The role of echocardiography in Kawasaki disease
Brian W McCrindle1, Barbara Cifra1
1Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
Insights
Echocardiography is crucial for diagnosing Kawasaki disease (KD) complications like coronary artery abnormalities. Serial imaging helps monitor disease progression and guides long-term management for affected children.
Area of Science:
- Pediatric Cardiology
- Pediatric Rheumatology
- Diagnostic Imaging
Background:
- Kawasaki disease (KD) is an acute vasculitis in children, potentially causing coronary artery abnormalities.
- Delayed diagnosis or treatment of KD increases the risk of severe cardiac complications.
- Echocardiography is vital for detecting and managing these coronary artery issues.
Purpose of the Study:
- To highlight the role of echocardiography in diagnosing and managing Kawasaki disease.
- To emphasize the importance of standardized imaging protocols and Z-score measurements.
- To outline follow-up strategies based on coronary artery status in KD patients.
Main Methods:
- Utilizing echocardiography for initial diagnosis, risk stratification, and monitoring of KD patients.
- Implementing standardized imaging protocols and Z-score measurements for coronary arteries.
- Employing serial echocardiography for surveillance, with consideration for stress echocardiography and intravascular ultrasound for complex cases.
Main Results:
- Echocardiography effectively detects coronary artery abnormalities and assesses myocardial function in KD.
- Standardized Z-score measurements are essential for characterizing abnormalities and risk stratification.
- Patients with large or giant aneurysms (Z score ≥ 10) face the highest risk of thrombosis and stenosis, requiring intensive follow-up.
Conclusions:
- Serial echocardiography is fundamental for surveillance and management of Kawasaki disease.
- Echocardiography guides risk stratification and identifies patients needing advanced imaging or intervention.
- Prompt and accurate echocardiographic assessment is key to preventing long-term cardiovascular sequelae in KD.
Abstract:
Kawasaki disease (KD) is an acute, self-limited vasculitis affecting young children. It can result in coronary artery abnormalities in a significant proportion of patients, especially if the diagnosis is missed or treatment gets delayed. Echocardiography is the imaging modality of choice for detection of coronary artery abnormalities and assessment of myocardial function. It is also useful for characterization and risk stratification of patients with KD. Echocardiography should be performed at the time of diagnosis and then again at 1-2 weeks and 4-6 weeks after treatment, for uncomplicated cases who do not have significant coronary artery involvement. Use of a standardized imaging protocol is necessary to detect and characterize coronary artery abnormalities, including standardization of measurements (Z scores). For patients with evolving abnormalities, more frequent assessment is necessary in order to detect thromboses in aneurysms. Long-term prognosis and management is dependent on both the maximal and current Z scores of aneurysms. Patients with large or giant aneurysms (i.e., Z score ≥ 10) are at the highest risk of both thrombosis and stenosis. Such patients need careful follow-up for subsequent cardiovascular events. Many of them would be candidates for advanced cardiovascular imaging and may require revascularization therapy. Serial echocardiography plays a key role in surveillance. In addition, stress echocardiography has proven useful as a modality to assess for inducible myocardial ischemia. Intravascular ultrasound has been recommended for functional and structural assessment of coronary arteries in children with KD.
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