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Predictive value of aneurysm characteristics for one-year persistence in Kawasaki disease: a retrospective cohort

Shang Lifeng1, Su Danyan1, Qin Suyuan1

  • 1Difficult and Critical Illness Center and the Pediatric Clinical Medical Research Center of Guangxi, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.

Frontiers in Cardiovascular Medicine
|January 5, 2026
PubMed

Insights

Kawasaki disease coronary aneurysms are predicted by their size (Z-score), shape, and location. A comprehensive model using these features improves prediction of aneurysm persistence one year after onset.

Area of Science:

  • Pediatric Cardiology
  • Rheumatology
  • Vascular Biology

Background:

  • Kawasaki disease (KD) can lead to coronary artery aneurysms (CAA).
  • Predicting the persistence of CAA is crucial for long-term patient management.
  • Systemic factors are known influences, but intrinsic aneurysm characteristics require further investigation.

Purpose of the Study:

  • To determine the independent and incremental prognostic value of coronary aneurysm characteristics for predicting persistence.
  • To assess the predictive performance of aneurysm size (Z-score), morphology, and location.
  • To compare a comprehensive aneurysm characteristic (CAC) model with a Z-score-only model.

Main Methods:

  • Retrospective cohort study of 135 children with KD and CAA.
  • Analysis of maximum Z-score (ZM), morphology (fusiform/saccular), and location (Left/Right/Bilateral) of the index aneurysm.
  • Logistic regression and ROC curve analysis to evaluate predictive models.

Main Results:

  • Early ZM strongly predicted persistent CAA (AUC 0.909).
  • Multivariable analysis identified larger ZM, saccular morphology, and LAD involvement as independent predictors.
  • The CAC model significantly improved prediction over the ZM-only model (AUC 0.941 vs. 0.909, P=0.025).

Conclusions:

  • Intrinsic coronary aneurysm characteristics (size, shape, distribution) powerfully predict one-year persistence.
  • Anatomy-based assessment refines risk stratification for persistent CAA.
  • Specific morphological features are crucial, especially in high-risk subgroups.
Abstract

Keywords:
Kawasaki diseaseZ-scoreaneurysm locationaneurysm morphologycoronary artery aneurysms

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