and virus febrile infectious diseases. Our study pool consisted of 808 childhood patients from several studies and assigned to three groups, namely, the discovery set (n = 224), validation set-1 (n = 197), and validation set-2 (n = 387). We had identified 60 biologically relevant gene pairs and developed a top-ranked gene pair classifier (TRGP) using the first seven signatures, with the area under the receiver-operating characteristic curves (AUROC) of 0.947 (95% CI, 0.918-0.976), a sensitivity of 0.936 (95% CI, 0.872-0.987), and a specificity of 0.774 (95% CI, 0.705-0.836) in the discovery set. In the validation set-1, the TRGP classifier distinguished KD from FI with AUROC of 0.955 (95% CI, 0.919-0.991), a sensitivity of 0.959 (95% CI, 0.925-0.986), and a specificity of 0.863 (95% CI, 0.764-0.961). In the validation set-2, the predictive performance of classification was with an AUROC of 0.796 (95% CI, 0.747-0.845), a sensitivity of 0.797 (95% CI, 0.720-0.864), and a specificity of 0.661 (95% CI, 0.606-0.717). Our study reveals that gene pair signatures are robust across diverse studies and can be utilized as objective biomarkers to distinguish KD from FI, helping to develop a fast, simple, and effective molecular approach to improve the diagnosis of KD.
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Abstract
BACKGROUND Platelet count is considered as a biomarker for the development of coronary artery abnormalities (CAAs) among Kawasaki disease (KD) patients. However, previous studies have reported inconsistent results. We addressed the controversial association of platelet count with CAAs using a large-scale dataset. METHODS A retrospective cohort study was conducted using KD survey data from Japan (2015-2016; n = 25,448). Classifying patients by intravenous immunoglobulin (IVIG) responsiveness, we described the trends in platelet count using the lowest and highest values along with the specific illness days. Multivariate logistic regression analysis was performed to evaluate the association between platelet count and CAAs, adjusting for relevant factors. RESULTS Platelet counts rapidly decreased from admission, reached the lowest count at 6-7 days, and peaked after 10 days. Platelet counts in IVIG non-responders decreased with a lower minimum value than IVIG responders, but subsequently rebounded toward a higher maximum. Compared with patients with normal platelet counts (150-450 × 10/L), patients with abnormally high platelet counts (>450 × 10/L) were more likely to have CAAs at admission (adjusted odds ratio: IVIG responders, 1.50 [95% confidence interval 1.20-1.87] and non-responders, 1.46 [1.01-2.12]). By contrast, IVIG non-responding patients whose counts were below normal (<150 × 10/L) after hospitalization were at higher risk for developing CAAs (2.27 [1.44-3.58]). CONCLUSIONS Platelet count varied widely by illness day and was confounded by IVIG responsiveness, which might have contributed to previous inconsistent findings. KD patients with abnormally high platelet counts at admission or abnormally low counts after hospitalization were at higher risk for CAAs.
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Gambacorta A, Buonsenso D, De Rosa G, Lazzareschi I, Gatto A, Brancato F, Pata D, Valentini P. Resolution of Giant Coronary Aneurisms in a Child With Refractory Kawasaki Disease Treated With Anakinra. Front Pediatr 2020; 8:195. [PMID: 32457855 PMCID: PMC7223693 DOI: 10.3389/fped.2020.00195] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
Kawasaki disease (KD) is an acute, febrile illness of unknown etiology that mainly affects children under 5 years of age. intravenous immunoglobulin (IVIG), the standard treatment, has reduced coronary involvement to <5%. Patients who do not improve after an initial IVIG have a higher risk of developing coronary arteries aneurysms, and its optimal treatment remains controversial. We present a case of IVIG, steroids, and infliximab-resistant KD in a 9-month-old child, which developed giant aneurysms and was successfully treated with anakinra, a recombinant antagonist of the IL-1 receptor. In our case, the introduction of IL-1 receptor antagonist therapy seems to have blocked the disease from both a clinical and a laboratory point of view. We also noted a very rapid regression of coronary aneurysms passed from giant aneurysms to small ones, or, as in the case of the anterior descending artery, the complete disappearance of the aneurysm formation. We think that our case adds more evidences to the potential role of IL-1RA as therapy in some selected cases of refractory KD, in particular with severe involvement of coronary arteries, although new efficacy trials are needed to better understand the role of Anakinra in these patients.
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Affiliation(s)
- Alessandro Gambacorta
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Microbiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella De Rosa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gatto
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Brancato
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Pata
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Zhang D, Liu L, Huang X, Tian J. Insights Into Coronary Artery Lesions in Kawasaki Disease. Front Pediatr 2020; 8:493. [PMID: 32984207 PMCID: PMC7477115 DOI: 10.3389/fped.2020.00493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
This review summarizes recent advances in understanding the development of coronary arteritis in Kawasaki disease. Kawasaki disease is the most common cause of acquired heart disease among children characterized with coronary artery abnormalities, which can cause myocardial ischemia, infarction, and even death. The pathogenic factors of Kawasaki disease and the pathological process of coronary artery disease are not clear at present, which brings challenges to the prevention and treatment of the disease. The treatment of Kawasaki disease focuses mainly on timely administration of intravenous high doses of immunoglobulin and aspirin. However, there are still some patients who do not respond well to this standard treatment, and its management remains a challenge. As a result, coronary artery lesions still occur in patients and affect their quality of life. In this review, we discuss updated research data of Kawasaki disease coronary artery lesions.
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Affiliation(s)
- Danfeng Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lingjuan Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xupei Huang
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Jie Tian
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Ko TM, Chang JS, Chen SP, Liu YM, Chang CJ, Tsai FJ, Lee YC, Chen CH, Chen YT, Wu JY. Genome-wide transcriptome analysis to further understand neutrophil activation and lncRNA transcript profiles in Kawasaki disease. Sci Rep 2019; 9:328. [PMID: 30674924 PMCID: PMC6344526 DOI: 10.1038/s41598-018-36520-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
Kawasaki disease (KD) is the most common cause of acquired cardiac disease in children in developed countries. However, little is known regarding the role of transcriptomic targets of KD in the disease progression and development of complications, especially coronary artery aneurysms (CAA). The aim of our study was to identify transcripts affected by KD and their potential role in the disease. We enrolled 37 KD patients and collected blood samples along a comprehensive time-course. mRNA profiling demonstrated an abundance of CD177 transcript in acute KD, and in the intravenous immunoglobulin (IVIG)-resistant group compared to in the IVIG-sensitive group. lncRNA profiling identified XLOC_006277 as the most highly expressed molecule. XLOC_006277 expression in patients at acute stage was 3.3-fold higher relative to patients with convalescent KD. Moreover, XLOC_006277 abundance increased significantly in patients with CAA. XLOC_006277 knockdown suppressed MMP-8 and MMP-9 expression, both associated with heart lesions. Our result suggested that the increase of CD177pos neutrophils was associated with KD. Moreover, this study provided global long non-coding RNA transcripts in the blood of patients with KD, IVIG-resistant KD, or CAA. Notably, XLOC_006277 abundance was associated with CAA, which might contribute to further understanding of CAA pathogenesis in KD.
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Affiliation(s)
- Tai-Ming Ko
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Jeng-Sheng Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Ping Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yi-Min Liu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chia-Jung Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Genetics, China Medical University Hospital, Taichung, Taiwan.,Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
| | - Yi-Ching Lee
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yuan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. .,School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Kuwabara M, Yashiro M, Ae R, Yanagawa H, Nakamura Y. The effects of early intravenous immunoglobulin therapy for Kawasaki disease: The 22nd nationwide survey in Japan. Int J Cardiol 2018; 269:334-338. [DOI: 10.1016/j.ijcard.2018.07.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 02/01/2023]
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Abstract
Kawasaki disease (KD) is an acute-onset systemic vasculitis of medium-sized vessels that mostly affects infants and toddlers. Globally, it is the most common form of childhood primary vasculitis. Delayed diagnosis and treatment results in coronary artery aneurysms in up to 25% of all affected individuals. Thus, KD is the most common acquired heart disease in developed countries. Here, the current understanding of clinical presentations, pathophysiological concepts, disease-associated complications, and available pharmaceutical treatment is provided and discussed in the context of available literature.
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Affiliation(s)
- Christian M. Hedrich
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom
- Pädiatrische Rheumatologie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Anja Schnabel
- Pädiatrische Rheumatologie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Toni Hospach
- Zentrum für Pädiatrische Rheumatologie am Klinikum Stuttgart, Stuttgart, Germany
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Kuo HC, Guo MMH, Lo MH, Hsieh KS, Huang YH. Effectiveness of intravenous immunoglobulin alone and intravenous immunoglobulin combined with high-dose aspirin in the acute stage of Kawasaki disease: study protocol for a randomized controlled trial. BMC Pediatr 2018; 18:200. [PMID: 29933749 PMCID: PMC6015467 DOI: 10.1186/s12887-018-1180-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile systemic vasculitis most commonly seen in children under 5 years old. High-dose aspirin is often administered, but the duration of such treatment varies. Many centers reduce the aspirin dose once the patient is afebrile, even before treating said patient with intravenous immunoglobulin (IVIG). However, a randomized controlled trial regarding high-dose aspirin in the acute stage of KD has not previously been carried out. METHODS/DESIGN This trial has been designed as a multi-center, prospective, randomized controlled, evaluator-blinded trial with two parallel groups to determine whether IVIG alone as the primary therapy in acute-stage KD is as effective as IVIG combined with high-dose aspirin therapy. The primary endpoint is defined as coronary artery lesion (CAL) formation at 6-8 weeks. Patients meeting the eligibility criteria are randomly assigned (1:1) to a test group (that receives only IVIG) or a standard group (that receives IVIG plus high-dose aspirin). This clinical trial is conducted at three medical centers in Taiwan. DISCUSSION Since high-dose aspirin has significant anti-inflammatory and anti-platelet functions, it does not appear to affect disease outcomes. Furthermore, it can decrease hemoglobin levels. Therefore, we have initiated this randomized controlled trial to evaluate the necessity of high-dose aspirin in the acute stage of KD. TRIAL REGISTRATION Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan. ClinicalTrials.gov Identifier: NCT02951234. Release Date: November 3, 2016.
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Affiliation(s)
- Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, #123 Da-Pei Road, Niaosong District, Kaohsiung, 83301 Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mindy Ming-Huey Guo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, #123 Da-Pei Road, Niaosong District, Kaohsiung, 83301 Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mao-Hung Lo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, #123 Da-Pei Road, Niaosong District, Kaohsiung, 83301 Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, #123 Da-Pei Road, Niaosong District, Kaohsiung, 83301 Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, #123 Da-Pei Road, Niaosong District, Kaohsiung, 83301 Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Goh YG, Ong CC, Tan G, Liang CR, Soomar SM, Terence Lim CW, Quek SC, Teo LSL. Coronary manifestations of Kawasaki Disease in computed tomography coronary angiography. J Cardiovasc Comput Tomogr 2018; 12:275-280. [PMID: 29426687 DOI: 10.1016/j.jcct.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/10/2017] [Indexed: 12/31/2022]
Abstract
Coronary arteritis in Kawasaki disease can lead to serious complications such myocardial infarction and sudden death. The identification of coronary manifestations with a method that is minimally invasive and of low radiation exposure is therefore important in paediatric patients with Kawasaki disease. Coronary CT angiography can be an attractive alternative to invasive coronary angiography. This paper describes imaging techniques for coronary CT angiography in pediatric patients and demonstrates the spectrum of cardiovascular manifestations in patients with Kawasaki disease.
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Affiliation(s)
- Yong Geng Goh
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Grace Tan
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Sanah Merchant Soomar
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Chee Wen Terence Lim
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Swee Chye Quek
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Li San Lynette Teo
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074.
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Advani N, Sastroasmoro S, Ontoseno T, Uiterwaal CS. Long-term outcome of coronary artery dilatation in Kawasaki disease. Ann Pediatr Cardiol 2018; 11:125-129. [PMID: 29922008 PMCID: PMC5963225 DOI: 10.4103/apc.apc_172_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis syndrome with a high incidence of coronary aneurysms in untreated children. The majority of aneurysms resulting from KD are known to regress with time. Aims This study aimed to determine the course and outcome of coronary artery dilatation in patients with KD and ascertain whether there are any differences in the outcomes in the different branches. Setting and Design This is a retrospective cohort study of patients diagnosed with KD with midterm follow-up data. Methods Serial echocardiography was performed in all KD patients with coronary dilatation for 1-10½ years. The Kaplan-Meier curve was used for statistical analysis. Results There were 154 patients with coronary dilatation studied. The frequency of coronary dilatation in acute phase was 33.3% and decreased to 7.9% 6-8 weeks later. Each patient could have dilatations at more than one branch, so the total number of dilatations was 245. The median time needed for regression was 2.6 months (mean: 10.5 months) while the median of follow-up duration was 41 months (mean: 23 months). Small- and medium-sized dilatations had more favorable outcomes compared to the giant ones. Location of dilatation did not influence the outcome. Conclusions The majority (77.4%) of small- and medium-sized dilatations regress within 2 years, but giant aneurysms tend to persist. The outcome of coronary dilatation is determined by the diameter and not by the location. Regression rate is faster in smaller dilatations. Left main coronary artery is the most frequent location for dilatation.
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Affiliation(s)
- Najib Advani
- Department of Child Health, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sudigdo Sastroasmoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Teddy Ontoseno
- Department of Child Health Faculty of Medicine, Universitas Airlangga-Sutomo Hospital, Surabaya, Indonesia
| | - Cuno Spm Uiterwaal
- Julius Center for Health Science and Primary Care, University of Medical Center Utrecht, Utrecht, The Netherlands
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Lee H, Shin J, Eun L. Myocardial Assessment in School-Aged Children with Past Kawasaki Disease. J Korean Med Sci 2017; 32:1835-1839. [PMID: 28960037 PMCID: PMC5639065 DOI: 10.3346/jkms.2017.32.11.1835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/29/2017] [Indexed: 12/15/2022] Open
Abstract
Coronary artery involvement remains the most important complication with Kawasaki disease (KD). Additional myocardial injury can be caused by inflammatory response and ischemic event. However, the long-term outcome of myocardial function has not been fully known in KD. The purpose of this study is to evaluate myocardial function in school-aged children who had the past history of KD. Sixty-seven children in the second grade of elementary schools, who had the past history of KD, were included. Echocardiographic measurements of each coronary artery and myocardial function were obtained as the long-term follow-up data, and compared with the baseline data at the time of initial presentation of KD. The mean age of the subjects was 8.6 ± 2.4 years, and 4.3 ± 3.4 years have passed since the diagnosis of KD. Among the echocardiographic data, interventricular septum thickness at end-diastole (IVSd), LV internal diameters at end-systole (LVIDs), maximal velocity of late diastolic filling across mitral valve (mitral A) flow, maximal velocity of early diastolic filling across mitral valve (mitral E)/A ratio, mitral inflow E wave to peak early diastolic tissue velocity (E/E') ratio showed significant differences between the baseline and follow-up measurements. Coronary Z-score of left main artery (LMA), left anterior descending (LAD), and right coronary artery (RCA) showed no significant difference. The school-aged children with the past history of KD may have diastolic dysfunction. Therefore, appropriate assessment of myocardial function would be recommended during the follow-up period in children with KD.
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Affiliation(s)
- Heeyoung Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea
| | - Jaeeun Shin
- Division of Pediatric Cardiology, Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea
| | - Lucy Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea.
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Saling LJ, Raptis DA, Parekh K, Rockefeller TA, Sheybani EF, Bhalla S. Abnormalities of the Coronary Arteries in Children: Looking beyond the Origins. Radiographics 2017; 37:1665-1678. [PMID: 29019754 DOI: 10.1148/rg.2017170018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coronary arterial abnormalities are uncommon findings in children that have profound clinical implications. Although anomalies of the coronary origins are well described, there are many other disease processes that affect the coronary arteries. Immune system-mediated diseases (eg, Kawasaki disease, polyarteritis nodosa, and other vasculiditides) can result in coronary arterial aneurysms, strictures, and abnormal tapering of the vessels. Because findings at imaging are an important component of diagnosis in these diseases, the radiologist's understanding of them is essential. Congenital anomalies may present at varying ages, and findings in hemodynamically significant anomalies, such as fistulas, are key for both diagnosis and preoperative planning. Pediatric heart surgery can result in wide-ranging postoperative imaging appearances of the coronary arteries and also predisposes patients to a multitude of complications affecting the heart and coronary arteries. In addition, although rare, accidental trauma can lead to injury of the coronary arteries, and awareness and detection of these conditions are important for diagnosis in the acute setting. Patients with coronary arterial conditions at presentation may range from being asymptomatic to having findings of myocardial infarction. Recognition of the imaging findings is essential to direct appropriate treatment. ©RSNA, 2017.
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Affiliation(s)
- Lauren J Saling
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Demetrios A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Keyur Parekh
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Toby A Rockefeller
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Elizabeth F Sheybani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
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Bang JS, Kim GB, Kwon BS, Song MK, An HS, Song YW, Bae EJ, Noh CI. Long-Term Prognosis for Patients with Kawasaki Disease Complicated by Large Coronary Aneurysm (diameter ≥6 mm). Korean Circ J 2017; 47:516-522. [PMID: 28765744 PMCID: PMC5537154 DOI: 10.4070/kcj.2016.0163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/01/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives Some patients with Kawasaki disease (KD) develop large coronary aneurysms and subsequent coronary stenosis or obstruction, leading to ischemic heart disease. This study examined the long-term outcomes of patients with KD complicated by large coronary aneurysms. Subjects and Methods The medical records of 71 patients (53 men and 18 women) diagnosed with large coronary aneurysms (diameter ≥6 mm) between December 1986 and December 2013 were retrospectively reviewed from our institutional database. Results The mean age at onset was 4.6±3.3 years, and the mean follow-up duration was 12.5±6.9 years. Maximum coronary artery internal diameter ranged from 6.1 to 25 mm. Giant coronary aneurysms occurred in 48 patients and coronary aneurysms 6-8 mm in diameter developed in 23 patients. Coronary stenosis and/or complete occlusion occurred in 30 patients (42.3%). Catheter and/or surgical interventions (mean: 1.5 interventions, range: 1-5 interventions) were performed in 20 patients (28.2%), 9 months to 18 years after KD onset, resulting in 33.7% cumulative coronary intervention rates at 20 years after onset. There were no differences in cumulative coronary intervention rates between two coronary aneurysm groups (6-8 mm vs. ≥8 mm). Myocardial infarction occurred in 7 patients with a giant aneurysm and there was one death. Conclusions Long-term survival of patients with KD complicated by large coronary aneurysm was good even though 28.2% of patients underwent multiple catheter or surgical interventions. Careful follow-up is also necessary in KD patients with coronary aneurysms 6-8 mm in diameter, such as those with giant aneurysms.
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Affiliation(s)
- Ji Seok Bang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Bo Sang Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Mi Kyung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyo Soon An
- Department of Pediatrics, Seoul National University Boramae Hospital, Seoul, Korea
| | - Young Whan Song
- Department of Pediatrics, Bundang Seoul National University Hospital, Seongnam, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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Chen PT, Lin MT, Chen YS, Chen SJ, Wu MH. Computed tomography predict regression of coronary artery aneurysm in patients with Kawasaki disease. J Formos Med Assoc 2017; 116:806-814. [PMID: 28734587 DOI: 10.1016/j.jfma.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/PURPOSE The study evaluated possible factors influencing the regression of coronary artery aneurysm (CAA) in patients with Kawasaki disease (KD) through electrocardiographically gated cardiac computed tomography (CT). METHODS 18 patients with KD exhibited CAAs in at least 2 CT examinations conducted from December 2004 to September 2015, and 37 aneurysms were observed. Every aneurysm was corrected through the descending aorta at the origin level of the left main coronary artery under a normal distribution and measured under a fixed window level. These aneurysms were divided into 2 groups according to regression. Clinical symptoms, laboratory data, and imaging characteristics of both groups were analyzed. RESULTS All the aneurysms of 4 patients decreased in size, and totally, 14 aneurysms (37%) regressed. CAA regression tends to occur early after disease onset. No significant differences were observed in sex, aneurysm location, and the distance to the orifice between the 2 groups. The aneurysms with no calcification (p = 0.012), smaller diameter (p = 0.004), younger disease onset age (p = 0.048), and ectatic shape (p < 0.001) were more likely to regress according to univariate analysis. Receiver operating characteristic analysis revealed that the possible cut-off point of the maximal diameter to yield the highest sensitivity (91.3%) and specificity (92.9%) to predict CAA regression was 5.6 mm. CONCLUSION Calcified CAAs in patients with KD was less likely to regress. The aneurysm size and shape as well as disease onset age were possible factors influencing regression.
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Affiliation(s)
- Po-Ting Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Mavroudis C. Coronary artery bypass grafting in infants, children, and young adults for acquired and congenital lesions. CONGENIT HEART DIS 2017; 12:644-646. [DOI: 10.1111/chd.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins University School of Medicine, Florida Hospital for Children; Orlando Florida
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2158] [Impact Index Per Article: 308.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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Difference in Risk Factors for Subtypes of Acute Cardiac Lesions Resulting from Kawasaki Disease. Pediatr Cardiol 2017; 38:375-380. [PMID: 27878631 DOI: 10.1007/s00246-016-1525-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/11/2016] [Indexed: 12/19/2022]
Abstract
Few studies discuss the risk factors for acute cardiac lesions (within 30 days) resulting from Kawasaki disease (KD). We aimed to clarify the characteristics of patients with cardiac lesions within 30 days and determine the risk factors for acute cardiac lesion subtypes. Using the 23rd nationwide survey of KD in Japan, we analyzed data from patients with or without acute cardiac lesions resulting from KD (n = 31,380). We subdivided patients with acute cardiac lesions into three types: acute valvular lesions, coronary aneurysms, and giant coronary aneurysms (GCA), and calculated the odds ratios of potential risk factors for acute cardiac lesion subtypes. The prevalence of acute cardiac lesions was 8.6%, and these lesions were more prevalent among males than females (1.98:1). Male sex, age <1 year, and atypical definite cases predicted coronary artery lesions (CAL). The risk factors for valvular lesions differed from the risk factors for CALs, but GCA risk factors were similar to CAL risk factors: age <1 year, later presentation to hospital, atypical definite cases, and resistance to initial intravenous immunoglobulin (IVIG) therapy. Resistance to IVIG therapy was a significant risk factor for acute GCA. We found differences in cardiac lesion risk factors within 30 days of diagnosing KD between acute CAL and valvular lesions resulting from KD. In particular, pediatricians should consider atypical definite cases and resistance to initial IVIG when assessing the risk of acute-phase GCA.
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Lalude OO, Lerakis S. Cardiovascular Magnetic Resonance Imaging. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Stamatios Lerakis
- Emory University School of Medicine and Georgia Institute of Technology; Atlanta GA USA
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Prediction of intravenous immunoglobulin resistance in Kawasaki disease in an East China population. Clin Rheumatol 2016; 35:2771-2776. [PMID: 27491972 DOI: 10.1007/s10067-016-3370-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/15/2016] [Accepted: 07/28/2016] [Indexed: 11/27/2022]
Abstract
The objectives of the study were to find the risk factors associated with intravenous immunoglobulin (IVIG) resistance and generate a prediction scoring system of IVIG resistance in patients with Kawasaki disease (KD). We retrospectively reviewed the clinical records of KD patients between January 2006 and December 2014. Multivariate logistic regression was performed to identify the risk factors of IVIG non-responders. The independent risk factors were used to construct a new scoring system and compared with Kobayashi and Egami scoring systems. Multivariate logistic regression analysis identified age <6 months, rash, edema of extremities, % neutrophils, and serum albumin as independent risk factors for IVIG non-responders. We assigned one point for rash, edema of extremities, and % neutrophils ≥80 %. Two points were assigned for age <6 months and serum albumin <35 g/L. Using a cutoff point of three or more, we identified the IVIG non-responders with 71.4 % sensitivity and 76.0 % specificity. The new scoring system had a relatively better performance than Kobayashi and Egami scoring systems in the KD patients in East China. Clinical pediatricians must pay more attention to these high-risk patients, and use of additional therapies early in the course of their illness is necessary.
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Genetic variants in PLCB4/PLCB1 as susceptibility loci for coronary artery aneurysm formation in Kawasaki disease in Han Chinese in Taiwan. Sci Rep 2015; 5:14762. [PMID: 26434682 PMCID: PMC4593004 DOI: 10.1038/srep14762] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/04/2015] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is an acute, inflammatory, and self-limited vasculitis affecting infants and young children. Coronary artery aneurysm (CAA) formation is the major complication of KD and the leading cause of acquired cardiovascular disease among children. To identify susceptible loci that might predispose patients with KD to CAA formation, a genome-wide association screen was performed in a Taiwanese KD cohort. Patients with both KD and CAA had longer fever duration and delayed intravenous immunoglobulin treatment time. After adjusting for these factors, 100 susceptibility loci were identified. Four genes were identified from a single cluster of 35 using the Ingenuity Pathway Analysis (IPA) Knowledge Base. Silencing KCNQ5, PLCB1, PLCB4, and PLCL1 inhibited the effect of lipopolysaccharide-induced endothelial cell inflammation with varying degrees of proinflammatory cytokine expression. PLCB1 showed the most significant inhibition. Endothelial cell inflammation was also inhibited by using a phospholipase C (PLC) inhibitor. The single nucleotide polymorphism rs6140791 was identified between PLCB4 and PLCB1. Plasma PLC levels were higher in patients with KD and CC+CG rs6140791genotypes, and these genotypes were more prevalent in patients with KD who also had CAA. Our results suggest that polymorphism of the PLCB4/B1 genes might be involved in the CAA pathogenesis of KD.
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