scholarly journals Clinical Features in Children With Kawasaki Disease Shock Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhimin Zheng ◽  
Yanzhi Huang ◽  
Zhiyi Wang ◽  
Jia Tang ◽  
Xiaoqian Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Clinical Features ◽  
Artery Aneurysm ◽  
Left Ventricular ◽  
Current Evidence ◽  
Albumin Concentration ◽  
Case Control Studies ◽  
Significant Difference

Objective: This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children.Methods: The case-control studies of KDSS and KD children up until April 30, 2021 were searched in multiple databases. The qualified research were retrieved by manually reviewing the references. Review Manager 5.3 software was used for statistical analysis.Results: The results showed that there was no significant difference in the incidence of male and female in children with KDSS. Children with KDSS compared with non-shocked KD, there were significant difference in age, duration of fever, white blood cell (WBC) count, percentage of neutrophils (NEUT%), platelet count (PLT), c-reactive protein level (CRP), alanine transaminase concentration (ALT), aspartate transaminase concentration (AST), albumin concentration (ALB), sodium concentration (Na), ejection fraction, and length of hospitalization as well as the incidence of coronary artery dilation, coronary artery aneurysm, left ventricular dysfunction, mitral regurgitation, pericardial effusion, initial diagnosis of KD, intravenous immunoglobulin (IVIG) resistance and receiving second dose of IVIG, vasoactive drugs, hormones, and albumin. In contrast, there was no difference in the hemoglobin concentration, erythrocyte sedimentation rate, and the incidence of conjunctival injection, oropharyngeal change, polymorphous rash, extremity change, and incomplete KD.Conclusion: Current evidence suggested that the children with KDSS had more severe indicators of inflammation and more cardiac abnormalities. These patients were resistant to immunoglobulin treatment and required extra anti-inflammatory treatment.Systematic Review Registration: PROSPERO registration number CRD42021241207.

Prevalence and predictors of coronary artery disease in adults with Kawasaki disease

2014 ◽  
Vol 25 (6) ◽  
pp. 1124-1129 ◽  
Author(s):  
Jalaj Garg ◽  
Parasuram Krishnamoorthy ◽  
Chandrasekar Palaniswamy ◽  
Rajiv Paudel ◽  
Saurav Chatterjee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Hospital Admissions ◽  
Artery Aneurysm ◽  
Adult Patients ◽  
Significant Difference ◽  
Traditional Risk Factors ◽  
Artery Disease

AbstractBackground: Accelerated coronary atherosclerosis in patients with Kawasaki disease, in conjunction with coronary artery aneurysm and stenosis that characterise this disease, are potential risk factors for developing coronary artery disease in young adults. We aimed to determine the prevalence and predictors of coronary artery disease in adult patients with Kawasaki disease. Methods: All patients aged 18−55 years of age diagnosed with Kawasaki disease were sampled from Nationwide Inpatient Sample database using International Classification of Diseases 9th revision (ICD 9 code 446.1) from 2009 to 2010. Demographics, prevalence of coronary artery disease, and other traditional risk factors in adult patients with Kawasaki disease were analysed using ICD 9 codes. Results: The prevalence of Kawasaki disease among adults was 0.0005% (n=215) of all in-hospital admissions in United States. The mean age was 27.3 years with women (27.6 years) older than men (27.1 years). Traditional risk factors were hypertension (21%), hyperlipidaemia (15.6%), diabetes (11.5%), tobacco use (8.8%), and obesity (8.8%), with no significant difference between men and women. Coronary artery disease (32.4%), however, was more prevalent in men (44.7%) than in women (12.1%; p=0.03). In multivariate regression analysis, after adjusting for demographics and traditional risk factors, hypertension (OR=13.2, p=0.03) was an independent risk factor of coronary artery disease. Conclusion: There was increased preponderance of coronary artery disease in men with Kawasaki disease. On multivariate analysis, hypertension was found to be the only independent predictor of coronary artery disease in this population after adjusting for other risk factors.

scholarly journals The Occurrence of Coronary Artery Lesions in Kawasaki Disease Based on C-reactive Protein Levels: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Hyo Soon An ◽  
Gi-Beom Kim ◽  
Mi Kyoung Song ◽  
Sang Yun Lee ◽  
Hye Won Kwon ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Demographic Data ◽  
Artery Aneurysm ◽  
Nationwide Survey ◽  
Coronary Artery Lesions ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
Z Scores

Abstract BackgroundThis study aimed to assess the occurrence of coronary artery lesions (CAL) in patients with Kawasaki disease (KD) according to serum C-reactive protein (CRP) levels. MethodsThis retrospective analysis was based on the nationwide survey of KD conducted in the Republic of Korea between 2015 and 2017. We enrolled 9131 patients and defined low (<3 mg/dL) and high (≥3 mg/dL) CRP groups. Demographic data, clinical characteristics, z-scores, and scores based on the Japanese criteria for CAL were compared between the two groups. Logistic regression analysis was used to identify CAL risk factors.ResultsThe low CRP group accounted for 23% of patients. A significant difference was observed for the mean age at diagnosis (high vs. low CRP, 34.4 ± 24.9 vs. 31.7 ± 24.8 months, p<0.001) and fever duration (high vs. low CRP, 6.6 ± 2.2 vs. 6.3 ± 2.5 days, p<0.001). A non-response to intravenous immunoglobulin treatment was found in 1377 patients (20.1%) and 225 patients (11.7%) in the high and low CRP groups, respectively (p<0.001). CAL were found in 12.9% and 18.3% of the high and low CRP patients, respectively (p<0.001), based on z-scores; and in 9.9% and 12.5%, respectively (p = 0.001), based on the Japanese criteria in the acute phase. The giant coronary artery aneurysm occurrence ratio was similar between groups (p=1.0).ConclusionsCAL occurred in patients with both high and low CRP. Therefore, patients with KD should be carefully monitored regardless of their CRP levels.

scholarly journals Coronary Aneurysm and IVIG Resistance Prediction in Kawasaki Disease

2020 ◽  
Author(s):  
Yusuf Ziya Varlı ◽  
Kazim Oztarhan
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Clinical Laboratory ◽  
Systemic Vasculitis ◽  
Cervical Lymphadenopathy ◽  
Artery Aneurysm ◽  
Ivig Treatment ◽  
Left Circumflex Artery ◽  
Ivig Resistance ◽  
Significant Difference

Abstract Background: Kawasaki disease (KD) is the most common cause of coronary artery aneurysm (CAA) in children. This study aimed to determine the clinical characteristics, demographic features, frequency of coronary involvement, and resistance to intravenous immunoglobulin (IVIG) treatment in Turkey based on our data.Methods: Patients with KD were evaluated with demographic data, clinical, laboratory, and echocardiographic findings. Results: Between 2010–2019, a total of 259 patients (male/female: 1.67) were treated in our hospital, with 48 (%19) cases < 1 year of age. According to diagnostic criteria, 31% were diagnosed with typical KD and 69% with atypical (incomplete) KD. The frequency of clinical findings were as follows: changes in the lips and oral mucosa (79%); polymorphic rash (69%); conjunctivitis (65%); changes in the extremities (54%); and cervical lymphadenopathy (48%). There was no significant difference between typical and atypical KD in the frequency order. CAA development and IVIG resistance occurred in 11.6% and 12.3% of cases, respectively. IVIG resistance was more common in infants and hospitalization times were longer in this group. Coronary artery lesions existed in 45 patients; right coronary artery (RCA) alone (20%), left coronary artery (LCA) alone (44.5%), and RCA and LCA together were involved (35.5%). The left main coronary artery affected 20 patients, the left anterior descending artery (LAD) affected nine patients (45%), the left circumflex artery (LCx) affected two patients (10%), and the LAD and LCx together affected two patients (10%). None of the patients had myocardial infarctions or died during follow-up. Conclusion: KD is a systemic vasculitis common in pediatric infants in which coronary artery involvement affects prognosis. Due to IVIG resistance and increased coronary involvement accompanying this vasculitis, it is an important problem in countries where the disease is common. It is important to know the factors that increase the risk of coronary involvement and IVIG resistance development.

scholarly journals P316 A feasible and accurate method for the assessment of early ventricular dysfunction in children with kawasaki disease: result from the MyoWoRK (myocardial work related to kawasaki disease) study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N S Borrelli ◽  
G Di Salvo ◽  
J Sabatino ◽  
M Avesani ◽  
E Filippini ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Unknown Etiology ◽  
Male Age ◽  
Significant Difference ◽  
Global Work ◽  
Lv Systolic Function

Abstract Funding Acknowledgements EACVI Training Grant Introduction Kawasaki disease (KD) is an acute vasculitis of unknown etiology. It is associated with high morbidity and mortality due to the development of coronary artery aneurysms and myocardial dysfunction. Purpose The aim of this study was to evaluate sensitivity and specificity of left ventricular (LV) pressure–strain loop (PSL) area, which reflects regional myocardial work and metabolic demand, in predicting subtle myocardial abnormalities in KD patients with coronaries aneurisms. Methods A total of 88 patients (59 male, age 8.95 ± 4.95 years) were included in our study. Among the children admitted in our institution with a diagnosis of KD during the study time frame, 42 patients (KDg) (29 male) with coronary artery dilatation (Z-score &gt;2.5) were selected. These cases were compared with 46 (30 male) age-matched controls (CTRg). Classical echocardiographic parameters of LV systolic function were normal in both groups, while global longitudinal strain (GLS) was decreased in 6 KD patients. Global work index (GWI) was calculated as the area of the LV PSL. From GWI, it was estimated also Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). We also made a subgroup analysis between KD patients with normal GLS (&gt; -19 %) and control patients. Results Despite normal LV systolic function by routine echocardiography, compared to controls, KD patients had lower GWI (1448 ± 382 mmHg% in KDg vs 1751 ± 263] mmHg% in CTRg, p = 0.00003), GCW (1904 ± 390 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p= 0.0004) and GWE (94 ± 5 % in KDg vs 96 ± 2 % in CTRg, p= 0.01). There was not significant difference in GWW between the KDg and CTRg. When KD patients with normal GLS were analysed separately, they preserved a significant difference in GWI, GCW and GWE in comparison with controls (GWI: 1490 ± 347 mmHg% in KDg vs 1751 ± 263 mmHg% in CTRg, p = 0.0002; GCW: 1972 ± 321 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p = 0.004; GWE: 95 ± 3 in KDg vs 96 ± 2 % in CTRg, p= 0.04). No association was found between GWI, GCW, GWW, GWE and number or dimension of the involved aneurysmatic coronaries. Conclusions The estimation of myocardial work by PSL is a novel tool for the evaluation of patients with KD. GWI, GCW and GWE were significantly reduced in KD patients with dilated coronaries. In KD patients with normal GLS, estimation of GWI, GCW and GWE may be a sensitive indicator of myocardial dysfunction and an adjuvant criterion to avoid delayed diagnosis of KD. Abstract P316 Figure. Myocardial work in KD and CTR.

The Prevention of Coronary Artery Aneurysm in Kawasaki Disease: A Meta-analysis on the Efficacy of Aspirin and Immunoglobulin Treatment

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. 1057-1061 ◽  
Author(s):  
Kritvikrom Durongpisitkul ◽  
Vymutt J. Gururaj ◽  
Joon M. Park ◽  
Clyde F. Martin
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Confidence Interval ◽  
Coronary Artery Aneurysm ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Artery Aneurysm ◽  
True Proportion ◽  
Best Estimate ◽  
Significant Difference

Objective. Varying observations have been made concerning the use of aspirin (ASA) and/or intravenous immunoglobulin (IVIG) in the prevention of coronary artery aneurysm (CAA) in children with Kawasaki disease. A meta-analysis of published articles on the subject was conducted to evaluate the reported efficacy of these therapies. Methods. All published studies in all languages from 1967 through 1993 obtained from MEDLINE and EMBASE were considered, and a defined set of inclusion and exclusion criteria selected the studies for analysis. These studies were grouped based on whether the children in the studies received: (1) ASA alone, (2) low IVIG (≤1 g/kg) and ASA, (3) high IVIG (&gt;1 g/kg) and ASA, (4) single IVIG (&gt;1 g/kg) and ASA, (5) high IVIG and low ASA (≤80 mg/kg), or (6) high IVIG and high ASA (&gt; 80mg/kg). Studies that satisfied the test for homogeneity were subjected to further analysis. The best estimate of the true proportion of CAA as well as the 95% confidence interval for each group were calculated at 30 and 60 days. Hypothesis testing was conducted to determine the statistical significance of the calculated difference in each compared treatment group. Results. The best estimate of true proportion of CAA and the 95% confidence interval in each group at 30 and 60 days were: (1) ASA group, 30 days, 22.8% (20.6%, 25%); 60 days, 17.1% (13.6%, 20.7%); (2) low-IVIG group, 30 days, 17.3% (14.3%, 20.2%); 60 days, 11.1% (8.7%, 13.6%); (3) high-IVIG group, 30 days, 10.3% (8.3%, 12.3%); 60 days, 4.4% (2.8%, 6%); (4) single-IVIG group, 30 days, 2.3% (0.5%, 4.2%); 60 days, 2.4% (0.5%, 4.2%); (5) high-IVIG-low-ASA group, 30 days, 13% (9%, 17%); 60 days, 4.8% (2.3%, 7.4%); and (6) high-IVIG-high-ASA group, 30 days, 9.1% (6.9%, 11.4%); 60 days, 4% (2%, 6.1%). Conclusion. The incidence of CAA both at 30 and 60 days was significantly lower in low-IVIG than in ASA and in high-IVIG than in low-IVIG groups. Also, the incidence was lower in the single-IVIG than in the high-IVIG group, but this was noted at 30 days and not at 60 days. There was no statistically significant difference in the incidence of CAA both at 30 and 60 days between the high-IWIG-low-ASA and high-IVIG-high-ASA groups.

Abstract 44: Uveitis As An Important Ocular Sign To Help Early Diagnosis In Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Young Mi Hong ◽  
Han Seul Choi ◽  
Hae Soon Kim ◽  
Sejung Sohn
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Laboratory Data ◽  
Artery Aneurysm ◽  
Control Group ◽  
Echocardiographic Measurement ◽  
Arterial Complication ◽  
Increased Risk ◽  
Significant Difference ◽  
Treatment Responses

Purpose: Atypical or incomplete Kawasaki disease (KD) frequently leads to delay in diagnosis and treatment. Delayed diagnosis is associated with increased risk of coronary artery aneurysm. Anterior uveitis peaks about a week after the onset of fever. The purpose of this study was to assess the differences in laboratorial findings including echocardiographic measurements, clinical characteristics such as duration of fever and treatment responses between KD patients with and without uveitis. Materials and Methods: 106 KD patients were studied from January 2008 to June 2013. Study group (n=28, KD with uveitis) was compared with control group (n=78, KD without uveitis). Laboratory data were obtained from each patients including complete blood count (CBC), erythrocyte sedimentation rate (ESR), platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total protein, albumin, C-reactive protein (CRP), brain natriuretic peptide (BNP). Echocardiographic measurement and intravenous immunoglobulin responses were compared between two groups. Result: The incidence of uveitis was 26.4%. Neutrophil counts were higher in the uveitis group compared with the control group (64.3±15.8(х10 3 /mm 3 ) vs. 54.4±19.3 (х10 3 /mm 3 )). The age of patients was higher in the uveitis group compared with the control group (40.5±21.4 months vs. 33.4±29.3 months). ESR (43.3±27.2 mm/hr vs. 30.8±24.6 mm/hr) and CRP (8.1±6.1 mg/dL vs. 7.9±10.7mg/dL) were slightly increased in the uveitis group compared with the control group, but there was no significant difference between the two groups. Coronary artery diameter was slightly increased in the uveitis group but there was no significant difference between the two groups. There were no significant differences in duration of fever, BNP, coronary arterial complication and treatment responses between the two groups. Conclusion: Uveitis is the one of the important ocular signs to diagnose incomplete KD. It is significantly associated with the patient’s age and neutrophil count but not with the other laboratory measurements, coronary arterial complication or treatment responses.

scholarly journals Is there an association between intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease?—Current evidence based on a meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248812
Author(s):  
Xiaolan Zheng ◽  
Jinhui Li ◽  
Peng Yue ◽  
Lei Liu ◽  
Jiawen Li ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Diagnostic Criteria ◽  
Meta Analysis ◽  
Coronary Artery Lesion ◽  
Current Evidence ◽  
Cochrane Central Register ◽  
Ivig Resistance ◽  
Significant Difference

Background Coronary artery lesion (CAL) caused by Kawasaki disease (KD) is a leading cause of acquired heart disease in children. Initial treatment of intravenous immunoglobulin (IVIG) can reduce the incidence of CAL. Although most of the current studies have shown a certain correlation between CAL and IVIG resistance, the conclusions are not completely consistent. Thus, we performed this meta-analysis to evaluate the association between IVIG resistance and CAL in KD. Methods PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through April 21, 2020 were searched to detect relevant studies. Data analysis was performed with STATA 15.1. Results A total of 53 relevant studies were eligible to this analysis, including 30312 KD patients, of which 4750 were IVIG resistance and 25562 were responders. There was a significant difference found between IVIG resistance and IVIG response groups in the incidence of CAL (P < 0.001, odds ratio (OR), 3.89; 95% confidence interval (CI) (3.18, 4.75)). The heterogeneity test results showed that the I2 value was 74.8%. The meta-regression analysis showed that the study regions might be the sources of heterogeneity. The subgroup analysis suggested that the incidence of CAL in the IVIG resistance group was still higher than that in the IVIG response group under different regions, IVIG resistance diagnostic criteria, CAL diagnostic criteria, and study types. Meanwhile, the sensitivity analysis did not find any significant impact from every single study. Conclusions This is the first meta-analysis to reveal the incidence of CAL was associated with IVIG resistance in KD patients. Further well-designed studies with uniform criteria are needed to evaluate the incidence of CAL in IVIG resistant patients.

scholarly journals A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

2020 ◽  
Author(s):  
Akshar Jaglan ◽  
Tarek Ajam ◽  
Steven C Port ◽  
Tanvir Bajwa ◽  
A Jamil Tajik
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Treatment Options ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Artery Ectasia ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

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