Time Course of Coronary Artery Aneurysms in Kawasaki Disease
Etsuko Tsuda1, Shuji Hashimoto2
1Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
Coronary artery aneurysms (CAAs) from Kawasaki disease typically peak at 35 days and regress by 136 days. Smaller aneurysms (<6 mm) often resolve within six months, aiding clinical management.
Area of Science:
- Cardiology
- Pediatric Rheumatology
- Medical Imaging
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms (CAAs) are a significant complication, necessitating understanding of their natural history.
- Early identification and monitoring of CAA regression are crucial for patient outcomes.
Purpose of the Study:
- To establish the timeline for maximum diameter and regression of CAAs post-Kawasaki disease.
- To identify diameter cutoffs for defining CAA regression.
- To inform clinical management and prognostication of Kawasaki disease-associated CAAs.
Main Methods:
- Retrospective analysis of 195 CAAs in 84 patients using 2D echocardiography over one year.
- Assessment of maximum CAA diameter and time to regression using absolute diameter and Z-scores.
- Receiver operator characteristic curve analysis to determine regression cutoff points.
Main Results:
- Maximum CAA diameter was reached between 11-87 days (median 35 days).
- CAA regression occurred between 41-386 days (median 136 days), with 78% regressing by 200 days.
- Regression cutoffs at one year: <5.7 mm (absolute diameter) and <9.5 (Z-score).
Conclusions:
- Smaller CAAs (<6 mm) tend to regress earlier, often within six months.
- The identified timelines and cutoffs provide valuable benchmarks for monitoring CAA progression and regression.
- This study enhances the understanding of Kawasaki disease-related CAA dynamics, aiding clinical decision-making.
Objectives:
To determine the timeframe in which coronary artery aneurysms (CAAs) caused by Kawasaki disease reach their maximum diameter, the timeframe in which they regress to normal size, and the cutoff point of the diameter for CAA regression.
Study Design:
We reviewed 195 CAAs of the right coronary artery, left anterior descending artery, and left coronary artery measured by 2-dimensional echocardiography ≥5 times for 1 year after Kawasaki disease in 84 patients using medical records from 1995. The maximum diameters of CAAs were investigated retrospectively. The time to CAA regression using both absolute diameter and Z score were investigated. The cutoff points of the diameter of CAA regression in the 2 classifications were identified using receiver operator characteristic curve analysis. One year after Kawasaki disease, a CAA of <3.0 mm in absolute diameter and a Z score of <2.5 were defined as CAA regression.
Results:
The time when CAAs reached their maximum diameter ranged from 11 days to 87 days, with a median of 35 days (n = 195). The time to CAA regression ranged from 41 to 386 days, with a median of 136 days in the absolute diameter classification (n = 92); 78% of CAA regression regressed by 200 days. The cutoff point for CAA regression at one year was 5.7 mm for the absolute diameter (area under the curve, 0.887; P < .0001; n = 190) and 9.5 for the Z score (area under the curve, 0.815; P < .0001; n = 195).
Conclusions:
CAAs with a smaller diameter regressed earlier, and most CAAs of <6 mm regressed by 6 months after Kawasaki disease.
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