Non-coronary cardiac events, younger age, and IVIG unresponsiveness increase the risk for coronary aneurysms in Italian children with Kawasaki disease

AbstractBackground:Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area.Methods and results:All patients diagnosed with giant coronary aneurysms (z-score ≥ 10 or absolute dimension ≥ 8 mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active.Conclusion:In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.

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Cardiac Events in Kawasaki Disease With Coronary Aneurysms Revisited, A Two-center Retrospective Cohort Study in Thailand

10.21203/rs.3.rs-252578/v1 ◽

2021 ◽

Author(s):

Kanokvalee Santimahakullert ◽

Chodchanok Vijarnsorn ◽

Yuttapong Wongswadiwat ◽

Prakul Chanthong ◽

Sappaya Khrongsrattha ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Artery Bypass ◽

Coronary Intervention ◽

Ivig Treatment ◽

Cardiac Events ◽

Coronary Aneurysms ◽

Adverse Cardiac Events ◽

Percutaneous Coronary

Abstract Kawasaki disease (KD) is a common vasculitis in children, which may be complicated with coronary artery aneurysms (CAAs). We aimed to report the rates of major adverse cardiac events (MACE) and determine the risks of MACE in children diagnosed with KD and CAAs in Thailand. Data of 170 children diagnosed with KD and CAAs in two centers of Thailand between 1994 and 2019 was retrospectively reviewed. The risks of MACE were analyzed using multivariate analysis. Of 170 patients, forty-nine patients (28.8%) had giant CAAs. During the median time of follow-up (5.4 years; ranging from 22 days to 23 years), 19 patients (11.1%) experienced MACE including 12 coronary artery bypass grafting, 2 percutaneous coronary intervention and 5 patients with evidence of coronary occlusion. Coronary interventions were performed at 4 years (ranging from 0.01 to 9.5 years) after the KD diagnosis. Independent risks of MACE in KD with CAAs were from the presence of giant aneurysms (HR 16.55; 95% CI 2.52 to 108.63; p=0.003) and lack of intravenous immunoglobulin (IVIG) treatment (HR 11.43; 95% CI 2.8 to 46.62; p=0.001). The intervention-free rate at 5 and 10 years in patients with giant CAAs was 78.7% and 52.2%, respectively.Trial registration: TCTR20190125004

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Cardiac events in Patients in their forties with Kawasaki disease and regression of coronary artery aneurysms

Cardiology in the Young ◽

10.1017/s104795112000284x ◽

2020 ◽

Vol 30 (12) ◽

pp. 1821-1825 ◽

Cited By ~ 1

Author(s):

Etsuko Tsuda ◽

Shuichi Yoneda ◽

Yasuhide Asaumi ◽

Atsuko Suzuki

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Coronary Arteries ◽

Coronary Artery Calcification ◽

Coronary Aneurysm ◽

Coronary Artery Lesions ◽

Cardiac Events ◽

Coronary Artery Aneurysms ◽

Coronary Aneurysms ◽

Middle Aged Adult

AbstractOver a 50-year period from the first description of Kawasaki disease, we encountered three male patients with a history of Kawasaki disease, who had their first cardiac events in their forties. They were considered to have almost normal coronary arteries in the coronary angiograms when they were children and adolescents. They had no follow-up examinations after 20 years old. The 1st patient had an acute myocardial infarction, and the 2nd was a new appearance of coronary aneurysm and stenotic lesions with coronary artery calcification. The 3rd patient had unexpected sudden death. The interval from the onset of Kawasaki disease to the cardiac events ranged from 37 to 38 years. In the former two patients, coronary artery lesions could not be evaluated immediately after Kawasaki disease. Although the 3rd patient had bilateral medium-sized coronary artery aneurysms, his coronary aneurysms regressed 1 year after acute Kawasaki disease. The intimal thickening at a previous coronary aneurysm at the age of 19 was mild. The patients with regressed coronary aneurysms were asymptomatic for about 40 years after Kawasaki disease, prior to their cardiac events. Coronary artery calcification of the proximal portion of the major coronary arteries was a predictable marker in such patients. To prevent serious cardiac events in middle-aged adult patients, reevaluation of coronary artery lesions and restarting of anti-thrombotic therapy are needed. We must be aware that there are some differences in the clinical course and time of cardiac events between patients with giant aneurysms and those with medium aneurysms.

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Variation in the management of Kawasaki disease

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-317191 ◽

2019 ◽

Vol 105 (10) ◽

pp. 1004-1006 ◽

Cited By ~ 2

Author(s):

Audrey Dionne ◽

David Burgner ◽

Sarah De Ferranti ◽

Davinder Singh-Grewal ◽

Jane Newburger ◽

...

Keyword(s):

Kawasaki Disease ◽

Initial Treatment ◽

Coronary Aneurysm ◽

Medical Specialty ◽

Primary Treatment ◽

Management Options ◽

Necrosis Factor Alpha ◽

Coronary Aneurysms ◽

Factor Alpha ◽

Collaborative Efforts

Intravenous immunoglobulin (IVIG) reduces coronary aneurysms in patients with Kawasaki disease (KD), but additional management options remain challenging, with no generalisable evidence-based recommendations. We performed a survey of 724 physicians from 73 countries to assess variation in practice. IVIG was the preferred initial treatment by 659 (91%) of respondents. Criteria for adjunctive primary treatment varied considerably and definitions of IVIG resistance varied markedly by geographical continent, Human Development Index tiers and medical specialty. A second dose of IVIG was used most often for patients with coronary aneurysm non-responsive to initial treatment (572, 79%), but corticosteroids (379, 52%) and tumour necrosis factor alpha inhibitors (208, 29%) were also frequently used. Our findings highlight the need for international collaborative efforts to optimise management of patients with KD worldwide.

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AB0865 Vitamin D Receptor Polymorphisms Are Not Associated with The Risk of Kawasaki Disease (KD) in A Group of Italian Children

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-eular.4709 ◽

2016 ◽

Vol 75 (Suppl 2) ◽

pp. 1198.1-1198

Author(s):

F. Falcini ◽

F. Marini ◽

S. Stagi ◽

D. Rigante ◽

G. Lepri ◽

...

Keyword(s):

Vitamin D ◽

Kawasaki Disease ◽

Vitamin D Receptor ◽

Italian Children

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Kawasaki disease complicated by cerebral infarction

Cardiology in the Young ◽

10.1017/s1047951103000179 ◽

2003 ◽

Vol 13 (1) ◽

pp. 103-105 ◽

Cited By ~ 14

Author(s):

Kenji Suda ◽

Masahiko Matsumura ◽

Shigeru Ohta

Keyword(s):

Kawasaki Disease ◽

Cerebral Infarction ◽

Clinical Situation ◽

Sudden Onset ◽

X Ray ◽

Coronary Aneurysms ◽

Intracoronary Thrombolysis ◽

Tissue Plasminogen ◽

X Ray Computed ◽

The Right

An 8-month-old boy presented with right hemiplegia of sudden onset after 20 days of Kawasaki disease, which was not initially treated by gamma globulin. Cranial X-ray computed tomography confirmed cerebral infarction as the cause of the right hemiplegia. In subsequent weeks, he developed multiple thromboses in coronary aneurysms. He successfully underwent intracoronary thrombolysis using tissue plasminogen activator without haemorrhagic complications. Cerebral infarction as a complication of Kawasaki disease is rare, and is a difficult clinical situation to manage.

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Follow-up duration of echocardiography in patients with Kawasaki disease with no initial coronary aneurysms

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.11.022 ◽

2021 ◽

Author(s):

Qianzhi Wang ◽

Yoshihiko Morikawa ◽

Shogo Akahoshi ◽

Koichi Miyata ◽

Hiroshi Sakakibara ◽

...

Keyword(s):

Kawasaki Disease ◽

Coronary Aneurysms

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Abstract O.73: Long-term Results Of Percutaneous Transluminal Coronary Rotational Atherectomy For Localized Stenosis Caused By Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.o73 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Etsuko Tsuda ◽

Shinsuke Hoshino ◽

Yasuhide Asaumi ◽

Yosuke Hayama ◽

Osamu Yamada

Keyword(s):

Kawasaki Disease ◽

Graft Patency ◽

Rotational Atherectomy ◽

Long Term Results ◽

Cardiac Events ◽

Main Trunk ◽

One Year ◽

Percutaneous Transluminal ◽

Localized Stenosis

We report the results of percutaneous transluminal coronary rotational atherectomy (PTCRA) for localized stenosis caused by Kawasaki disease (KD). Thirteen male and a female, aged 5 to 29 years (median 13 years), underwent PTCRA and the interval from the PTARA to the latest angiogram ranged from 3 months to 16 years (median 6 years). The target vessels were the left anterior descending artery (3 patients), the left circumflex (2), left main trunk (2) and the right coronary artery (7). The immediate results of PTCRA were successful in all patients, and the mean stenosis degree improved from 86 ± 11% to 36 ± 13%. Five cardiac events occurred within one year (acute myocardial infarction 2, transient complete atrioventricular block 1 and re-PTCRA 2). The survival rate and cardiac event free rate at 15 years after PTCRA were 93% and 71%, respectively. For the graft patency, 4 pts who underwent PTCRA within 10 yeas old, had asymptomatic occlusion within 1 year. The patency rate at 15 years after PTCRA was 69%, in 10 pts who underwent it more than 10 years old. Cardiac events and restenosis occurred within a year after PTCRA. The results in patients less than 10 years old was poor. If a graft is patent in one year after procedure, long-term patency may be expected in patients more than 10 years old.

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Abstract 212: Acute Myocardial Infarction in the Acute Phase in Kawasaki Disease in Mexican Children.

Circulation ◽

10.1161/circ.131.suppl_2.212 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

William Sarmiento-Robles ◽

Luis M Garrido-Garcia

Keyword(s):

Myocardial Infarction ◽

Kawasaki Disease ◽

Acute Phase ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Unknown Origin ◽

Z Score ◽

Laboratory Parameters ◽

Small Series ◽

Coronary Aneurysms

Background: Kawasaki disease (KD) is an acute febrile vasculitis of unknown origin. Despite treatment with intravenous immunoglobulin during the acute phase of the disease, up to 5% of those affected will develop coronary aneurysms predisposing them to thrombotic complications that could result in myocardial infarction (AMI). In Mexico there are few reports of ischemic complications secondary to KD. Objective: To describe the clinical features, the laboratory parameters, treatment used and the outcome of children who presented with myocardial infarction during the acute phase of KD in a third level facility in Mexico City Methods: From our Institutional Database of KD we search for children who presented AMI in the acute phase of the disease from August 1995 to August 2014. We analyzed gender, age, clinical manifestations, time from the onset of the symptoms to diagnosis, laboratory parameters, treatment used, and outcome in the acute phase of the disease. Results: Eight infants were diagnosed with AMI during the study period. The median age at diagnosis was 8 months (range 2 to 53 months). Seven patients were male (87.5%). The median from the onset of the clinical manifestations to diagnosis of KD was 22 days (range 4 to 26 days). All patients developed giant coronary aneurysms (median Z-score 18.98, with a range of Z-score from 11.58 - 27.70). An abnormal EKG and abnormal perfusion tests demonstrated the myocardial infarction in all cases. Two patients died in the acute phase of cardiogenic shock, one more patient died of dilated cardiomyopathy 12 months after coronary bypass surgery with an overall mortality of 62.5% of this group. Conclusions: AMI is a fatal complication of KD. In our small series it was associated with a delayed diagnosis of the disease and therefore the development of giant coronary aneurysms. Treatment of AMI in children after KD is a medical challenge with a poor prognosis in children.

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