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Marked variations in serial coronary artery diameter measures in Kawasaki disease: a new indicator of coronary

Frédéric Dallaire1, Anne Fournier, Jolène Breton

  • 1Division of Pediatric Cardiology, Department of Pediatrics, Laval University Hospital, Faculty of Medicine, Laval University, Quebec, Quebec, Canada.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|July 25, 2012
PubMed

Insights

Kawasaki disease patients with occult coronary artery dilatation show increased inflammation and resistance to treatment. This previously unrecognized condition may indicate higher cardiovascular risk.

Area of Science:

  • Pediatric Cardiology
  • Rheumatology
  • Immunology

Background:

  • Long-term risks for Kawasaki disease patients remain unclear.
  • Coronary artery diameter variations are common but their significance is unknown.
  • Inflammatory response and treatment resistance in Kawasaki disease warrant further investigation.

Purpose of the Study:

  • To test if normal-range coronary artery diameter variation (occult dilatation) indicates increased inflammation and treatment resistance.
  • To compare patients with occult dilatation to those with definite dilatation and normal coronary arteries.
  • To define occult coronary artery dilatation in Kawasaki disease patients.

Main Methods:

  • Retrospective study of 197 Kawasaki disease patients with serial echocardiograms up to 12 months.
  • Comparison of patients with occult CA dilatation (Z-score variation > 2 units, within normal range) versus definite dilatation (Z-score > 2.5) and normal CA.
  • Analysis of resistance to intravenous immunoglobulin therapy and systemic inflammatory markers.

Main Results:

  • 32% of patients (63/197) had occult coronary artery dilatation.
  • A significant trend of increasing inflammatory markers was observed: normal < occult dilatation < definite dilatation.
  • Occult dilatation significantly increased resistance to intravenous immunoglobulin (RR 2.6, P=.006).

Conclusions:

  • A new definition for occult coronary artery dilatation was proposed.
  • This definition identifies patients with unrecognized coronary artery involvement.
  • Patients with occult dilatation may face higher cardiovascular risks than currently understood.
Abstract

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