Serial analysis of regional left ventricular wall motion by two-dimensional echocardiography in patients with coronary artery enlargement after Kawasaki disease (original) (raw)
Related papers
BMC Cardiovascular Disorders, 2014
Background: Kawasaki disease (KD) is a generalized systemic vasculitis of unknown etiology involving medium and small size blood vessels, particularly the coronary arteries. In these vessels a progressive stenosis may result from active remodeling with an intimal proliferation and neoangiogenesis. The aim of our study was to assess, by using high-resolution transthoracic 2D Echocardiography, if subjects with a previous diagnosis of Kawasaki disease after several years show a coronary intimal thickening, suggestive of a persistent cardiovascular risk. Methods: We assessed measurement of thickening, inner diameter and outer diameter of coronary arteries using 2D Echocardiography (Philips E 33 with multy-frequency S8-3 and S12-4 probes) and examining the proximal portion of left main coronary artery just above the aortic valve with parasternal short axis view. Results: We found a significant intimal thickening in patients with previous Kawasaki disease compared to healthy controls. In particular, we noticed that also subjects not suffering from coronary impairment in acute phase have higher values of thickening than healthy controls, and this wall thickening may confer a higher cardiovascular risk. Conclusions: Therefore we concluded that the assessment of coronary artery thickening by high-resolution transthoracic 2D Echocardiography may become an essential instrument to evaluate late cardiovascular risk in subjects with a diagnosis of Kawasaki disease in childhood.
Iranian Journal of Pediatrics, 2016
Background: Kawasaki disease (KD) is the most common cause of acquired myocardial infarction in children. Coronary artery involvement is the most serious feature of this vasculitis syndrome. Timely diagnosis of coronary artery involvement is of utmost importance since it can prevent long-term morbidity and mortality. The current methods for the diagnosis of coronary artery dilation in KD are inconsistent and are also not capable of detecting all the abnormal coronary arteries or the so-called occult dilations present. Objectives: The aim of this study was to determine the sensitivity and specificity of three novel allometric indices for the diagnosis of left main coronary artery (LMCA) involvement in KD. Methods: We performed a prospective case-control study in 69 children (38 with KD and 31 healthy children). All the followed up patients underwent two complete echocardiographic examinations at the time of admission and 4-6 weeks later. We measured the size of the LMCA, coronary sinus (CS) and aorta (A) and calculated the LMCA/CS, LMCA/A and LMCA/CS/A ratios. We also calculated the cutoff scores for each index using receiver operating characteristic curves both in the acute phase and 4-6 weeks later. Results: In the acute phase, the cutoff scores for the LMCA/A ratio was > 0.23; LMCA/CS, > 0.44; and LMCA/CS/A, > 0.03. This implied 60% sensitivity and 80% specificity for the detection of abnormal LMCA in KD. Four to six weeks after the acute phase, the LMCA/A cutoff score was > 0.23; LMCA/CS, > 0.73; and LMCA/CS/A, > 0.73. This implied 100% sensitivity and 100% specificity for the detection of abnormal LMCA. There was a significant decrease in the size of the CS in comparison with the control group (1.92 ± 0.363 mm; P = 0.007 and 0.023). Conclusions: The LMCA/A, LMCA/CS and LMCA/CS/A ratios seem to provide simple and patient-specific indices for the detection of abnormal LMCA in KD, both in the acute and subacute phase. Further, a decrease in the size of the CS may imply a decrease in coronary artery flow in the acute and subacute phases of KD.
Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease
Pediatric Cardiology, 2015
Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e 0), and lower median TV e 0 velocity compared to the non-PA dilation group (0.50 vs 0.38 p \ 0.01, 4.2 vs 3.6 p \ 0.05, and 13.5 vs 15.2 cm/s p \ 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e 0 in the subacute phase (p \ 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population.
Medical Laboratory Journal, 2023
Background: Kawasaki disease (KD) is a febrile systemic vasculitis that affects children. Further research is required due to the disease's significance, consequences, and increasing prevalence. This study aimed to determine the frequency of coronary artery complications in patients with KD referred to Taleghani Hospital (Gorgan, Iran) from 2007 to 2017. Methods: Between 2007 and 2017, 108 cases with a definitive diagnosis of KD were studied retrospectively. Data were obtained from medical records and the patients' biographical, clinical, laboratory, radiographic, and echocardiographic data. Results: A total of 108 patients diagnosed with KD were involved in the study, 21 (19.44%) of whom showed coronary artery-associated complications. There was no significant difference in clinical and laboratory findings and coronary artery involvement between male and female groups (P-value < 0.05). Left coronary artery (LCA) involvement and the pattern of vascular involvement as ectasia and aneurysm were significantly higher in the echocardiography of the studied patients (P-value = 0.0001). Conclusion: Kawasaki disease-related coronary artery complication is more common in children under the age of 3, particularly males, in Gorgan. The LCA is the most common site of coronary artery complications in KD children. The findings can improve the prognosis of KD patients and their related heart diseases.
Coronary Artery Dilation in Acute Kawasaki Disease and Acute Illnesses Associated With Fever
Pediatric Infectious Disease Journal, 2012
Background: In the absence of a specific test, the diagnosis of clinically incomplete Kawasaki disease (KD) can be challenging. The 2004 American Heart Association guidelines state that the diagnosis of KD is supported by the presence of coronary artery dilation documented by echocardiography. However, the specificity of coronary artery dilation and its prevalence in children with other acute illnesses associated with fever has not been studied. Methods: A 2-center, prospective study compared the internal diameters and Z-scores (standard deviation [SD] units from the mean internal diameter normalized for body surface area) of the proximal left anterior descending and right coronary arteries measured by echocardiography in febrile children (FC) and children with KD. Results: The median Z-score (interquartile range) of the left anterior descending coronary artery was −0.05 (−0.86, 0.62) and 1.06 (0.36, 2.06) SD units for the 45 FC and the 145 KD patients, respectively (P < 0.0001). For the right coronary artery, the median Z-score was 0.21 (−0.20, 0.87) and 1.04 (0.31, 1.85) SD units for the FC and KD patients, respectively (P < 0.0001). There was no correlation between body temperature at the time of echocardiography and coronary artery Z-score. No febrile child had a coronary artery Z-score ≥ 2.5 SD units. Conclusions: Z-scores ≥ 2.5 SD units were not observed in our cohort of FC. Therefore, echocardiographic evidence of coronary artery dilation can be used to support the diagnosis of KD.
Coronary artery dimensions may be misclassified as normal in Kawasaki disease
Journal of Pediatrics, 1998
Background: Current American Heart Association guidelines indicate that patients with Kawasaki disease and no coronary artery abnormalities on echocardiography at any stage of illness may be discharged from cardiologic follow-up 1 year after onset of illness. Methods and Results: To determine whether coronary artery dimensions in patients with Kawasaki disease whose vessels are classified as “normal” by Japanese Ministry of
The role of cross-sectional echocardiography in Kawasaki disease
Cardiology in the Young, 1991
SummaryCross-sectional echocardiography is an essential tool in the evaluation ofchildren with Kawasaki disease, both in the acute and chronic stages. In the acute phase of the illness, it is valuable for diagnosis and management of pancarditis and for the long-term monitoring of pericardial effusions, left ventricular function, and the rare cases of chronic valvar dysfunction. When coronary arterial abnormalities are detected, echocardiography can serially evaluate long-term treatment with drugs which prevent the aggregation of platelets and monitor the resolution of coronary aneurysms. The value of cross-sectional echocardiography, nonetheless, is very limited in the detection of coronary arterial stenosis. Coronary arteriography is still important for the diagnosis of obstructive lesions in the coronary arteries and should be used in conjunction with cross-sectional echocardiography for the appropriate long- term management of children with Kawasaki disease at high risk of develo...