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Endothelial dysfunction late after Kawasaki disease
R Dhillon1, P Clarkson, A E Donald
1Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Insights
Children with Kawasaki disease (KD) show long-term endothelial dysfunction years after illness, even without early coronary issues. This suggests a need for lifelong monitoring to prevent future vascular complications.
Area of Science:
- Cardiology
- Pediatrics
- Vascular Biology
Background:
- Kawasaki disease (KD) is a childhood vasculitis causing acute endothelial damage.
- Late vascular complications like heart attack are known but poorly understood.
- The nature of late vascular abnormalities post-KD requires further investigation.
Purpose of the Study:
- To assess long-term endothelial function in childhood Kawasaki disease survivors.
- To investigate the persistence of vascular abnormalities years after acute KD.
- To correlate late endothelial function with acute illness characteristics.
Main Methods:
- High-resolution ultrasound used to evaluate brachial artery endothelial function.
- Studied 20 patients 5-17 years post-KD and 20 age/sex-matched controls.
- Measured endothelium-dependent (flow-mediated dilation) and independent (GTN) responses.
Main Results:
- No significant differences in baseline vessel diameter, hyperemia, or GTN response between groups.
- Flow-mediated dilation was significantly reduced in KD patients (3.1%) vs. controls (9.4%).
- Late endothelial function was not linked to acute KD illness features.
Conclusions:
- Systemic endothelial dysfunction persists for many years after Kawasaki disease resolution.
- This dysfunction occurs even in patients without early coronary artery involvement.
- Long-term follow-up is crucial for all KD patients due to potential late vascular risks.
Background:
Kawasaki disease (KD) is a systemic vasculitis of childhood with widespread vascular endothelial damage in the acute stage. Long-term complications, such as myocardial infarction and death, are recognized, but the extent and nature of late vascular abnormalities that might predispose to these events have not been studied.
Methods And Results:
We used high-resolution ultrasound to study endothelial function in the brachial artery of 20 patients 5 to 17 years after acute KD (median, 11 years) and compared findings with those in 20 age- and sex-matched control subjects. Vascular responses to reactive hyperemia (with flow increase leading to endothelium-dependent dilation) and to sublingual glyceryl trinitrate (GTN; endothelium-independent dilation) were recorded. The relationship between endothelium-dependent vascular responses and features of the endothelium acute illness was examined. There was no difference in baseline vessel diameter, degree of reactive hyperemia, or response to GTN between patients and control subjects. In contrast, flow-mediated dilation was markedly reduced in KD patients compared with control subjects (3.1% versus 9.4%; P < .001). Late endothelium-dependent responses were not related to features of the acute illness.
Conclusions:
Abnormalities of systemic endothelial function are present many years after resolution of acute KD, even in patients without detectable early coronary artery involvement. Because this may be an important factor in the genesis of late vascular complications, long-term follow-up of all patients with KD is indicated.