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[Cardiovascular abnormalities in Kawasaki disease. An Italian prospective study]
P Salice1, M C Pietrogrande, P Barbier
1Sezione di Cardiologia Pediatrica, Servizio di Cardiologia, Istituti Clinici di Perfezionamento, Milano.
Insights
Early treatment with intravenous immunoglobulin for Kawasaki disease significantly reduces coronary artery aneurysms. Prompt intervention in children with Kawasaki disease is crucial for better outcomes and lower risk of cardiac complications.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Infectious Diseases
Context:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Cardiac involvement, particularly coronary artery aneurysms, is a major concern.
- Long-term sequelae can include myocardial infarction and sudden death.
Purpose:
- To investigate the risk factors for coronary artery aneurysm development in children with Kawasaki disease.
- To evaluate the impact of early intravenous immunoglobulin (IVIG) treatment on aneurysm formation and regression.
- To analyze the relationship between patient demographics, laboratory markers, and cardiac involvement.
Summary:
- A 9-year prospective study of 96 children with Kawasaki disease identified male sex, age under 12 months, elevated ESR, increased platelet count, and pericardial effusion as significant risk factors for coronary artery aneurysms.
- Early IVIG treatment (within 10 days of fever onset) was associated with a lower frequency of aneurysms and a higher regression rate compared to late treatment.
- While IVIG dosing schemes did not show significant differences, early administration proved beneficial in preventing and managing cardiac complications.
Impact:
- Findings emphasize the importance of timely diagnosis and early intervention with IVIG to mitigate cardiac sequelae in Kawasaki disease.
- Identifies specific patient subgroups at higher risk, enabling targeted monitoring and management strategies.
- Contributes to improved long-term cardiovascular health in pediatric patients affected by Kawasaki disease.
Abstract:
We report a prospective study performed over a 9 year period in 96 children with Kawasaki disease (mean age 35 +/- 29 months), 84 of whom < 5 years of age. The male/female ratio was 1.5 (57/39). A total of 38 patients had cardiac involvement, including flattened T waves in the ECG (10 patients), pericardial effusion (6 patients), myocarditis (1 patient), and coronary artery aneurysms (25 patients; frequency of aneurysms: 26%). All patients were evaluated during the acute phase (first month) of the illness. The first echocardiographic examination was performed 15 days (range 4.30 days) from the appearance of fever, and coronary aneurysms were observed in 23 patients; in 2 patients, however, aneurysms appeared later (2 and 6 months). Aneurysms were small (< or = 4.5 mm) in 12, medium (4.5-7 mm) in 11, and large (> 7 mm) in 12 patients. Male sex (p = 0.02), age < 12 months (p = 0.005), ESR (p = 0.001), platelet count (p = 0.009), and pericardial effusion (p = 0.02) were significantly related to the presence of aneurysm. Among females, incidence of aneurysms was significantly higher in infants < 12 months than in older patients (60 vs 6%, p < 0.001). Intravenous immunoglobulin treatment was started early (within 10 days) in 61 patients and late (> 10 days) in 22. Compared to late treatment, early i.v. immunoglobulin treatment was associated with smaller aneurysms and higher regression rate (67 vs 28%, p < 0.05). No difference was observed concerning frequency and number of dilated vessels as related to therapeutical regimens. Total i.v. immunoglobulin dose (2 g/kg) was administered over 1-2 days in 26 patients (scheme I) or over 4-5 days in 58 (scheme II). Frequency of aneurysms was significantly lower in patients treated early (p = 0.02). No myocardial infarctions or deaths occurred at short- or long-term follow-up.