Cardiovascular risk factors after Kawasaki disease: A case-control study (original) (raw)
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Coronary Artery Involvement in Children With Kawasaki Disease
Circulation, 2007
Background— Most studies of coronary artery involvement and associated risk factors in Kawasaki disease have used the Japanese Ministry of Health dichotomous criteria. Analysis of serial normalized artery measurements may reveal a broader continuous spectrum of involvement and different risk factors. Methods and Results— Clinical, laboratory, and echocardiographic measurements obtained at baseline and 1 week and 5 weeks after presentation were examined in 190 Kawasaki disease patients as part of a clinical trial of primary therapy with pulse steroids in addition to standard intravenous immunoglobulin. Maximum coronary artery z score normalized to body surface area was significantly greater than normal at all time points, decreasing significantly over time from baseline. A maximal z score ≥2.5 at any time was noted in 26% of patients. Japanese Ministry of Health dimensional criteria were met by 23% of patients. Significant independent factors associated with greater z score at any ti...
Coronary Artery Complications in Pediatric Patients with Kawasaki Disease: A 12-Year National Survey
Zhonghua Minguo xin zang xue hui za zhi = Acta Cardiologica Sinica, 2013
Coronary artery complications are the predominant causes of morbidity and mortality in childhood Kawasaki disease (KD). The aim of this study was to investigate the incidence of coronary artery complications and cardiac sequelae in pediatric patients with KD. Using the Taiwan National Health Insurance (NHI) database from 1997 to 2008, records of patients with KD were reviewed retrospectively, utilizing the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 446.1 in pediatric patients aged 18 years or under. The ICD-9CM was also used to identify the outcomes for coronary artery complications (ICD-9-CM codes 410-414), including coronary artery aneurysm (CAA) (ICD-9-CM code 414.11). From the records of pediatric patients with KD admitted to hospitals between 1997 and 2004, 8148 patients without any history of coronary artery complications before KD were selected for study. Of those patients, 694 patients (8.5%) were followed-up until the end...
The Turkish journal of pediatrics
The aim of this study was to identify the risk factors for persistence of coronary artery abnormalities (CAAs) in Kawasaki disease and to compare the differences between complete (n=25) and incomplete (n=18) forms of the disease in relation to CAAs. The patients' demographic (age and sex), clinical (season of admission, duration of fever, form of Kawasaki disease), laboratory (complete blood count, eosinophil count, serum biochemistry, C-reactive protein level, erythrocyte sedimentation rate [ESR], urinary analysis), echocardiographic and therapeutic data were evaluated retrospectively from the medical records. The incidence of sterile pyuria was nearly twofold greater in patients with initial CAAs than in patients in which CAAs were not present (25% and 13%, respectively; p=0.33). In multivariate logistic regression analysis, ESR and pyuria were found to be associated with persistence of CAAs (p=0.035 and p=0.046, respectively). In addition, we found that duration of fever was ...
Predictors for coronary artery dilatation in Kawasaki disease
Paediatrica Indonesiana
Background Kawasaki disease (KD) is an acute, self-limited, febrile illness of unknown cause that predominantly affects children below 5 years of age. It has a high incidence of coronary complications such as aneurysms. The current treatment of choice is intravenous immunoglobulin, which is costly, with aspirin. Identifying the predictive factors for coronary artery dilatation or aneurysm is important in order to establish the indications for giving immunoglobulin, especially when resources are limited. Objective To identify the predictors for the development of coronary artery dilatation in patients with Kawasaki disease Methods This cross-sectional study was done between January 2003 and July 2013. Inclusion criteria were patients who fulfilled the American Heart Association criteria for acute Kawasaki disease, and had complete clinical, echocardiogram, and laboratory data [hemoglobin, leukocyte, platelet, albumin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR)...
Coronary artery sequel of Kawasaki disease in adulthood, a concern for internists and cardiologists
Acta medica Indonesiana
Young adults suffered from acute cardiac event, such as acute coronary syndrome, ischemic-associated arrhythmia and sudden death, are frequently encountered without known etiology and significant risk factors. Coronary vasculitis due to Kawasaki disease contributes to be a risk factor in young adult population to develop acute coronary event. Afflicted predominantly during childhood, Kawasaki disease gives rise to vasculitis of coronary artery which becomes major concern since it leads to coronary aneurysm and stenosis. Self-limited nature of Kawasaki disease make those suffered in childhood survive into adult life. Accelerated coronary atherosclerosis in the Kawasaki disease-related lesion occurring in young adult and subsequent acute coronary syndrome and sudden death in this population are devastating impacts of the sequel of Kawasaki disease. It is expected that internists and adult cardiologists become familiar with this sequel and provide better care for the patients.
Kawasaki Syndrome and Risk Factors for Coronary Artery Abnormalities
The Pediatric Infectious Disease Journal, 2006
Background: Kawasaki syndrome (KS) causes significant morbid ity among children in the United States and other countries and can result in a range of cardiac and noncardiac complications. Methods: To describe the occurrence of KS in the United States and risk factors for the development of coronary artery abnormalities (CAA), national KS surveillance data were analyzed for patients with KS onset during 1994-2003. The surveillance is a passive system, and information is collected on a standardized case report form. Results: During 1994 through 2003, 3115 patients who met the KS case definition were reported to the national KS surveillance system. The median age of KS patients was 32 months; the male-female ratio was 1.5:1. Nearly one-third (31.8%) of the cumulative number of KS cases occurred during January through March. During the study period, 362 (12.9%) of 2798 KS patients had CAA. The proportion of patients with CAA increased from 10.0% in 1994 to 17.8% in 2003. Age younger than 1 year and 9-17 years, male sex, Asian and Pacific Islander race and Hispanic ethnicity (a previously unidentified risk factor) were significantly associated with the development of CAA. Conclusions: The increase in CAA was attributed to widespread use of the criteria of de Zorzi et al, resulting in increased recognition of coronary artery dilatations. The factors contributing to a higher risk of CAA, such as delayed treatment, particularly among Hispanics, need to be investigated.
Journal of Cardiology, 2009
Objective: Kawasaki disease (KD) is a diffuse necrotizing vasculitis with predominant involvement of coronary arteries. Endothelial dysfunction has been implicated as an important event in the pathogenesis of arteriosclerosis, coronary vasoconstriction, hypertension, and myocardial ischemia. We examined the presence of endothelial dysfunction in North Indian children (of Caucasoid ethnicity) with KD without overt coronary artery involvement. Methods: Twenty children (mean age 8.4 ± 2.3 years; range 4.5-12.1 years) in the convalescent phase of KD were studied. All had received intravenous immunoglobulin during the acute phase of the disease. The interval between acute episode and enrolment ranged from 3 to 78 months (mean 25.3 ± 20.1 months). High-resolution ultrasonography was used to analyze brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilatation) and sublingual nitroglycerine (causing endothelium-independent dilatation). Flow-mediated dilatation was also studied in an equal number of healthy age-and sex-matched controls. Carotid artery stiffness index (SI) was calculated and compared in all subjects using previously published equations. Results: Significant differences were observed between the percent flow mediated dilatation in children with KD (5.7 ± 9.2%) compared with controls (12.2 ± 8.9%, p = 0.017). Sublingual nitroglycerine-mediated dilatation in children with KD was 28.5 ± 12.3%. Carotid artery SI was higher in children with KD (2.81 ± 0.77 U) when compared to controls (2.32 ± 0.80 U), but it failed to meet statistical significance (p = 0.058).
Vascular function long term after Kawasaki disease: another piece of the puzzle?
Cardiology in the Young, 2016
BackgroundKawasaki disease is an acute systemic vasculitis. Cardiac complications are frequent and include endothelial dysfunction in patients with coronary anomalies. Thus far, endothelial dysfunction in patients with no coronary lesions is poorly understood. Our aim was to access the vascular function in adolescents and young adults long term after Kawasaki disease, but without coronary aneurysms or any other cardiac risk factors.MethodsWe carried out a single-centre prospective study in a Portuguese population. We evaluated two groups of subjects: (1) Kawasaki disease patients over 11 years of age, diagnosed >5 years ago, with no coronary lesions or any other risk factors for cardiovascular disease; (2) control group of individuals without cardiovascular risk factors. Patients and controls were clinically assessed. Endo-PAT and carotid intima-media thickness assessment were performed to determine vascular function.ResultsIn total, 43 Kawasaki disease patients were assessed and...