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Coronary artery dimensions may be misclassified as normal in Kawasaki disease
A de Zorzi1, S D Colan, K Gauvreau
1Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
Insights
Kawasaki disease patients with "normal" coronary arteries show larger body surface area-adjusted dimensions. This suggests coronary artery dilation is more common, requiring long-term surveillance.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Coronary Artery Abnormalities
Background:
- Current guidelines allow discharge from cardiology follow-up 1 year after Kawasaki disease if no coronary artery abnormalities are detected.
- The Japanese Ministry of Health criteria classify coronary arteries as "normal" based on echocardiography.
Purpose of the Study:
- To assess if body surface area-adjusted coronary artery dimensions in Kawasaki disease patients, deemed "normal" by Japanese criteria, align with population norms.
- To identify potential underestimation of coronary artery dilation in Kawasaki disease follow-up protocols.
Main Methods:
- Studied 125 Kawasaki disease patients at four intervals: ≤10 days, 2 weeks, 6 weeks, and 1 year post-onset.
- Measured left main, proximal LAD, and proximal RCA lumen diameters using 2D echocardiography.
- Calculated body surface area-adjusted coronary artery dimensions.
Main Results:
- Body surface area-adjusted dimensions of LAD and RCA were significantly larger in Kawasaki disease patients compared to population norms across all periods (P < .01).
- Left main coronary artery dimensions showed statistical significance at ≤10 days and a trend at 2 weeks (P = .02).
- 27% of patients classified as having normal coronary arteries by Japanese criteria had at least one body surface area-adjusted dimension >2 SD above the mean.
Conclusions:
- Coronary artery dilation in Kawasaki disease is more prevalent than previously recognized.
- A significant proportion of patients with "normal" coronary arteries by current criteria exhibit enlarged dimensions.
- Systematic, long-term surveillance is crucial for Kawasaki disease patients due to the higher prevalence of coronary artery dilation.
Background:
Current American Heart Association guidelines indicate that patients with Kawasaki disease and no coronary artery abnormalities on echocardiography at any stage of illness may be discharged from cardiologic follow-up 1 year after onset of illness.
Methods And Results:
To determine whether coronary artery dimensions in patients with Kawasaki disease whose vessels are classified as "normal" by Japanese Ministry of Health criteria have a distribution similar to expected population norms when adjusting for body surface area, we studied 125 patients during 4 intervals from onset of illness: (1) 10 days or less, (2) 2 weeks (11 to 21 days), (3) 6 weeks (22 days to 3 months), and (4) 1 year (4 months to 1.5 years). Using two-dimensional echocardiography, we measured the internal lumen diameter of the left main, proximal left anterior descending, and proximal right coronary arteries. Mean body surface area-adjusted dimensions of the proximal left anterior descending and right coronary arteries were significantly larger (P < .01) in patients with Kawasaki disease than those in subjects in all periods, except for a marginal difference at 6 weeks for the proximal right coronary artery (P = .02); for the left main coronary artery, this difference achieved statistical significance in the period of 10 days or less, with a trend at 2 weeks (P = .02). Among patients classified as having normal coronary arteries on all echocardiograms by the Japanese Ministry of Health criteria, 27% had at least 1 body surface area-adjusted coronary dimension more than 2 standard deviations above the expected mean.
Conclusions:
Coronary artery dilation in Kawasaki disease is thus more prevalent than previously reported, highlighting the need for systematic long-term surveillance of this population.