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Coronary changes and cardiac events in children diagnosed with kawasaki disease without initial coronary aneurysm: A
Chanikarn Wongbundit1, Chodchanok Vijarnsorn1, Varisara Pornprasertchai2
1Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Serial echocardiography is crucial for monitoring Kawasaki disease (KD) in children. Follow-up at two to eight weeks is recommended for patients without initial coronary artery aneurysm (CAA) to assess cardiac health.
Area of Science:
- Pediatric Cardiology
- Systemic Vasculitis Research
- Diagnostic Imaging in Pediatrics
Background:
- Kawasaki disease (KD) is a significant cause of acquired heart disease in children, potentially leading to coronary artery aneurysms (CAA).
- The optimal surveillance strategy, particularly the timing of serial echocardiography, for KD patients without initial CAA remains a subject of clinical debate.
Purpose of the Study:
- To evaluate the evolution of coronary artery Z-scores in children diagnosed with KD but without initial CAA.
- To determine the incidence of adverse cardiac events and the necessity of long-term echocardiographic follow-up in this patient cohort.
Main Methods:
- A retrospective review of medical records from four Thai centers (2017-2020) identified children with KD and no initial CAA (coronary artery Z-score < 2.5).
- Eligibility included absence of congenital heart disease and availability of baseline and eight-week echocardiograms; two-week and one-year data were also analyzed.
- Primary outcome was the maximal coronary Z-score at eight weeks and one year, with exploration of adverse cardiac events.
Main Results:
- Of 200 KD patients, 144 (72%) lacked initial CAA; 110 were included. Median age was 23 months, 60% male.
- Twenty-three percent had initial coronary ectasia; at two weeks, four new small CAAs and five ectasias were noted.
- No patients had residual CAA at eight weeks; one had transient ectasia. No cardiac events were reported at one-year follow-up (n=90).
Conclusions:
- New coronary artery aneurysms are rare in KD patients without initial CAA.
- Normal echocardiographic findings at two or eight weeks generally persist at one year.
- Echocardiographic follow-up at two to eight weeks is recommended for KD patients without initial CAA, especially if the Z-score remains below 2.
Background:
Kawasaki disease (KD) is a systemic vasculitis affecting young children, which may lead to coronary artery aneurysm (CAA). The optimal timing of serial echocardiography in patients with uncomplicated KD is debated.
Objectives:
To assess changes in coronary artery Z-scores from the initial diagnosis, two weeks, eight weeks, and one year following diagnosis and adverse cardiac events in children diagnosed with KD without initial CAA.
Methods:
Retrospective chart reviews of four referral centers in Thailand were conducted of all children who were diagnosed with KD without initial CAA (coronary artery Z-score < 2.5) between 2017 and 2020. Eligibility criteria included the absence of congenital heart disease and patients with available echocardiographic evaluations at baseline and at eight weeks of illness. The two-week and one-year echocardiographies were reported. Adverse cardiac events at one year from diagnosis were explored. The primary outcome was a maximal coronary Z-score on the follow-up echocardiography at eight weeks and one year.
Results:
Of 200 patients diagnosed with KD, 144 patients (72%) did not have CAA. A total of 110 patients were included in the study. The median age was 23 months (IQR, 2-39 months) and 60% were male. Fifty patients (45.5%) had incomplete KD, and four (3.6%) received a second intravenous immunoglobulin treatment. Of 110 patients, 26 patients (23.6%) had coronary ectasia (Z-score of 2-2.49) on their initial echocardiographic examination. Sixty-four patients were evaluated in two-week echocardiographic studies, which showed four new small CAAs and five coronary ectasia. At 8 weeks, 110 patients had undergone complete echocardiographic studies. No patient had residual CAAs. Only one patient had persistent coronary ectasia that regressed to normal within one year. At one-year follow-up (n = 90), no cardiac events were reported.
Conclusion:
New CAA in-patients with KD who had no previous CAA in their initial echocardiography are rare. In addition, patients who had normal echocardiographic follow-up at two weeks or eight weeks mostly continued to be normal at one year. The optimal timing of the echocardiographic follow-up should be at two to eight weeks in patients without initial CAA, who still have a coronary artery Z-score < 2 at the second echocardiography.Trial registration: TCTR20210603001.
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