Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

Abstract ABSTRACT Risk factors for coronary artery lesion (CAL) development in patients with Kawasaki disease (KD) include male sex, age <12 months, intravenous immunoglobulin (IVIG) resistance, and delayed diagnosis. We aimed to explore the relationship between CAL development and Z-score. We enrolled 281 patients with KD who were treated with our protocol. Echocardiography was performed in three phases: pre-treatment (P1), post-treatment (P2), and 4 weeks after onset (P3). The highest Z-score of the right, left main, left anterior descending, and left circumflex coronary arteries was expressed as Zmax at each phase. P3-Zmax ≥2.5 represented CAL development. Clinical parameters, such as laboratory data and Z-scores, were retrospectively compared between patients with and without CAL development. Sixty-seven patients (23.8%) showed a P1-Zmax ≥2.0, and CAL development occurred in 21 patients (7.5%). Independent risk factors associated with CAL development were P1-Zmax, a ΔZmax (P2-Zmax − P1-Zmax) ≥1, male sex, <12 months of age, and resistant to the first IVIG administration (adjusted odds ratio [95% confidence interval]: 1.98 [1.01–3.92], 4.04 [1.11-14.7], 6.62 [1.33–33.04], 4.71 [1.51–14.68], 5.26 [1.62–17.13], respectively). Using receiver operating characteristic curve analysis, a P1-Zmax ≥1.43 detected CAL development with an area under the curve of 0.64 (sensitivity = 81.0%; specificity = 48.1%). Conclusions : Our results suggest that P1-Zmax and a ΔZmax (P2-Zmax − P1-Zmax) ≥1 may predict CAL development.

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Abstract 221: Use of Statins in Patients with Coronary Artery Aneurysms: A Pilot Study from the North American Kawasaki Disease Registry

Circulation ◽

10.1161/circ.131.suppl_2.221 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Michael Khoury ◽

Michael A Portman ◽

Cedric Manlhiot ◽

Anne Fournier ◽

Rejane F Dillenburg ◽

...

Keyword(s):

Coronary Artery ◽

Pilot Study ◽

Kawasaki Disease ◽

Linear Regression ◽

North American ◽

Z Score ◽

Disease Registry ◽

Coronary Artery Aneurysms ◽

The North ◽

Significant Difference

Background: Statins have been considered as therapy for children with coronary artery aneurysms (CAA) after Kawasaki disease (KD), due to potential beneficial pleiotropic effects which might influence chronic vascular processes and inflammation. Methods: The North American Kawasaki Disease Registry was queried to identify patients who have received statins in the first 6 months following the convalescent phase of KD. Each identified patient was matched by age, gender and CAA z score to 3 patients who were statin-naïve (controls). Linear regression models adjusted for repeated measures and maximum coronary involvement were used to determine an association of statin use with longitudinal changes in coronary artery diameter z-score. Kaplan-Meier analysis was used to compare freedom from angiographically-confirmed stenosis or interventions. Results: Of 29 patients with KD and CAA (maximum coronary artery z-score >10) who received statins at any time (of n=621, 5%), 10 (9 males) patients were started within 6 months of the acute KD episode. The mean age at KD was 6.3±3.4 years (5.4±3.5 for controls, p=0.57). Mean maximum CAA z-score was 36±14 (vs. 29±16, p=0.20); 90% of statin patients and 87% of matched controls had CAAs in 3 or more branches. Linear regression analysis of 442 serial echocardiograms showed that maximum CAA z-score decreased by -1.5 (95%CI: -2.7; -0.4) SD/year (p=0.008) for control patients compared to -2.9 (95%CI: -4.4; -1.4) SD/year (p<0.001) for statin treated patients. The difference between the rate of change of CAA z-score for statin vs. control patients did not reach statistical significance (controls vs. statins: +1.4 SD/year, 95%CI: -0.6; +3.4, p=0.18). n=7 patients (3 on statin, 4 controls) developed stenosis or had revascularization, with no significant difference between groups (HR for statin group: 2.2 (0.4-11.4), p=0.41). Conclusions: This underpowered pilot study suggests that equipoise likely exists with regards to statin therapy in children with KD and CAA, and that a formal registry-nested trial might be considered.

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Abstract 28: African American Race is Not Protective Against Coronary Artery Involvement in Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.28 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Emily P Williams ◽

Michael S Kelleman ◽

William T Mahle

Keyword(s):

African American ◽

Coronary Artery ◽

Kawasaki Disease ◽

Reference Group ◽

Artery Aneurysm ◽

Z Score ◽

Strict Adherence ◽

Hispanic Patients ◽

American Children ◽

African American Race

It has been previously reported that African American race may be protective against coronary artery aneurysm development in Kawasaki Disease (KD). We aimed to test this with our own cohort of KD patients from a large pediatric cardiology practice. Data from 250 subjects diagnosed with KD and followed as outpatients with surveillance echocardiography over a two-year period were analyzed. Twelve patients were excluded due to incomplete records or an unconfirmed diagnosis. Race designated by parent was recorded. Charts were reviewed for any coronary involvement (ectasia or aneurysm) and coronary Z-score greater than 2.5 at the time of diagnosis and at subsequent follow-up visits. Odds rations were calculated comparing each racial group to others for any coronary involvement and for coronary Z-score > 2.5. Of 238 included patients, 44.5% were African American, 37.4% were non-Hispanic white, 10.5% were Hispanic, and 7.6% identified with other racial designations. Approximately 21.9% of African American patients had any coronary involvement and 9.5% had a coronary Z-score > 2.5. Approximately 21.4% of non-Hispanic whites had any coronary involvement and 13.5% of non-Hispanic whites had a coronary Z-score > 2.5. Twenty-eight percent of Hispanic patients had any coronary involvement and 12% had a coronary Z-score > 2.5%. Of patients that identified with other racial designations, 38.9% had coronary involvement and 22.2% had a coronary Z-score > 2.5. No statistically significant odds ratios were identified. Relative to reference group (non-Hispanic whites) African American patients had nearly identical rates of 1) any coronary involvement, or 2) coronary Z-score > 2.5. KD occurs commonly in African-American children. Given equal risk for late coronary sequelae vigilance and strict adherence to consensus guidelines is essential.

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Association of MnSOD gene polymorphism with susceptibility to Kawasaki disease in Chinese children

Cardiology in the Young ◽

10.1017/s104795112000356x ◽

2020 ◽

pp. 1-7

Author(s):

Jiping Wu ◽

Meng Yu ◽

Lihua Huang ◽

Yujie Qian ◽

Min Kong ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Human Body ◽

Gene Polymorphisms ◽

Coronary Artery Lesion ◽

Nucleotide Polymorphisms ◽

Coronary Artery Lesions ◽

Single Nucleotide ◽

Significant Difference ◽

Mnsod Gene

Abstract Background: Kawasaki disease is a type of acute febrile rash disease that is common in children and is characterised by primary lesions of systemic middle and small vasculitis, which can lead to coronary artery lesions. Manganese superoxide dismutase (MnSOD), one of the most important antioxidases in the human body, plays a key role in maintaining the balance of free radicals in the human body. Two single-nucleotide polymorphisms (SNPS) (rs4880 and rs5746136) in the MnSOD gene were related to oxidative stress disease. The purpose of this study is to explore the possible relationship between MnSOD gene polymorphisms and Kawasaki disease susceptibility. Methods: This study included 100 Kawasaki disease children and 102 healthy children. Two single-nucleotide polymorphisms (rs4880 and rs5746136) were detected by polymerase chain reaction sequence-based typing. Results: There was a significant difference in both the genotype frequency (χ2 = 10.805, p = 0.005) and the allele frequency (χ2 = 7.948, p = 0.005) of rs5746136 between the Kawasaki disease group and the control group. Children with the A allele had a 0.558 times lower risk of Kawasaki disease than those without the A allele (χ2 = 7.948, p = 0.005, odds ratio = 0.558, 95% confidence interval = 0.371–0.838). There was no significant difference in the genotype and gene frequencies of rs5746136 between the Kawasaki disease-coronary artery lesion and Kawasaki disease-without coronary artery lesion groups (p > 0.05), and there was no significant difference in the rs4880 genotype and allele frequencies between the Kawasaki disease and healthy control groups or between the Kawasaki disease-coronary artery lesion and Kawasaki disease-without coronary artery lesions groups (p > 0.05). Conclusion: This study provides evidence supporting an association between MnSOD gene polymorphisms and susceptibility to Kawasaki disease. The genotype AA and the allele A of the MnSOD gene locus rs5746136 were risk factors for Kawasaki disease.

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