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Watanabe M, Fukazawa R, Kiriyama T, Imai S, Matsui R, Shimada K, Hashimoto Y, Hashimoto K, Abe M, Kamisago M, Itoh Y. Hemodynamic Evaluation of Coronary Artery Lesions after Kawasaki Disease: Comparison of Fractional Flow Reserve during Cardiac Catheterization with Myocardial Flow Reserve during 13N-Ammonia PET. J Cardiovasc Dev Dis 2024; 11:229. [PMID: 39195137 DOI: 10.3390/jcdd11080229] [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: 06/20/2024] [Revised: 07/19/2024] [Accepted: 07/19/2024] [Indexed: 08/29/2024] Open
Abstract
Coronary artery lesions (CALs) after Kawasaki disease present complex coronary hemodynamics. We investigated the relationship between coronary fractional flow reserve (FFR), myocardial flow reserve (MFR), and myocardial blood flow volume fraction (MBF) and their clinical usefulness in CALs after Kawasaki disease. Nineteen patients (18 men, 1 woman) who underwent cardiac catheterization and 13N-ammonia positron emission tomography, with 24 coronary artery branches, were included. Five branches had inconsistent FFR and MFR values, two had normal FFR but abnormal MFR, and three had abnormal FFR and normal MFR. The abnormal MFR group had significantly higher MBF at rest than the normal group (0.86 ± 0.13 vs. 1.08 ± 0.09, p = 0.001). The abnormal FFR group had significantly lower MBF at adenosine loading than the normal group (2.23 ± 0.23 vs. 1.88 ± 0.29, p = 0.021). The three branches with abnormal FFR only had stenotic lesions, but the MFR may have been normal because blood was supplied by collateral vessels. Combining FFR, MFR, and MBF will enable a more accurate assessment of peripheral coronary circulation and stenotic lesions in CALs and help determine treatment strategy and timing of intervention.
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Affiliation(s)
- Makoto Watanabe
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
| | - Ryuji Fukazawa
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
| | - Tomonari Kiriyama
- Department of Radiology, Nippon Medical School, Tokyo 113-8603, Japan
| | - Shogo Imai
- Department of Radiology, Nippon Medical School, Tokyo 113-8603, Japan
| | - Ryosuke Matsui
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
| | - Kanae Shimada
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
| | | | - Koji Hashimoto
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
| | - Masanori Abe
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
| | | | - Yasuhiko Itoh
- Department of Pediatrics, Nippon Medical School, Tokyo 113-8603, Japan
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Shiono Y, Takahata M, Ino Y, Tanimoto T, Kakimoto N, Suenaga T, Suzuki T, Taruya A, Wada T, Ota S, Ozaki Y, Kashiwagi M, Kuroi A, Yamano T, Kitabata H, Tokuhara D, Tanaka A. Pathological Alterations of Coronary Arteries Late After Kawasaki Disease: An Optical Coherence Tomography Study. JACC. ADVANCES 2024; 3:100937. [PMID: 38938853 PMCID: PMC11198662 DOI: 10.1016/j.jacadv.2024.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 06/29/2024]
Abstract
Background The long-term impact of Kawasaki disease on coronary arteries in vivo is unclear. Objectives The purpose of this study was to investigate coronary arteries in the late convalescent phase, we followed patients with Kawasaki disease who developed coronary artery aneurysms (CAAs). Methods We followed 24 patients and used optical coherence tomography at a median of 16.6 years after the onset of Kawasaki disease. Results Of 72 coronary arteries, optical coherence tomography was performed on 61 arteries: 17 with a persistent CAA, 29 with a regressed CAA, and 15 without a CAA. Between-group comparison was performed by chi-square or Fisher's exact test, and intimal thickening (17 vs 29 vs 15, all 100%, P = NA) and medial disruption (17 [100%] vs 29 [100%] vs 14 [93%], P = 0.25) were commonly observed in the investigated arteries. Advanced features of atherosclerosis were more frequently seen in arteries with persistent CAAs than in those with regressed CAAs and in those without CAAs: calcification (12 [71%] vs 5 [17%] vs 1 [7%], P < 0.001), microvessels (12 [71%] vs 10 [35%] vs 4 [27%], P = 0.020), cholesterol crystals (6 [35%] vs 2 [7%] vs 0 [0%], P = 0.009), macrophage accumulation (11 [65%] vs 4 [14%] vs 4 [27%], P = 0.002), and layered plaque (8 [47%] vs 11 [38%] vs 0 [0%], P = 0.004). Conclusions Long after onset of Kawasaki disease, all arteries showed pathological changes. Arteries with persistent CAAs had more advanced features of atherosclerosis than those with regressed CAAs and those without CAAs.
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Affiliation(s)
- Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Aihara H. Multisystem Inflammatory Syndrome in Adults-Related Unstable Angina With Coronary Aneurysm in a Young Female: A Case Report. Cureus 2024; 16:e56162. [PMID: 38618393 PMCID: PMC11015871 DOI: 10.7759/cureus.56162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a systemic inflammatory disease associated with COVID-19 and follows coronary artery aneurysms similar to Kawasaki disease. In many cases, it is improved by treatments such as high-dose steroids or intravenous immunoglobulin (IVIg). However, the role of untreated coronary artery aneurysms leading to future stenosis remains unknown. Untreated MIS-A may potentially lead to the formation of coronary aneurysms. In cases of COVID-19 where young adults present with angina-like symptoms, an evaluation for angina is considered. Herein, we report a case of a 27-year-old female who developed unstable angina with coronary artery aneurysms six months after COVID-19 infection. She required surgery for unstable angina, which resulted in an improvement in chest pain. Coronary artery lesions are considered to be related to MIS-A, and treatment was conducted in accordance with that for Kawasaki disease. Currently, the pathological differences and prognosis between MIS-A and Kawasaki disease remain unclear, but the elucidation of the conditions is warranted in the future.
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Affiliation(s)
- Hiroki Aihara
- Department of Cardiovascular Medicine, Abashiri-Kosei General Hospital, Abashiri, JPN
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Suzuki N, Watanabe M, Kiriyama T, Imai S, Abe M, Fukazawa R, Itoh Y. Evaluation of Coronary Circulation by 13N-Ammonia Myocardial Perfusion Positron Emission Tomography in Patients with Right Coronary Artery Occlusion Due to Kawasaki Disease. J NIPPON MED SCH 2024; 91:277-284. [PMID: 38972740 DOI: 10.1272/jnms.jnms.2024_91-306] [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] [Indexed: 07/09/2024]
Abstract
BACKGROUND Although occlusion of the right coronary artery (RCA) is common in the remote stages of Kawasaki disease, revascularization of the RCA is challenging in children and is usually managed by observation without intervention. METHODS Using adenosine-stress 13N-ammonia myocardial perfusion positron emission tomography, we evaluated coronary circulation in 14 patients (12 males) with RCA occlusion to identify ischemia (myocardial flow ratio < 2.0) in the RCA region and examined hemodynamics, cardiac function, and coronary aneurysm diameter. These variables were also compared in patients with/without RCA segmental stenosis (SS). RESULTS There were five cases of ischemia in the RCA region. RCA myocardial blood flow (MBF) at rest was higher in patients with ischemia than in those without ischemia, but the difference was not significant (1.27 ± 0.21 vs. 0.82 ± 0.16 mL/min/g, p = 0.2053). Nine patients presented with RCA SS, and age at onset of Kawasaki disease tended to be lower in those with SS. The maximum aneurysm diameter of RCA was significantly smaller in patients with SS (10.0 ± 2.8 vs. 14.7 ± 1.6, p = 0.0239). No significant differences in other variables were observed between patients with/without ischemia and SS. CONCLUSIONS At rest, MBF in the RCA region was relatively well preserved, even in patients with RCA occlusion, and there was no progressive deterioration in cardiac function. Adenosine stress showed microcirculatory disturbances in only half of the patients, indicating that it is reversible in children with Kawasaki disease.
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Affiliation(s)
| | | | | | - Shogo Imai
- Department of Radiology, Nippon Medical School
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Tasci O, Dogan K. Evaluation of tumour necrosis factor alpha-stimulated gene-6 and fibroblast growth factor-2 levels in patients diagnosed with multi-system inflammatory syndrome in children. Cardiol Young 2023; 33:1086-1091. [PMID: 36918343 DOI: 10.1017/s1047951123000355] [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: 03/16/2023]
Abstract
Investigations are still ongoing about the pathophysiology of multi-system inflammatory syndrome in children, which can progress with serious morbidity and mortality after COVID-19 infection. In this study, we aimed to investigate whether fibroblast growth factor-2 and tumour necrosis factor alpha-stimulated gene-6 levels play a role in the diagnosis of the disease and on cardiac involvement. Twenty-three patients (11 girls, 12 boys) and 26 healthy controls (10 girls, 16 boys) were included in the study. The mean age of the patient and control group was 8.45 ± 2.43 and 10.73 ± 4.27 years, respectively. There was no difference between the fibroblast growth factor-2 and tumour necrosis factor alpha-stimulated gene-6 levels of the patient and control groups. When the patients with myocardial involvement in the patient group were compared with the patients without myocardial involvement in terms of fibroblast growth factor-2 and tumour necrosis factor alpha-stimulated gene-6 levels, no difference was found between these groups. The correlation of fibroblast growth factor-2 and tumour necrosis factor alpha-stimulated gene-6 levels with other laboratory parameters was investigated in the patient group. Fibroblast growth factor-2 was moderately inversely correlated with white blood cell count (r = -0.541, p = 0.008), absolute neutrophil count (r = -0.502, p = 0.015) and C-reactive protein (r = -0.528, p = 0.010). Fibroblast growth factor-2 was strongly inversely correlated with erythrocyte sedimentation rate (r = -0.694, p =<0.001). Our data show that fibroblast growth factor-2 and tumour necrosis factor alpha stimulated gene-6 do not provide sufficient information about diagnosis and cardiac involvement in multi-system inflammatory syndrome in children.
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Affiliation(s)
- Onur Tasci
- Sivas Numune Hospital, Department of Pediatric Cardiology, Sivas, Turkey
| | - Kubra Dogan
- Sivas Numune Hospital, Department of Biochemistry, Sivas, Turkey
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Liu J, Yue Q, Qin S, Su D, Ye B, Pang Y. Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease. Front Cardiovasc Med 2022; 9:969495. [PMID: 36158849 PMCID: PMC9505689 DOI: 10.3389/fcvm.2022.969495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which differ in size and emergence time, and track its regression within 3 years of onset. The laboratory data, clinical features, and coronary artery outcomes of patients, who were diagnosed with KD and received treatment from January 2003 to January 2019 were retrospectively analyzed. A total of 484 pediatric patients with KD were examined during the study period. Among them, 130 (26.9%) presented with CAA, including mid- to large-sized CAA in 38 patients (7.9%) and de novo CAA after intravenous immunoglobulin (IVIG) treatment in 22 patients (4.5%). Albumin-to-globin (A/G) ratio was significantly negatively associated with the absolute internal diameter of coronary artery at 1 month of onset and may be used as a predictor of mid- to large-sized CAA development in patients with KD. The area under the receiver operating characteristic curve was 0.637 (95% confidence interval: 0.551–0.724), and a cutoff of 1.32 yielded a sensitivity and specificity of 79 and 49%, respectively, for predicting mid- to large-sized CAA development. De novo CAA after IVIG may lead to an increased risk of developing progressive CAA [13 (59.1%) of 22 vs. 31 (28.7%) of 108; P = 0.006] and had significantly greater changes in both the magnitude of CAA dimension variation and maximum z-score of the coronary arteries at 2 and 4 weeks and then 3 months after onset (P < 0.001). Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in the progressive CAA group than in the non-progressive CAA group (25 vs. 4 months, P < 0.001), as well as among the three groups of patients (giant CAA > medium-sized CAA > small-sized CAA, P < 0.001). Children with KD who had low A/G ratio were more likely to develop mid- to large-sized CAA. Nevertheless, de novo CAA after IVIG treatment may increase the risk of more severe arterial damage and development of progressive coronary artery damage; and both mid- to large-sized and de novo CAA could dramatically prolong coronary artery normalization time. Thus, aggressive risk modifications should be employed, and close monitoring with frequent echocardiography is needed for this vulnerable patient population.
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Prognosis of Coronary Artery Bypass Grafting in Preschool-Aged Patients with Myocardial Ischemia Due to Giant Aneurysm of Kawasaki Disease. J Clin Med 2022; 11:jcm11051421. [PMID: 35268512 PMCID: PMC8910851 DOI: 10.3390/jcm11051421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Coronary artery bypass grafting (CABG) for severe cardiac sequelae of Kawasaki disease (KD) complicated by myocardial ischemia is feasible even in childhood. However, no report has summarized the prognosis of CABG in preschool-aged children. Therefore, we evaluated the outcomes of seven preschool-aged children who underwent CABG for the cardiac sequelae of KD in our hospital. The median age at KD onset and CABG was 36 and 59 months, respectively. The median period from KD onset to CABG was 12 months. The median post-operative observation period was 108 months. CABG between the left internal thoracic artery and left anterior descending artery was performed in all patients. In all patients, postoperative cardiac catheter examination revealed good graft patency and no anastomotic stenosis. Further, pre-operative abnormality of coronary flow reserve returned to normal after CABG. Currently, only one patient is taking warfarin. Regarding school–life management, no patient has exercise limitations, except for one patient who had acute myocardial infarction before CABG. Further, the risk of graft stenosis or occlusion was evaluated in the included patients. However, no accidents have been reported to date, and myocardial ischemia and school–life management have improved. Thus, CABG is an effective treatment in preschool-aged children.
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Yalta K, Yalta T, Yetkin E, Ozturk C. Late Coronary Aneurysm Formation after Kawasaki Disease: a Review of Mechanistic and Clinical Aspects. Korean Circ J 2021; 51:837-850. [PMID: 34494409 PMCID: PMC8484996 DOI: 10.4070/kcj.2021.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/17/2021] [Accepted: 07/14/2021] [Indexed: 12/04/2022] Open
Abstract
Evolution of coronary artery aneurysms (CAAs) has been an ominous clinical finding in patients with Kawasaki disease (KD). CAAs generally emerge within the first few weeks in patients with KD, and appear to be strongly associated with the failure to timely initiate specific management strategies. CAA formation might occasionally arise as a late-onset phenomenon long after the index KD episode. Late CAAs in the setting of KD have particular mechanistic and clinical characteristics. Late CAAs in the setting of KD may be confused with other CAA types (atherosclerotic, etc.), and are possibly underdiagnosed in clinical practice. In patients with Kawasaki disease (KD), evolution of coronary artery aneurysms (CAAs) generally emerges within the first few weeks after disease onset. However, CAA formation in these patients might occasionally arise as a late-onset phenomenon after a long latent period. Characteristically, late CAAs manifest as new-onset vascular pathologies or expansion of long-stable CAAs on coronary imaging modalities, and might have diverse mechanistic and clinical implications. Accordingly, the present paper aims to focus on late CAA formation and its implications in the setting of KD.
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Affiliation(s)
- Kenan Yalta
- Department of Cardiology, Trakya University, Edirne, Turkey.
| | - Tulin Yalta
- Department of Pathology, Trakya University, Edirne, Turkey
| | - Ertan Yetkin
- Department of Cardiology, Derindere Hospital, Istanbul, Turkey
| | - Cihan Ozturk
- Department of Cardiology, Trakya University, Edirne, Turkey
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Medeiros R. de Magalhães C, Coutinho de Almeida F, Gandolfi L, Pratesi R, Ribeiro de M. Alves N, Selleski N, Zandonadi RP, Nakano EY, Pratesi CB. Clinical Manifestations of Kawasaki Disease at Different Age Spectrum: A Ten-Year Study. MEDICINA-LITHUANIA 2020; 56:medicina56040145. [PMID: 32218369 PMCID: PMC7231131 DOI: 10.3390/medicina56040145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: The present study is the first known in Latin America to enroll a substantial number of Kawasaki disease (KD) patients with an extended follow-up. This study aimed to: (1) to expose the difficulties and delays in the diagnosis of KD in a developing country, (2) to describe and correlate the clinical features of this disorder with the children’s age at the time of disease onset, (3) to correlate the frequent lack of early diagnosis with a delayed application of appropriate treatment, and (4) to describe the outcome and eventual recurrences of KD in our region. Materials and Methods: Three hundred and one participants (183 males and 118 females) included in the study were diagnosed and, subsequently, clinically followed for ten years (January 2007 to December 2016) at the Pediatric Rheumatology Walk-in Clinic of the Children’s Hospital of Brasilia. Results: Episodes ranged from four months to two years. This rate of recurrence was well-above that disclosed by previous reports. Delay in diagnosis, in all age groups, caused an undesirable delay between the disease onset, the final diagnosis, and the administration of intravenous immunoglobulin (IVIG). KD recurred in 25 (8.3%) of the children during the first three years of follow-up. In seven patients, KD recurred twice, with an interval between episodes ranging from four months to two years. Conclusions: This rate of recurrence was well-above that disclosed by previous reports. In Latin America, aside from a handful of physicians and researchers, KD is being ignored. There is a pressing need to educate primary health care physicians and bring awareness to the fact that KD is not an exotic condition that affects only the Asian populations but a disorder that already exists among us and that frequently results in severe consequences.
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Affiliation(s)
- Cristina Medeiros R. de Magalhães
- Pediatric Rheumatology Unit, Children’s Hospital José Alencar, Brasilia 74083-330, Brazil;
- School of Medicine, Brasilia University Center—UNICEUB, Brasilia 70790-075, Brazil
| | - Fernanda Coutinho de Almeida
- Interdisciplinary Laboratory of Biosciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil; (F.C.d.A.); (L.G.); (R.P.); (N.R.d.M.A.); (N.S.)
- Post-graduate Program in Medical Sciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil
| | - Lenora Gandolfi
- Interdisciplinary Laboratory of Biosciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil; (F.C.d.A.); (L.G.); (R.P.); (N.R.d.M.A.); (N.S.)
- Post-graduate Program in Medical Sciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Riccardo Pratesi
- Interdisciplinary Laboratory of Biosciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil; (F.C.d.A.); (L.G.); (R.P.); (N.R.d.M.A.); (N.S.)
- Post-graduate Program in Medical Sciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Natália Ribeiro de M. Alves
- Interdisciplinary Laboratory of Biosciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil; (F.C.d.A.); (L.G.); (R.P.); (N.R.d.M.A.); (N.S.)
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Nicole Selleski
- Interdisciplinary Laboratory of Biosciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil; (F.C.d.A.); (L.G.); (R.P.); (N.R.d.M.A.); (N.S.)
- Post-graduate Program in Health Sciences, School of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil;
| | | | - Claudia B. Pratesi
- Interdisciplinary Laboratory of Biosciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil; (F.C.d.A.); (L.G.); (R.P.); (N.R.d.M.A.); (N.S.)
- Post-graduate Program in Medical Sciences, School of Medicine, University of Brasilia, Brasilia 70910-900, Brazil
- Correspondence: ; Tel.: +1407230-1661
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Nagatomo Y, Muneuchi J, Nakashima Y, Nanishi E, Shirozu H, Watanabe M, Uike K, Nagata H, Hirata Y, Yamamura K, Takahashi Y, Okada S, Suzuki Y, Hasegawa S, Ohga S. Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease. Int J Cardiol 2018; 271:317-321. [PMID: 30144998 DOI: 10.1016/j.ijcard.2018.04.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is limited information available regarding the role of infliximab (IFX) following the acute phase of Kawasaki disease (KD). We aimed to evaluate whether IFX is associated with coronary artery aneurysm (CAA) regression. METHODS Between 2005 and 2016, we identified 971 consecutive patients with KD from 3 tertiary institutions, and 49 (5%) with CAAs were enrolled in our study. Patients were divided into 2 groups: 27 who received IFX and 22 who did not. The persistence rate of CAAs was compared between the groups. RESULTS Age, sex, and duration of the febrile period did not significantly differ between the groups. The maximum value of C-reactive protein was higher in the IFX- than in the non-IFX group. The maximum z-score of CAAs did not differ between the groups. The 2-, 4- and 6-year cumulative persistence rate of CAA was 24%, 24% and 24% in IFX-group, whereas 67%, 52% and 33% in non-IFX group, respectively (P = 0.03). The median duration of CAA regression was 1.1 vs. 4.6 years. Among those who developed medium- or large-sized CAAs, the 2-, 4- and 6-year cumulative persistence rate of CAA was 33%, 33% and 33% in IFX group, whereas 77%, 51% and 48% in non-IFX group, respectively (P = 0.047). Multivariate logistic regression analysis indicated that the maximum z-score (hazard ratio 0.72, p < 0.001) and response to IFX (hazard ratio 4.56, p = 0.017) were independently related to regression. CONCLUSION IFX therapy was observed to be effective for the early improvement of CAAs in patients with intravenous immunoglobulin-resistant KD.
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Affiliation(s)
- Yusaku Nagatomo
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Muneuchi
- Division of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan.
| | - Yasutaka Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromitsu Shirozu
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mamie Watanabe
- Division of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan
| | - Kiyoshi Uike
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Hirata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiko Takahashi
- Division of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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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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Abstract
INTRODUCTION Kawasaki disease (KD) is a major cause of acquired heart disease in children, and there is limited information on postmortem findings in the pediatric population in Canada. CASES For a 15-year time span (January 2000-March 2015), we had 2 cases of KD presented to the Department of Forensic Pathology at Hamilton General Hospital. DISCUSSION There were common cardiac findings including presence of giant coronary artery aneurysms and microscopic changes occurring within the coronary arteries and the myocardium. Evidence of old infarction was present in both heart specimens, but acute infarction was noted in one of the specimens. CONCLUSIONS This case series documents postmortem findings that outline cardiac complications of KD including aneurysms, thrombotic events, and infarcts. In addition to addressing the medical complications of KD, it is also important to address the psychosocial effect due to its impact on quality of life.
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N'Guetta R, Yao H, Ekou A, Boka B, Konin C, Coulibaly I, Anzouan-Kacou JB, Seka R, Adoh M. [Coronary artery aneurysms probably due to Kawasaki's disease]. JOURNAL DES MALADIES VASCULAIRES 2016; 41:224-227. [PMID: 27090101 DOI: 10.1016/j.jmv.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.
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Affiliation(s)
- R N'Guetta
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire.
| | - H Yao
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - A Ekou
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - B Boka
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - C Konin
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - I Coulibaly
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - J B Anzouan-Kacou
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - R Seka
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - M Adoh
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
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Chen YC, Shen CT, Wang NK, Huang YL, Chiu HH, Chen CA, Chiu SN, Lin MT, Wang JK, Wu MH. High Sensitivity C Reactive Protein (hs-CRP) in Adolescent and Young Adult Patients with History of Kawasaki Disease. ACTA CARDIOLOGICA SINICA 2016; 31:473-7. [PMID: 27122910 DOI: 10.6515/acs20150424e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND For children with a history of Kawasaki disease (KD), low grade inflammation was generally reported to be associated with persistent coronary artery lesions (CAL). However, this association has not been clearly demonstrated to hold true in KD adolescents and young adults (10-25 years of age). METHODS We enrolled 104 subjects into our study, who were separated into the following 3 groups and controls: 1): 22 KD patients with angiography-confirmed CAL which persisted for an average of 12.5 years after onset of KD; 2) 38 KD patients with regressed aneurysms; 3) 44 KD patients without any coronary complications from the disease onset; and 4) 31 age-matched (18.7 ± 1.88 years old) healthy controls. Plasma levels of high-sensitivity C reactive protein (hs-CRP) were measured for all participants. RESULTS Plasma levels of hs-CRP were significantly higher in KD patients than in the controls, regardless of their coronary severity. However, there was no significant difference in hs-CRP levels among KD patients with different severities of CAL. Of the candidate risk factors of elevated hs-CRP such as body mass index, gender, coronary severity, and levels of high-density lipoprotein-cholesterol, linear regression analysis showed the only independent predictor of hs-CRP levels was BMI (β = 0.306, p = 0.01), rather than patient grouping (p = 0.091). CONCLUSIONS Our study found that levels of hs-CRP are significantly higher in adolescent and young adult patients with a history of KD, compared with age-matched controls. Low grade inflammation may play a minor role when KD patients enter into adulthood. body mass index (BMI), rather than coronary severity, was independently associated with the elevation of hs-CRP levels, one of biomarkers for further cardiovascular event. Therefore, ongoing control and management of BMI may be one of beneficial strategies that can be employed to help avoid elevation of hs-CRP levels in KD patients. KEY WORDS Adolescents; High sensitivity-C reactive protein; Kawasaki disease; Young adult.
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Affiliation(s)
| | | | | | | | - Hsin-Hui Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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Chih WL, Wu PY, Sun LC, Lin MT, Wang JK, Wu MH. Progressive Coronary Dilatation Predicts Worse Outcome in Kawasaki Disease. J Pediatr 2016; 171:78-82.e1. [PMID: 26852179 DOI: 10.1016/j.jpeds.2015.12.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/19/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the implication of serial coronary changes on the late coronary outcomes in patients with Kawasaki disease (KD) with coronary aneurysms ≧ 4 mm. STUDY DESIGN We performed a retrospective review of 78 patients with KD with large coronary aneurysms (1980-2013, male: 76.9%; 792 patient-years). Progressive coronary dilatation was defined for those with progressive enlargement of coronary arteries in 3 consecutive echocardiograms. RESULTS We studied 27 patients with KD with giant aneurysms (≧ 8 mm) and 51 patients with KD with medium aneurysms (4-8 mm). All the giant and 43.1% of medium aneurysms persisted during the study period. For the patients with giant aneurysms, their 10-year freedom from acute myocardial infarction/cardiovascular death and all ischemia was 66% and 52%, respectively. The median intervals for the aneurysm diameters reaching their peak were 3.3 months (giant) and 0.25 months (medium), respectively. In patients with giant aneurysms, the 10-year freedom from ischemia was much lower in those with progressive coronary dilatation (28% vs 59%, P = .021). In patients with medium aneurysms, the probability of 5-year persistence of aneurysm was much greater (67.2% vs 14.8%, P < 10(-3)) in those with progressive coronary dilatation. Male sex and intravenous immunoglobulin therapy were not associated with the late outcomes in the patients with KD who had aneurysms larger than 4 mm. CONCLUSIONS In addition to coronary diameters 1 month after the onset of KD, progressive coronary dilatation at 2 or more months after diagnosis may be an indicator of duration, and the severity of vasculitis and adverse dilative remodeling were associated with worse late coronary outcomes.
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Affiliation(s)
- Wan-Ling Chih
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Pei-Yuan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Li-Chuang Sun
- Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan.
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Gorrab AA, Fournier A, Bouaziz AA, Spigelblatt L, Scuccimarri R, Mrabet A, Dahdah N. Incidence Rate and Epidemiological and Clinical Aspects of Kawasaki Disease in Children of Maghrebi Origin in the Province of Quebec, Canada, Compared to the Country of Origin. Glob Pediatr Health 2016; 3:2333794X16630670. [PMID: 27336001 PMCID: PMC4905125 DOI: 10.1177/2333794x16630670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/12/2023] Open
Abstract
The incidence of Kawasaki disease in Maghreb countries is apparently low, unlike those living in the province of Quebec, Canada. This retrospective study compared Maghrebi children living in Quebec to the countries of origin, Morocco, Algeria, and Tunisia. The annualized incidence rate in Quebec (18.49/year/100 000 children under 5 years of age) was 4 to 12 times higher than in Tunisia, Morocco, and Algeria (0.95, 4.52, and 3.15, respectively). The prevalence of incomplete diagnostic criteria was higher in Quebec at 39%, Morocco 43%, and Tunisia 39% compared to Algeria at 8%, with minimal delayed diagnosis (7%) only in Quebec compared to 30%, 35%, and 62%, respectively (P < .001). The rate of coronary aneurysms was comparable however (11% in Quebec vs 4%, 10%, and 25%, in Tunisia, Morocco, and Algeria, respectively; P = .31). The higher incidence of Kawasaki disease in the Maghreb community in Quebec versus the countries of origin seems due to underdiagnosis, which represents a public health concern in those countries.
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Affiliation(s)
- Arbia Abir Gorrab
- CHU Ste-Justine, University of Montreal, Montreal. Canada; Tunis El Manar, Tunis, Tunisia
| | - Anne Fournier
- CHU Ste-Justine, University of Montreal, Montreal. Canada
| | | | - Linda Spigelblatt
- Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Canada
| | | | | | - Nagib Dahdah
- CHU Ste-Justine, University of Montreal, Montreal. Canada
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Lin MT, Sun LC, Wu ET, Wang JK, Lue HC, Wu MH. Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy. Arch Dis Child 2015; 100:542-7. [PMID: 25564534 DOI: 10.1136/archdischild-2014-306427] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/10/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore acute and late coronary outcomes and their risk/modifiers in patients with Kawasaki disease (KD). DESIGN Retrospective study. SETTING AND PATIENTS 1073 patients with KD identified from a tertiary care medical centre (1980-2012; 8677 patient-years). MAIN OUTCOME MEASURES The acute coronary severities and late outcomes (survival free of coronary aneurysm persistence and ischaemia) were assessed. RESULTS Coronary arterial lesions occurred in 40.6% of cases at their acute febrile stages, and persisted beyond 1 month in 196 (18.3%, M/F=138/58) patients: 125 (11.6%) had small aneurysms, 44 (4.1%) had medium aneurysms, and 27 (2.5%) had giant aneurysms. At follow-up (1-46 years), coronary aneurysms persisted in all with giant aneurysms, in 55% of those with medium aneurysms (18% with stenosis), and in 9% of those with small aneurysms. Ischaemia events occurred in 14 patients (M/F=13/1) and caused four deaths. Among the patients with KD with coronary aneurysms, 10-year ischaemia event-free and aneurysm persistence probability was 87.5% and 20.6%, respectively. The only independent risk for aneurysm persistence was the aneurysm severity 1 month after KD onset (χ(2)=80.73, p<10(-3)). Male patients and intravenous γ-immunoglobulin (IVIG) therapy were independent risk factors of initial coronary severity but were not associated with the late coronary outcomes, even in severity stratified subgroups. CONCLUSIONS The coronary severity 1 month after KD onset is most crucial to the late coronary outcomes. Although IVIG use improves the initial severity of coronary lesions, it does not further modify the long-term fate of coronary aneurysms.
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Affiliation(s)
- Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Li-Chuan Sun
- Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hung-Chi Lue
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Han BK, Lesser A, Rosenthal K, Dummer K, Grant K, Newell M. Coronary computed tomographic angiographic findings in patients with Kawasaki disease. Am J Cardiol 2014; 114:1676-81. [PMID: 25307199 DOI: 10.1016/j.amjcard.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/20/2022]
Abstract
Kawasaki disease (KD) is the leading cause of acquired coronary disease in children and may lead to subsequent myocardial ischemia and infarction. Because coronary computed tomographic angiography (CTA) is the most sensitive noninvasive test in patients with atherosclerosis, the aim of this study was to retrospectively evaluate coronary CTA performed in patients with KD for aneurysm, stenosis, and calcified and noncalcified coronary artery disease (CAD). Clinical histories and prior stress and imaging test results were reviewed. Thirty-two patients underwent coronary CTA for KD, and 385 coronary segments were evaluated. Twenty-three of 32 patients had ≥1 diseased coronary segment. There were 20 aneurysms, 7 lesions, and 75 segments (20%) with nonobstructive CAD (16% noncalcified, 2% calcified, and 2% mixed). All nonobstructive and obstructive CAD was in patients with histories of acute-phase coronary artery dilatation or aneurysm (echocardiographic z score 4 to 44), and were almost always associated with normal stress imaging test results on follow-up. No lesion or CAD was found in coronary computed tomographic angiographic studies performed in a control group referred for other indications (n = 32, 422 segments evaluated). The median coronary computed tomographic angiographic dose-length product was 59 mGy cm (interquartile range 32 to 131), the median unadjusted radiation dose was 0.8 mSv (interquartile range 0.4 to 1.8), and the median age- and size-adjusted radiation dose was 1.3 mSv (interquartile range 0.7 to 2.3). In conclusion, high-risk patients with histories of KD had nonobstructive and obstructive CAD not visualized by other noninvasive imaging tests. In properly selected high-risk patients with KD, coronary CTA may identify a subset at increased risk for future coronary pathology who may benefit from medical therapy.
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Abstract
PURPOSE Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease. MATERIALS AND METHODS Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected. RESULTS The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2±6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs. CONCLUSION The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.
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Affiliation(s)
- Ji Hee Kwak
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea.
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Manlhiot C, Niedra E, McCrindle BW. Long-term management of Kawasaki disease: implications for the adult patient. Pediatr Neonatol 2013; 54:12-21. [PMID: 23445738 DOI: 10.1016/j.pedneo.2012.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/10/2012] [Indexed: 12/28/2022] Open
Abstract
Coronary artery complications from Kawasaki disease (KD) range from no involvement to giant coronary artery aneurysms (CAA). Current long-term management protocols are calibrated to the degree of maximal and current coronary artery involvement reflecting the known likelihood of severe long-term cardiac complications. It has recently been suggested that all KD patients may be at potential risk of severe long-term cardiac complications. If this assertion was to be confirmed, current follow-up protocols would need to be extensively modified, with important implications both for the growing adult population with a previous history of KD and for the healthcare system. Based on the available evidence, patients with multiple large and/or giant CAA are at substantial risk of severe long-term cardiac complications and should have regular specialized follow-up. Patients with transient or no CAA have not been reported to be at risk of severe long-term cardiac complications. The influence of KD on the atherosclerotic process remains suboptimally defined, and should be the focus of future studies. Heightened cardiovascular risk factor surveillance and management is recommended regardless of coronary artery involvement. Based on the currently available evidence, existing long-term management protocols seem to be appropriately calibrated to the level of risk. Revised long-term management protocols should incorporate newer, noninvasive imaging methods and intensive management of atherosclerotic risk. There is insufficient evidence at this time to mandate long-term specialized follow-up and invasive testing for patients who have not had CAA.
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Affiliation(s)
- Cedric Manlhiot
- Labatt Family Heart Centre, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study. PLoS One 2012; 7:e38998. [PMID: 22723916 PMCID: PMC3377625 DOI: 10.1371/journal.pone.0038998] [Citation(s) in RCA: 239] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/15/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Kawasaki disease is recognized as the most common cause of acquired heart disease in children in the developed world. Clinical, epidemiologic, and pathologic evidence supports an infectious agent, likely entering through the lung. Pathologic studies proposing an acute coronary arteritis followed by healing fail to account for the complex vasculopathy and clinical course. METHODOLOGY/PRINCIPAL FINDINGS Specimens from 32 autopsies, 8 cardiac transplants, and an excised coronary aneurysm were studied by light (n=41) and transmission electron microscopy (n=7). Three characteristic vasculopathic processes were identified in coronary (CA) and non-coronary arteries: acute self-limited necrotizing arteritis (NA), subacute/chronic (SA/C) vasculitis, and luminal myofibroblastic proliferation (LMP). NA is a synchronous neutrophilic process of the endothelium, beginning and ending within the first two weeks of fever onset, and progressively destroying the wall into the adventitia causing saccular aneurysms, which can thrombose or rupture. SA/C vasculitis is an asynchronous process that can commence within the first two weeks onward, starting in the adventitia/perivascular tissue and variably inflaming/damaging the wall during progression to the lumen. Besides fusiform and saccular aneurysms that can thrombose, SA/C vasculitis likely causes the transition of medial and adventitial smooth muscle cells (SMC) into classic myofibroblasts, which combined with their matrix products and inflammation create progressive stenosing luminal lesions (SA/C-LMP). Remote LMP apparently results from circulating factors. Veins, pulmonary arteries, and aorta can develop subclinical SA/C vasculitis and SA/C-LMP, but not NA. The earliest death (day 10) had both CA SA/C vasculitis and SA/C-LMP, and an "eosinophilic-type" myocarditis. CONCLUSIONS/SIGNIFICANCE NA is the only self-limiting process of the three, is responsible for the earliest morbidity/mortality, and is consistent with acute viral infection. SA/C vasculitis can begin as early as NA, but can occur/persist for months to years; LMP causes progressive arterial stenosis and thrombosis and is composed of unique SMC-derived pathologic myofibroblasts.
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Daniels LB, Tjajadi MS, Walford HH, Jimenez-Fernandez S, Trofimenko V, Fick DB, Phan HAL, Linz PE, Nayak K, Kahn AM, Burns JC, Gordon JB. Prevalence of Kawasaki disease in young adults with suspected myocardial ischemia. Circulation 2012; 125:2447-53. [PMID: 22595319 DOI: 10.1161/circulationaha.111.082107] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Up to 25% of patients with untreated Kawasaki disease (KD) and 5% of those treated with intravenous immunoglobulin will develop coronary artery aneurysms. Persistent aneurysms may remain silent until later in life when myocardial ischemia can occur. We sought to determine the prevalence of coronary artery aneurysms suggesting a history of KD among young adults undergoing coronary angiography for evaluation of possible myocardial ischemia. METHODS AND RESULTS We reviewed the medical histories and coronary angiograms of all adults <40 years of age who underwent coronary angiography for evaluation of suspected myocardial ischemia at 4 San Diego hospitals from 2005 to 2009 (n=261). History of KD-compatible illness and cardiac risk factors were obtained by medical record review. Angiograms were independently reviewed for the presence, size, and location of aneurysms and coronary artery disease by 2 cardiologists blinded to the history. Patients were evaluated for number of risk factors, angiographic appearance of their coronary arteries, and known history of KD. Of the 261 young adults who underwent angiography, 16 had coronary aneurysms. After all clinical criteria were assessed, 5.0% had aneurysms definitely (n=4) or presumed (n=9) secondary to KD as the cause of their coronary disease. CONCLUSIONS Coronary sequelae of KD are present in 5% of young adults evaluated by angiography for myocardial ischemia. Cardiologists should be aware of this special subset of patients who may benefit from medical and invasive management strategies that differ from the strategies used to treat atherosclerotic coronary artery disease.
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Affiliation(s)
- Lori B Daniels
- UCSD Sulpizio Cardiovascular Center, Mail Code 7411, 9444 Medical Center Dr, La Jolla, CA 92037-7411, USA.
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Breunis WB, Davila S, Shimizu C, Oharaseki T, Takahashi K, van Houdt M, Khor CC, Wright VJ, Levin M, Burns JC, Burgner D, Hibberd ML, Kuijpers TW. Disruption of vascular homeostasis in patients with Kawasaki disease: involvement of vascular endothelial growth factor and angiopoietins. ACTA ACUST UNITED AC 2012; 64:306-15. [PMID: 21905000 DOI: 10.1002/art.33316] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In Kawasaki disease (KD), a pediatric vasculitis of medium-sized arteries, the coronary arteries are most commonly affected. Angiopoietins and vascular endothelial growth factor (VEGF) play an important role in maintaining vascular homeostasis. Recently, we identified ANGPT1 and VEGFA as susceptibility loci for KD. This study was undertaken to fine-map these associations and to gain further insight into their role in this vasculitis of unknown etiology to further the search for improved diagnostic and therapeutic options. METHODS A total of 292 single-nucleotide polymorphisms (SNPs) located in VEGF and ANGPT and their receptors were genotyped in 574 families, including 462 trios. For replication, 123 cases and 171 controls were genotyped. RESULTS A significant association with KD susceptibility was observed with 5 SNPs in the ANGPT1 gene (most significantly associated SNP +265037 C>T; Pcombined=2.3×10(-7) ) and 2 SNPs in VEGFA (most significantly associated SNP rs3025039; Pcombined=2.5×10(-4) ). Both ANGPT1 +265037 C>T and VEGFA rs3025039 are located in 3' regulatory regions at putative transcription factor binding sites. We observed significantly down-regulated transcript levels of angiopoietin 1 (Ang-1) in patients with acute KD compared to patients with convalescent KD. In patients with acute KD, high serum protein levels of VEGF and Ang-2 were observed compared to patients with convalescent KD and to both controls with and controls without fever. Immunohistochemistry demonstrated VEGF and angiopoietin expression in the coronary artery wall in autopsy tissue. CONCLUSION Our data support the hypothesis that dysregulation of VEGF and angiopoietins contributes to the disruption of vascular homeostasis in KD.
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Affiliation(s)
- Willemijn B Breunis
- Emma Children's Hospital, Academic Medical Center, and Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands.
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Toyono M, Shimada S, Aoki-Okazaki M, Kubota H, Oyamada J, Tamura M, Takahashi T. Expanding coronary aneurysm in the late phase of Kawasaki disease. Pediatr Int 2012; 54:155-8. [PMID: 22335330 DOI: 10.1111/j.1442-200x.2011.03403.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yahata T, Suzuki C, Hamaoka A, Fujii M, Hamaoka K. Dynamics of reactive oxygen metabolites and biological antioxidant potential in the acute stage of Kawasaki disease. Circ J 2011; 75:2453-9. [PMID: 21785226 DOI: 10.1253/circj.cj-10-0605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The dynamics of oxidation/reduction control system activities using reactive oxygen metabolites (ROM) and biological antioxidant potential (BAP) in acute stage patients was evaulated to understand the mechanism of vascular injury and remodeling in Kawasaki disease (KD). METHODS AND RESULTS ROM, BAP, high-sensitivity C-reactive protein (hs-CRP), interleukin-1,2,6, and tumour necrosis factor-α in 19 KD patients were measured. ROM decreased in good correlation only with hs-CRP (P<0.05) at 2 weeks after intravenous immunoglobulin (IVIG). Patients were further classified as responding well (Group A) or responding poorly (Group B) to IVIG. Both treatment groups had significantly higher ROM values than the control group (P<0.01). ROM decreased in Group A both immediately and 2 weeks after the IVIG treatment (P<0.05), but it did not decrease in Group B until 2 weeks post-treatment (P<0.01). BAP levels were unremarkable in Group A, but were significantly lower in Group B than in both other groups (P<0.05). BAP increased in Group A 2 weeks after IVIG treatment (P<0.01), but remained low in Group B (P<0.01). CONCLUSIONS Acute stage KD patients suffer from obvious hyperoxidant stress, and improved in response to IVIG treatment in most patients. Blood BAP level might be a useful index for predicting responsiveness to IVIG the treatment.
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Affiliation(s)
- Tomoyo Yahata
- Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Abstract
PURPOSE OF REVIEW Whereas the cause of Kawasaki disease is still unknown, progress in treatment during its acute phase has decreased the incidence of coronary artery lesions from 25-30% to 3-5%. In addition to acute-phase coronary disturbances, sclerotic vascular changes are often observed in post-Kawasaki disease patients, including those without coronary lesions during the acute phase. Survivors of Kawasaki disease are now reaching the age of atherosclerosis and it is unknown if these individuals carry a higher risk of coronary disease. This review aims to report the current state of knowledge concerning the long-term prognosis of patients with Kawasaki disease. RECENT FINDINGS Histopathological studies prove the changes of Kawasaki disease to be distinctive from those of atherosclerosis. However, endothelial dysfunction and risk factors for the development of atherosclerosis, such as dyslipidemia, decreased vascular elasticity, increased C-reactive protein, oxidative stress, inflammatory cytokines, and reactive oxygen species, are known to be present in the late phase of Kawasaki disease. In addition, postarteritis coronary arteries in animal models are more prone to the development of atherosclerotic changes. SUMMARY Potential cardiovascular risks are present in survivors of Kawasaki disease. Epidemiological studies enrolling a large cohort of Kawasaki disease patients surviving to middle age are awaited.
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Long-term anticoagulation in Kawasaki disease: Initial use of low molecular weight heparin is a viable option for patients with severe coronary artery abnormalities. Pediatr Cardiol 2010; 31:834-42. [PMID: 20431996 DOI: 10.1007/s00246-010-9715-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/03/2010] [Indexed: 01/29/2023]
Abstract
Patients with severe coronary artery involvement after Kawasaki disease (KD) require long-term systemic anticoagulation. We sought to compare our experience with thrombotic coronary artery occlusions, safety profile, and degree of coronary artery aneurysm regression in KD patients treated with low molecular weight heparin (LMWH) versus warfarin. Medical records of all KD patients diagnosed between January 1990 and April 2007 were reviewed. Of 1374 KD patients, 38 (3%) received systemic anticoagulation, 25 patients received LMWH from diagnosis onward, 12 of whom were subsequently switched to warfarin, and 13 received warfarin from onset. The frequency of thrombotic coronary artery occlusions was similar between drugs. Severe bleeding was more frequent in patients on warfarin, but minor bleeding was more frequent for patients on LMWH. Patients on warfarin were at greater risk of underanticoagulation or overanticoagulation (defined as achieving an anti-activated factor X level or an international normalized ratio below or above target level) than patients on LMWH (P < 0.05). Maximum coronary artery aneurysm z-scores diminished with time for patients on LMWH (P = 0.03) but not for those on warfarin (P = 0.55). This study suggests that LMWH is a potentially viable alternative for patients, especially young ones, with severe coronary artery involvement after KD.
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Weng KP, Hsieh KS, Hwang YT, Huang SH, Lai TJ, Yuh YS, Hou YY, Lin CC, Huang SC, Chang CK, Lin MW, Ger LP. IL-10 polymorphisms are associated with coronary artery lesions in acute stage of Kawasaki disease. Circ J 2010; 74:983-9. [PMID: 20339193 DOI: 10.1253/circj.cj-09-0801] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The literature regarding interleukin (IL)-10 polymorphisms and coronary artery lesions (CALs) in Kawasaki disease (KD) is limited. We investigated whether 3 IL-10 genetic polymorphisms (-1082 A/G, -819 T/C, and -592 A/C) are associated with development of CALs in KD. METHODS AND RESULTS The genotyping of IL-10 polymorphisms was conducted for 279 KD children (172 without and 107 with CALs in acute stage). Thirty-three patients had CALs in chronic stage and 74 only with transient CALs. The homozygous variant genotype CC of IL-10-819 and IL-10-592 was associated with 80% (P=0.006) and 79% (P=0.008) reduction in risk of CALs in acute stage, respectively. The C allele of IL-10-819 and IL-10-592 was associated with 34% (P=0.034) and 33% (P=0.044) reduction in risk of CALs in acute stage, respectively. Compared with ATA haplotype (adjusted odds ratio (AOR) 0.63, P=0.029) or non-ACC haplotype (AOR 0.64, P=0.033), ACC haplotype was associated with a significantly reduced risk for CALs in acute stage, but not for CALs in chronic stage. Compared with non-ATA haplotype (AOR 1.53, P=0.034), ATA haplotype was associated with a significantly increased risk of CALs, except for CALs in the chronic stage. CONCLUSIONS The effects of IL-10 gene polymorphism on CALs in acute KD are important. The persistence of CALs in chronic stage depends much more on other factors such as the times of intravenous immunoglobulin treatment.
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Affiliation(s)
- Ken-Pen Weng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung and Taipei, Taiwan
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Manlhiot C, Millar K, Golding F, McCrindle BW. Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol 2010; 31:242-9. [PMID: 20024653 DOI: 10.1007/s00246-009-9599-7] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 11/02/2009] [Indexed: 12/15/2022]
Abstract
Competing definitions and classifications of coronary artery abnormalities (CAAs) after Kawasaki disease (KD) have been arbitrarily defined based on clinical experience. We sought to propose a classification system for CAAs based only on coronary artery z-scores. All echocardiograms performed between 1990 and 2007 on patients with a previous history of KD were reviewed. Coronary artery luminal dimensions were converted to body-surface-area-adjusted z-scores and compared to current classification systems. A total of 1356 patients with a previous history of KD underwent 4379 echocardiograms. There was important overlap in the distributions of coronary artery z-scores between the different CAA classes as defined by the American Heart Association (AHA). The AHA classification underestimated the severity of CAAs in 19-32% of small CAAs and 35-78% of medium CAAs. We determined the optimal definition of CAA to be small if the z-score is >or=2.5 to <5.0, large if the z-score is >or=5.0 to <10.0, and giant if the z-score is >or=10.0. This classification seems to appropriately apply to the circumflex branch despite a lack of normal values for this branch. The current AHA classification might not accurately classify CAAs in KD patients. Accurate classification is important for defining management and prognosis consistently across patient age and size.
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Affiliation(s)
- Cedric Manlhiot
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G-1X8, Canada
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Shimizu M, Imanishi J, Takano T, Masai H, Miwa Y. Arteries within the artery of coronary artery in an adult patient with acute coronary syndrome. Intern Med 2010; 49:659-63. [PMID: 20371955 DOI: 10.2169/internalmedicine.49.2994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 40-year-old man with acute coronary syndrome underwent coronary angiography, which showed a somewhat irregular contour with radiolucent lines in the left anterior descending artery. Intravascular ultrasound disclosed that the arterial lumen was separated by confining walls, yielding multiple inner lumens. Implantation of drug eluting stents resulted in slow coronary run-off, which was restored soon after intra-aortic balloon pumping support. The multiple inner lumens correspond to the histopathological finding of "arteries within the artery". While "arteries within the artery" is seen exclusively in children with a history of Kawasaki disease, it is rare in adults with undiagnosed Kawasaki disease.
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Affiliation(s)
- Masatoshi Shimizu
- Department of Cardiology, National Hospital Organization Kobe Medical Center, Kobe.
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32
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Sabharwal T, Manlhiot C, Benseler SM, Tyrrell PN, Chahal N, Yeung RS, McCrindle BW. Comparison of factors associated with coronary artery dilation only versus coronary artery aneurysms in patients with Kawasaki disease. Am J Cardiol 2009; 104:1743-7. [PMID: 19962487 DOI: 10.1016/j.amjcard.2009.07.062] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 02/07/2023]
Abstract
We sought to determine whether differences exist in the factors associated with transient coronary artery (CA) dilation only compared to CA aneurysms after Kawasaki disease (KD). We reviewed all patients with KD assessed and treated at a single tertiary institution from January 1990 to April 2007. Of 1,374 patients (63% men) with KD, 1,108 (81%) had no CA abnormalities; 180 (13%) had CA dilation only, and 86 (6%) had CA aneurysms. The factors associated with any CA abnormality included male gender (odds ratio [OR] 1.8, p <0.001), lower albumin (OR per 1 g/dl, 1.07; p < 0.001), lower hemoglobin (OR per 10 g/dl; 1.02, p = 0.008), diagnosed outside of the 1 to 9-year-age range (OR for <1 year old, 1.5; p = 0.04; OR for >9 years old, 1.9, p = 0.03), longer duration of fever before treatment (OR per day, 1.05, p = 0.002), greater platelet count (OR per 10 x 10(9)/L, 1.14, p = 0.008), and nonresponse to initial intravenous immunoglobulin treatment (OR 2.4, p <0.001). Only age at diagnosis, duration of fever before treatment, greater platelet count, and nonresponse to initial intravenous immunoglobulin discriminated between CA dilation only versus CA aneurysms (c-statistic, 0.80, p <0.001). In conclusion, CA dilation only and CA aneurysms differ only in the total duration of inflammation, as measured by the number of days from fever onset to defervescence.
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Affiliation(s)
- Hideaki Senzaki
- Staff Office Bldg 303, Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298 Japan.
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Lin MT, Chen SJ, Ho YL, Huang KC, Chen CA, Chiu SN, Sun LC, Lee WJ, Chen HC, Wang JK, Wu MH. Abnormal Matrix Remodeling in Adolescents and Young Adults with Kawasaki Disease Late after Onset. Clin Chem 2008; 54:1815-22. [DOI: 10.1373/clinchem.2008.105023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: Patients with a history of Kawasaki disease (KD), have been found to have pericoronary and myocardial fibrosis. Serum biomarkers of fibrosis may be sensitive indices for detection of these late cardiac complications in KD patients.
Methods: We studied a cohort of 60 adolescents and young adults comprising 10 KD patients with persistent coronary artery lesions (CAL) occurring at a mean (SD) time of 14.5 (4.4) years after disease onset, 25 KD patients with no CAL after disease onset, and 25 healthy age-matched volunteers. We compared laboratory data from the patients and volunteers, including lipid profile, liver function, amino-terminal propeptide of type III procollagen (PIIINP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), and MMP-9:TIMP-1 ratios. Severity of CAL was determined on the basis of computed tomography determinations of the frequency of aneurysms and the extent of coronary stenosis/occlusion, thrombosis, and calcification.
Results: Increased PIIINP and decreased MMP-9 and TIMP-1 concentrations and decreased MMP-9:TIMP-1 ratios were found not only in KD patients with persistent CAL but also in KD patients without CAL, although to a lesser extent in the latter group. In KD patients, the concentrations of PIIINP were positively associated with the severity of coronary stenosis/occlusion (r = 0.72, P = 0.011) and with the extent of coronary thrombus (r = 0.64, P = 0.014). The concentrations of high-sensitivity C-reactive protein, however, did not differ across groups.
Conclusions: Our results demonstrate alterations in extracellular matrix biomarkers in KD patients, suggesting enhanced collagen synthesis and ameliorated degradation in adolescents and young adults late after the onset of KD. We also observed an association between the concentrations of PIIINP and the extent of coronary stenosis/occlusion or thrombosis in KD patients, a finding that needs confirmation in further studies.
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Affiliation(s)
| | | | | | - Kuo-Chin Huang
- Family Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | - Hui-Chi Chen
- Graduate Institute of Epidemiology, National Taiwan University, Taipei, Taiwan
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Hsueh KC, Lin YJ, Chang JS, Wan L, Tsai YH, Tsai CH, Chen CP, Tsai FJ. Association of vascular endothelial growth factor C-634 g polymorphism in taiwanese children with Kawasaki disease. Pediatr Cardiol 2008; 29:292-6. [PMID: 17874221 DOI: 10.1007/s00246-007-9049-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 07/28/2007] [Accepted: 08/09/2007] [Indexed: 10/22/2022]
Abstract
High expression of circulating vascular endothelial growth factor (VEGF) has been reported in patients with Kawasaki disease (KD). In the pathophysiology of KD, VEGF is considered to be involved, especially in the development of coronary artery lesions. This study aimed to examine whether the VEGF-634 promoter polymorphism is a marker of KD susceptibility or severity in Chinese patients in Taiwan. The study included 93 KD patients and 96 normal control subjects. Genotype and allelic frequencies for the VEGF gene polymorphism in the two groups were compared. The number of individuals with the VEGF-634 G/G genotype was significantly greater among the patients with KD than among the healthy control subjects (p = 0.011). The odds ratio for the development of KD in individuals with the VEGF-634 G/G genotype was found to be 2.03 (95% confidence interval [CI], 1.14-3.63) compared with the VEGF-634 G/C and VEGF-634 C/C genotypes. No significant difference was observed in the genotype or allelic frequencies of VEGF C-634 G polymorphism between the patients with and those without coronary artery lesions. In conclusion, the results suggest that VEGF-634 G/G genotype may be involved in the development of KD in Taiwanese children.
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Affiliation(s)
- K-C Hsueh
- Department of Pediatrics, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, Taiwan
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36
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Lee HS, Yun SW, Jung YS, Chae SA, Lim IS, Lee DK, Choi ES, Yoo BH, Lee MK. Clinical significance of serum vascular endothelial growth factor in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.10.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ho Seok Lee
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Young Soo Jung
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Dong Keun Lee
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Eung Sang Choi
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Byung Hoon Yoo
- Department of Pediatrics, College of Medicine Chung-Ang University, Seoul, Korea
| | - Mi Kyung Lee
- Department of Laboratory Medicine, College of Medicine Chung-Ang University, Seoul, Korea
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Breunis WB, Biezeveld MH, Geissler J, Ottenkamp J, Kuipers IM, Lam J, Hutchinson A, Welch R, Chanock SJ, Kuijpers TW. Vascular endothelial growth factor gene haplotypes in Kawasaki disease. ACTA ACUST UNITED AC 2006; 54:1588-94. [PMID: 16645995 DOI: 10.1002/art.21811] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate whether common genetic variants in the vascular endothelial growth factor (VEGF) gene are associated with Kawasaki disease (KD) and the subsequent development of coronary artery lesions. METHODS Common genetic variants in the VEGF gene were analyzed in an association study in a Dutch cohort of 170 KD patients and 300 healthy Dutch Caucasian controls. Genotyping was done with 5'-nuclease TaqMan assays and 3'-hybridization-triggered fluorescence minor groove binder Eclipse assays. RESULTS An association with susceptibility to KD was observed with 2 of the 6 single-nucleotide polymorphisms analyzed in VEGF: -2594 A>C (rs699947) and the 236 bp 3' of STP C>T (rs3025039). Also for an 18-bp deletion in the promoter of VEGF a significant difference in the genotype and allele frequencies was observed between the KD patients and the controls. The haplotype CGCC (based on rs699947, rs2010963, rs25648, and rs3025039) was significantly associated with the development of KD (hap score 3.8; P = 0.0002). VEGF plasma levels were significantly higher in patients with the early phase of KD than in the healthy controls, and there was a trend toward higher VEGF plasma levels in KD patients with the -2594 CC and 236 bp 3' of STP CC genotypes. CONCLUSION Our results suggest that polymorphisms of the VEGF gene may play a role in the pathogenesis of KD.
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Affiliation(s)
- W B Breunis
- Emma Children's Hospital, Academic Medical Center, and Sanquin Research Institute at the Central Laboratory of the Blood Transfusion Service, University of Amsterdam, Amsterdam, The Netherlands.
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38
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Teo C. An uncommon cause of death in an older child Part 2. Pathology 2005. [DOI: 10.1016/s0031-3025(16)34102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fukazawa R, Sonobe T, Hamamoto K, Hamaoka K, Sakata K, Asano T, Imai T, Kamisago M, Ohkubo T, Uchikoba Y, Ikegami E, Watanabe M, Ogawa S. Possible synergic effect of angiotensin-I converting enzyme gene insertion/deletion polymorphism and angiotensin-II type-1 receptor 1166A/C gene polymorphism on ischemic heart disease in patients with Kawasaki disease. Pediatr Res 2004; 56:597-601. [PMID: 15295089 DOI: 10.1203/01.pdr.0000139426.16381.c8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ACE I/D and AT1R 1166A/C polymorphisms are considered to comprise individual risk factors for the development of coronary disease. We sought to demonstrate that the ACE I/D and AT1R 1166A/C polymorphisms affect coronary artery stenosis in patients with Kawasaki disease (KD). We examined 147 healthy controls and 281 Japanese children with KD. The patients were further divided into group N (n = 246, no ischemia) and group I (n = 35, severe coronary artery stenosis with myocardial ischemia), and we studied the genotype of ACE I/D and AT1R 1166A/C polymorphisms. We also examined ACE activity in patients with acute KD. We did not detect any prevalent genotypes of the ACE and AT1R polymorphisms between controls and KD patients. However, the prevalence of the D allele in the ACE polymorphism and of the C allele in the AT1R polymorphism tended to be higher in group I than in group N (odds ratios, 2.00 and 2.32, respectively). In addition, the presence of the D and/or C alleles significantly increased the relative risk of developing myocardial ischemia (odds ratio, 2.71; p = 0.038). During the convalescent phase of KD, ACE activity was increased despite significant attenuation during the acute phase. These results suggested that the renin-angiotensin system is associated with the formation of severe coronary artery stenosis and myocardial ischemia.
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Affiliation(s)
- Ryuji Fukazawa
- Department of Pediatrics, Nippon Medical School, 113-8603 Tokyo, Japan
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Negoro N, Nariyama J, Nakagawa A, Katayama H, Okabe T, Hazui H, Yokota N, Kojima S, Hoshiga M, Morita H, Ishihara T, Hanafusa T. Successful catheter interventional therapy for acute coronary syndrome secondary to kawasaki disease in young adults. Circ J 2003; 67:362-5. [PMID: 12655171 DOI: 10.1253/circj.67.362] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Acute coronary syndrome occurred in 2 young adults who had a history of Kawasaki disease (KD), but few other coronary risk factors. The first patient was a 27-year-old male with acute myocardial infarction without stenosis detected by coronary arteriography 4 years earlier. Emergency coronary arteriography showed occlusion of the right coronary artery. Aspiration-thrombectomy and rescue balloon angioplasty were successfully performed. The second patient was a 32-year-old male with unstable angina. Right coronary arteriography showed total occlusion with severe calcification. Left coronary arteriography showed 99% stenosis at the proximal site of the circumflex artery, and a directional coronary atherectomy was performed. Histological examination of a specimen from this site revealed a lipid core, macrophages, and smooth muscle cells. Restenosis was not observed on follow-up coronary arteriography after 5-6 months in either case. The coronary stenosis in each case was probably caused by accelerated atherosclerosis at the site without aneurysm as it seemed to be 'normal' on arteriography. Conventional catheter intervention was effective treatment. The sequelae of KD should be recognized as independent coronary risk factors.
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Affiliation(s)
- Nobuyuki Negoro
- First Department of Internal Medicine, Osaka Medical College, Takatsuki City, Japan.
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Abstract
Kawasaki disease is now being recognized as the leading cause of acquired heart disease in children in North America and Japan. This review discusses the recent developments and controversies in Kawasaki disease. Increasing evidence has supported an infectious etiology for Kawasaki disease; however, the debate continues as to whether the inflammatory response results from a conventional antigen or a superantigen. Recent immunohistochemistry findings suggest many vascular growth factors then play a role in the formation of the coronary artery lesions. Many studies have focused on the identification and therapy for patients resistant to conventional therapy, as well as the long-term prognosis of Kawasaki disease survivors. The recent advances in Kawasaki disease are helping to provide some clues in the etiology, pathogenesis and therapy for Kawasaki disease.
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Affiliation(s)
- A F Freeman
- Department of Pediatrics, The Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614-3363, USA.
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