The Role of Early Echocardiography in Low-Risk Patients With Kawasaki Disease

Anecdotally, in some centres in Australia and New Zealand, there is difficulty in obtaining early echocardiograms in patients with Kawasaki disease (KD) considered at low risk of coronary artery (CA) involvement, justified by the argument that the risk of coronary artery aneurysm (CAA) is low and that results will not change management. We sought to determine how often in practice the results of early echocardiography alter management in patients with KD, particularly in those at low risk of medium-giant aneurysms.

A retrospective chart review of patients with KD at a large paediatric tertiary referral centre was performed. Data collected included demographic features, echocardiography results, and treatments. Analysis of data was stratified by risk of coronary involvement using criteria prospectively defined by the study authors.

Of the 147 included patients, 53 (36.1%) were female and the mean age was 3.4 years (range 0.3-11.4 years). 13 (8.8%) had aneurysms on baseline echocardiogram; 4/86 'low-risk' (4.7%) and 9/61 (14.7%) 'high-risk' patients (odds ratio 3.55; 95% confidence interval 1.04-12.11). Baseline echocardiogram findings changed management in three 'low-risk' patients who had primary treatment intensification. Seven 'high-risk' patients had changes in management including primary treatment intensification, additional anti-platelet treatment, and anticoagulation.

These data support recommendations for baseline echocardiography in all patients with KD regardless of perceived risk of CAA. Further research into risk stratification in KD is required.