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Progressive Coronary Dilatation Predicts Worse Outcome in Kawasaki Disease
Wan-Ling Chih1, Pei-Yuan Wu1, Li-Chuang Sun2
1Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
Insights
Progressive coronary dilatation in Kawasaki disease (KD) patients with large aneurysms indicates worse long-term cardiac outcomes. This finding aids in predicting risks for acute myocardial infarction and ischemia in KD survivors.
Area of Science:
- Cardiology
- Pediatric Rheumatology
- Vascular Biology
Background:
- Kawasaki disease (KD) can lead to coronary artery aneurysms, posing long-term cardiovascular risks.
- Large coronary aneurysms (≥ 4 mm) in KD patients require careful monitoring for late sequelae.
- Serial changes in coronary dimensions are crucial for assessing disease progression and prognosis.
Purpose of the Study:
- To investigate the impact of serial coronary artery changes on late coronary outcomes in Kawasaki disease patients with significant coronary aneurysms (≥ 4 mm).
- To identify specific patterns of coronary dilatation that predict adverse cardiovascular events in the long term.
Main Methods:
- Retrospective review of 78 Kawasaki disease patients with large coronary aneurysms (≥ 4 mm) from 1980-2013.
- Definition of progressive coronary dilatation based on three consecutive echocardiograms showing vessel enlargement.
- Analysis of late coronary outcomes, including acute myocardial infarction, cardiovascular death, and ischemia, over a median follow-up of 792 patient-years.
Main Results:
- Patients with giant aneurysms (≥ 8 mm) had significantly lower 10-year freedom from ischemia (28% vs. 59%) if they exhibited progressive coronary dilatation.
- Progressive dilatation was associated with a higher probability of aneurysm persistence at 5 years in patients with medium aneurysms (67.2% vs. 14.8%).
- Neither male sex nor intravenous immunoglobulin therapy correlated with late outcomes in this cohort.
Conclusions:
- Progressive coronary dilatation, particularly beyond two months post-diagnosis, serves as a significant indicator of prolonged vasculitis and adverse dilative remodeling.
- These findings suggest that serial echocardiographic monitoring for progressive dilatation is vital for risk stratification in Kawasaki disease patients with large coronary aneurysms.
- Identifying progressive dilatation aids in predicting worse late coronary outcomes, including ischemia and myocardial infarction.
Objective:
To explore the implication of serial coronary changes on the late coronary outcomes in patients with Kawasaki disease (KD) with coronary aneurysms ≧ 4 mm.
Study Design:
We performed a retrospective review of 78 patients with KD with large coronary aneurysms (1980-2013, male: 76.9%; 792 patient-years). Progressive coronary dilatation was defined for those with progressive enlargement of coronary arteries in 3 consecutive echocardiograms.
Results:
We studied 27 patients with KD with giant aneurysms (≧ 8 mm) and 51 patients with KD with medium aneurysms (4-8 mm). All the giant and 43.1% of medium aneurysms persisted during the study period. For the patients with giant aneurysms, their 10-year freedom from acute myocardial infarction/cardiovascular death and all ischemia was 66% and 52%, respectively. The median intervals for the aneurysm diameters reaching their peak were 3.3 months (giant) and 0.25 months (medium), respectively. In patients with giant aneurysms, the 10-year freedom from ischemia was much lower in those with progressive coronary dilatation (28% vs 59%, P = .021). In patients with medium aneurysms, the probability of 5-year persistence of aneurysm was much greater (67.2% vs 14.8%, P < 10(-3)) in those with progressive coronary dilatation. Male sex and intravenous immunoglobulin therapy were not associated with the late outcomes in the patients with KD who had aneurysms larger than 4 mm.
Conclusions:
In addition to coronary diameters 1 month after the onset of KD, progressive coronary dilatation at 2 or more months after diagnosis may be an indicator of duration, and the severity of vasculitis and adverse dilative remodeling were associated with worse late coronary outcomes.
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