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Coronary diameter in normal infants, children and patients with Kawasaki disease
Shunji Kurotobi1, Toshisaburo Nagai, Nobuhiro Kawakami
1Department of Pediatrics,Toyonaka Municipal Hospital, Shibahara-cho, 4-14-1, Toyonaka city, Osaka, Japan. kurotobi@ohp.toyonaka.osaka.jp
Insights
Kawasaki disease (KD) coronary artery assessments need improved criteria. Adjusted measurements reveal subtle abnormalities, preventing misclassification and ensuring better patient outcomes.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Vascular Health
Background:
- Current Kawasaki disease (KD) coronary assessments rely on age-based criteria.
- These criteria lack precision for detecting subtle coronary artery abnormalities.
Purpose of the Study:
- To establish precise normal values for coronary artery diameters.
- To evaluate coronary artery dimensions in children with Kawasaki disease.
- To refine diagnostic criteria for coronary abnormalities in KD.
Main Methods:
- Utilized 2-D echocardiography to measure coronary diameters in 71 healthy children.
- Established normal values adjusted for body surface area and anatomical site.
- Assessed coronary dimensions in KD patients at admission, 2-3 weeks, and long-term follow-up.
Main Results:
- Coronary diameters strongly correlated with body surface area.
- KD patients showed significantly larger coronary diameters than controls at admission and 2-3 weeks.
- 19% of followed KD patients maintained enlarged coronary diameters above two standard deviations.
Conclusions:
- Current age-based criteria for KD coronary assessments are insufficient.
- Body size and anatomical site-adjusted criteria are crucial for accurate diagnosis.
- Refined criteria can prevent misclassification of coronary artery abnormalities in KD.
Background:
The coronary assessments in Kawasaki disease are mainly based on the Japanese Ministry of Health and Welfare criteria, which is simply classified according to the patient's age, over 5 years and less than 4-years-old.
Methods:
We obtained normal values of coronary diameters adjusted for the body surface area and for the coronary anatomical site from 71 healthy children using 2-D echocardiography. We also studied patients with Kawasaki disease at three stages from the onset of illness: (i) 43 patients at admission; (ii) the subsequent 2-3 weeks; and (iii) 62 children followed at a clinic, for a median 2.2 years after the onset. No patients showed any coronary abnormalities by several echographic exams.
Results:
The coronary diameters were strongly correlated with the body surface area (r = 0.81 in left main, r = 0.89 in proximal right, r = 0.89 in left anterior descending artery). The coronary diameters in the patient groups at admission and at 2-3 weeks later were significantly larger than those in the normal group (P < 0.01). Although the coronary diameters in the follow-up group did not show a significant difference compared with those of normal, 19% retained their coronary diameters at greater than two standard deviations above the expected mean in at least one coronary artery.
Conclusions:
The more strictly defined criteria adjusted for body size and for the anatomical site should be used to detect the subtle changes and to prevent the misclassification of the coronary artery abnormalities in KD.