Long-term management of Kawasaki disease: implications for the adult patient

Area of Science:

• Cardiology
• Pediatric Rheumatology
• Vascular Medicine

Background:

• Kawasaki disease (KD) can lead to coronary artery complications, ranging from no involvement to giant coronary artery aneurysms (CAA).
• Current long-term management protocols for KD are based on the degree of coronary artery involvement.
• Recent suggestions propose that all KD patients may be at risk for severe long-term cardiac complications, necessitating a review of current protocols.

Purpose of the Study:

• To evaluate the current evidence regarding long-term cardiac risks in Kawasaki disease patients.
• To assess the adequacy of existing long-term management protocols for Kawasaki disease.
• To determine the need for modifications in follow-up strategies for adult KD survivors.

Main Methods:

• Review of available evidence on long-term cardiac complications in Kawasaki disease.
• Analysis of risk stratification based on coronary artery aneurysm (CAA) presence and size.
• Consideration of the influence of KD on the atherosclerotic process.

Main Results:

• Patients with multiple large or giant CAA face substantial long-term cardiac risks and require specialized follow-up.
• No increased risk of severe long-term cardiac complications has been reported for patients with transient or no CAA.
• Existing long-term management protocols seem appropriately calibrated to the current level of risk.

Conclusions:

• Current evidence supports specialized long-term follow-up for KD patients with significant CAA.
• There is insufficient evidence to mandate long-term specialized follow-up for patients without CAA.
• Future studies should investigate KD's impact on atherosclerosis, and revised protocols should include noninvasive imaging and risk factor management.