scholarly journals Geometrical and Hemodynamic Variables for Thrombotic Risk Stratification in Kawasaki Disease

2022 ◽  
Author(s):  
Qiong Yao ◽  
Chen Peng ◽  
Sheng-zhang Wang ◽  
Xi-hong Hu
Keyword(s):  
Kawasaki Disease ◽  
Cfd Simulation ◽  
Roc Curves ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Z Score ◽  
Thrombotic Risk ◽  
Hemodynamic Variables ◽  
Resident Time ◽  
Hemodynamic Information

Abstract Objectives Thrombosis is a major adverse outcome for coronary artery aneurysms (CAA) in Kawasaki disease (KD). We investigated the geometric and hemodynamic abnormalities in patients with CAA and identified the risk factors for thrombosis by computational fluid dynamics (CFD) simulation. Methods We retrospectively studied 27 KD patients with 77 CAAs, including 20 CAAs with thrombosis in 12 patients. Patient-specific anatomic models obtained from cardiac magnetic resonance imaging (CMRI) were constructed to perform a CFD simulation. From the simulation results, we produced local hemodynamic parameters comprising of time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and relative resident time (RRT). The CAA’s maximum diameter (Dmax) and Z-score were measured on CMRI. Results Giant CAAs tended to present with more severe hemodynamic abnormalities. Thrombosed CAAs exhibited lower TAWSS (1.551 ± 1.535 vs. 4.235 ± 4.640dynes/cm2, p = 0.002), higher Dmax (10.905 ± 4.125 vs. 5.791 ± 2.826mm, p = 0.008), Z-score (28.301 ± 13.558 vs. 13.045 ± 8.394, p = 0.002), OSI (0.129 ± 0.132 vs. 0.046 ± 0.080, p = 0.01), and RRT (16.780 ± 11.982s vs. 9.123 ± 11.770s, p = 0.399) than the non-thrombosed group. An ROC analysis for thrombotic risk proved that all of the five parameters had area under the ROC curves (AUC) above 0.7, with Dmax delineating the highest AUC (AUCDmax = 0.871) and a 90% sensitivity, followed by Z-score (AUCZ−score = 0.849). Conclusions It is reasonable to combine the geometric index with hemodynamic information to establish a severity classification for KD cases.

Patient-Specific Hemodynamic Simulations in a Group of Patients With Coronary Artery Aneurysms Caused by Kawasaki Disease

2013 ◽  
Author(s):  
Dibyendu Sengupta ◽  
Jane C. Burns ◽  
Andrew Kahn ◽  
Alison L. Marsden
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Thrombus Formation ◽  
Anticoagulation Therapy ◽  
Febrile Illness ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Coronary Artery Aneurysms ◽  
Patients At Risk ◽  
Life Threatening

Kawasaki disease (KD) is an acute febrile illness that can result in life threatening coronary artery aneurysms in up to 25% of untreated patients. These aneurysms put patients at risk for thrombus formation, myocardial infarction and sudden death. Currently, clinical decisions are made based on anatomy alone, with aneurysm diameter > 8mm as the arbitrary cutoff for anticoagulation therapy, despite a lack of evidence for this choice. We postulate that patient specific hemodynamics may be a better predictor for the risk of thrombosis than maximum diameter alone. To quantify hemodynamics, we performed computational fluid dynamics (CFD) simulations using patient specific models with custom coronary boundary conditions.

scholarly journals Hemodynamic variables in aneurysms are associated with thrombotic risk in children with Kawasaki disease

2019 ◽  
Vol 281 ◽  
pp. 15-21 ◽  
Author(s):  
Noelia Grande Gutierrez ◽  
Mathew Mathew ◽  
Brian W. McCrindle ◽  
Justin S. Tran ◽  
Andrew M. Kahn ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Thrombotic Risk ◽  
Hemodynamic Variables

scholarly journals Computational modeling of blood component transport related to coronary artery thrombosis in Kawasaki disease

2021 ◽  
Vol 17 (9) ◽  
pp. e1009331
Author(s):  
Noelia Grande Gutiérrez ◽  
Mark Alber ◽  
Andrew M. Kahn ◽  
Jane C. Burns ◽  
Mathew Mathew ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Patient Specific ◽  
Blood Component ◽  
Local Concentration ◽  
Thrombotic Risk ◽  
Artery Thrombosis ◽  
Activated Platelets ◽  
Coronary Artery Thrombosis ◽  
Coagulation Pathway

Coronary artery thrombosis is the major risk associated with Kawasaki disease (KD). Long-term management of KD patients with persistent aneurysms requires a thrombotic risk assessment and clinical decisions regarding the administration of anticoagulation therapy. Computational fluid dynamics has demonstrated that abnormal KD coronary artery hemodynamics can be associated with thrombosis. However, the underlying mechanisms of clot formation are not yet fully understood. Here we present a new model incorporating data from patient-specific simulated velocity fields to track platelet activation and accumulation. We use a system of Reaction-Advection-Diffusion equations solved with a stabilized finite element method to describe the evolution of non-activated platelets and activated platelet concentrations [AP], local concentrations of adenosine diphosphate (ADP) and poly-phosphate (PolyP). The activation of platelets is modeled as a function of shear-rate exposure and local concentration of agonists. We compared the distribution of activated platelets in a healthy coronary case and six cases with coronary artery aneurysms caused by KD, including three with confirmed thrombosis. Results show spatial correlation between regions of higher concentration of activated platelets and the reported location of the clot, suggesting predictive capabilities of this model towards identifying regions at high risk for thrombosis. Also, the concentration levels of ADP and PolyP in cases with confirmed thrombosis are higher than the reported critical values associated with platelet aggregation (ADP) and activation of the intrinsic coagulation pathway (PolyP). These findings suggest the potential initiation of a coagulation pathway even in the absence of an extrinsic factor. Finally, computational simulations show that in regions of flow stagnation, biochemical activation, as a result of local agonist concentration, is dominant. Identifying the leading factors to a pro-coagulant environment in each case—mechanical or biochemical—could help define improved strategies for thrombosis prevention tailored for each patient.

CFD Simulation of Flow Mixing in the Vertobrobasilar System

2010 ◽  
Author(s):  
Matthew D. Bockman ◽  
Akash P. Kansagra ◽  
Eric C. Wong ◽  
Alison L. Marsden
Keyword(s):  
Cfd Simulation ◽  
Right Hemisphere ◽  
Cerebral Arteries ◽  
Patient Specific ◽  
Vertebrobasilar System ◽  
Flow Mixing ◽  
Patient Specific Modeling ◽  
Hemodynamic Information ◽  
The Right ◽  
Specific Modeling

Patient specific modeling can provide detailed hemodynamic information that is not available through most standard imaging modalities. The vertebrobasilar system is comprised of the confluence of the two vertebral arteries into the basilar artery, followed by divergence into the posterior cerebral arteries. A pilot study, by Kansagra and Wong [2], utilized vessel-encoded arterial spin labeling, an experimental MRI technique to quantify vertebrobasilar perfusion. In this method, flow in different vessels can be tagged, and perfusion of tagged flow to different regions of the brain can be quantified. These results demonstrated that blood delivered to the right hemisphere came primarily from the right vertebral, and vice versa.

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

2021 ◽  
Author(s):  
Takayuki Suzuki ◽  
Nobuyuki Kakimoto ◽  
Tomoya Tsuchihashi ◽  
Tomohiro Suenaga ◽  
Takashi Takeuchi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Artery Lesion ◽  
Z Score ◽  
Lesion Development

Abstract 132: Methylprednisolone Pulse Therapy for Kawasaki Disease with Symptomatic Myocarditis

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
yeo hyang kim ◽  
Chae Ok Shin ◽  
Myung Chul Hyun ◽  
Dong Seok Lee
Keyword(s):  
Kawasaki Disease ◽  
Systolic Function ◽  
Systemic Vasculitis ◽  
Cervical Lymphadenopathy ◽  
Febrile Illness ◽  
Pulse Therapy ◽  
Left Ventricular ◽  
Acute Stage ◽  
Z Score ◽  
Intravenous Methylprednisolone

Purpose: Kawasaki disease (KD) is an acute febrile illness of infants and young children that is characterized by a systemic vasculitis, especially involving the coronary arteries. Although, sometimes, subclinical myocarditis is combined in KD, symptomatic myocarditis is extremely uncommon. We report a 7 year old boy who developed hypotension and decreased left ventricular systolic function (EF 40%) in the acute phase of KD. Case: A 7 year old boy (height 115 cm, body weight 20 kg) was admitted because of 2 days of persistent fever and left cervical lymphadenopathy (white blood cell count 17,870 /mm 3 , C reactive protein 23.6 mg/dL). Conjunctiva injection and lip redness developed on the 4th day of illness, and hypotension and tachycardia (SBP 59/DBP 29 mmHg, HR 153/bpm) were combined. The echocardiography revealed a decreased ejection fraction (EF) (40%) without chamber dilatation and normal coronary artery size (LM 1.9mm, z score=-1.3, RCA 2.3mm, z score=0.4). The level of N terminal pro BNP was 28,000 pg/mL. With a diagnosis of KD with myocarditis, he was initially treated with inotropics and intravenous immunoglobulin (2 g/kg). Without clinical improvement in spite of initial treatment, A change of coronary arterial size (LM 2.9mm, z score=1.2, RCA 3.1mm, z score=2.3) was developed and decreased LV systolic function (EF 45%) and fever were persisted. Then, he was given 3 daily pulses of intravenous methylprednisolone followed by tapering doses of oral prednisolone. He showed prompt clinical recovery after pulse therapy of intravenous methylprednisolone (SBP 95/DBP 49 mmHg, HR 98/bpm). Although EF was improved (59%), coronary arterial dilatation was progressed (LM 3.4mm, z score=2.4 RCA 5.5mm, z score=7.9). Conclusions: The present case serves to highlight the fact that methylprednisolone should be considered as the priority in children with KD who have symptomatic myocarditis during the acute stage.

Abstract WMP34: Multimodal Evaluation of Unruptured Intracranial Aneurysm Wall

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yukishige Hashimoto ◽  
Kazuhiro Furukawa ◽  
Koji Shimonaga ◽  
Hiroki Takahashi ◽  
Chiaki Ono ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Three Dimensional ◽  
Fast Spin Echo ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Wall Thickening ◽  
Hemodynamic Parameters ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Morphological Variables

Background and Purpose: Recent studies have suggested that MR-vessel wall imaging (VWI) or computational fluid dynamics (CFD) could evaluate aneurysm wall features in unruptured intracranial aneurysms (UIAs). The combination of these modalities might be comprehensive and help better understanding of the pathophysiology of aneurysm wall. This study was performed to disclose the relationship between VWI and hemodynamic characteristics evaluated by CFD. Methods: From April 2017 through May 2019, a total of 36 microsurgically-treated UIAs preoperatively underwent VWI and CFD were reviewed. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast medium, and aneurysm wall enhancement (AWE) was evaluated. CFD was carried out using patient specific geometry models from three-dimensional CT angiography. Morphological variables, intraoperative inspection and hemodynamic parameters were statistically analyzed between enhanced and nonenhanced wall of UIAs. Fourteen UIAs were available for histopathological examination. Results: In morphological variables, maximum diameter and irregularity were associated with AWE (p=0.02, respectively). AWE lesions corresponded to intraoperatively inspected atherosclerotic lesions of UIAs (sensitivity, 0.90; specificity, 0.79). Among hemodynamic parameters, oscillatory velocity index that suggests the directional changes of the flow velocity was significantly higher in UIAs with AWE (p=0.02). Histopathologic studies revealed that wall thickening accompanied by atherosclerosis, neovascularization, and macrophage infiltration corresponded to AWE lesions, while UIAs without AWE demonstrated various histopathological findings such as myointimal hyperplasia or thinning wall with loss of mural cells and wall degeneration. Conclusions: Pathophysiology of AWE could be explained as atherosclerotic changes with inflammation presumably associated with aberrant flow conditions in irregular UIAs. VWI and CFD are complementarily valuable imaging techniques to understand an aneurysm wall pathophysiology.

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

Circulation ◽  
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.

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

Circulation ◽  
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.

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

Circulation ◽  
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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