scholarly journals A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance

Children ◽  
2018 ◽  
Vol 5 (10) ◽  
pp. 141 ◽  
Author(s):  
Audrey Dionne ◽  
Nagib Dahdah
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Confidence Interval ◽  
Positive Likelihood Ratio ◽  
Biological Marker ◽  
Febrile Illness ◽  
Diagnostic Algorithm ◽  
Acquired Heart Disease ◽  
Acute Kawasaki Disease

Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients.

Recurrence of coronary artery lesions after complete regression in a peculiar case of Kawasaki disease

2019 ◽  
Vol 29 (5) ◽  
pp. 714-716
Author(s):  
Shiv D. Sharma ◽  
Kanupriya Chaturvedi ◽  
Avesh Saini ◽  
Swatantra Rathore ◽  
Mohit Tayal
Keyword(s):  
Heart Disease ◽  
Clinical Practice ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Complete Regression ◽  
Coronary Artery Lesions ◽  
Acquired Heart Disease ◽  
Peculiar Case

AbstractKawasaki disease is a leading cause of acquired heart disease in children with serious repercussions of coronary artery lesions. Recurrences of the disease are relatively rare in clinical practice. We present a case of recurrent Kawasaki disease, wherein the coronary artery lesions which were documented during the initial illness demonstrated complete regression over the following months, but reappeared with recurrence of the disease.

scholarly journals Kawasaki disease with bronchopneumonia: A case report

2012 ◽  
Vol 1 (8) ◽  
pp. 226-228
Author(s):  
Dayana Nicholas ◽  
Kenneth Nelson ◽  
Azmi Sarriff
Keyword(s):  
Heart Disease ◽  
Case Report ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Cervical Lymphadenopathy ◽  
Pharmaceutical Journal ◽  
Infectious Agents ◽  
School Aged Children ◽  
Acquired Heart Disease

disease (KD) is an acute systemic vasculitis that predominantly affects pre-school aged children. It is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy, and irritation and inflammation of the mouth, lips, and throat. Serious complications of KS include coronary artery dilatations and aneurysms, and KS is a leading cause of acquired heart disease. It has a predilection to coronary arteries, and its precise etiology is still unknown. Many infectious agents, including viruses and bacteria, have been suggested as potential causes of the disease.DOI: http://dx.doi.org/10.3329/icpj.v1i8.11256 International Current Pharmaceutical Journal 2012, 1(8): 226-228 

Abstract O.05: The Incidence and Outcome of Kawasaki Shock Syndrome:2003-2013

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Sara K Sexson Tejtel ◽  
Andrea A Ramirez ◽  
Thomas Seery ◽  
Amy Liou ◽  
Debra Canter ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Heart Disease ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Length Of Stay ◽  
Health Information Systems ◽  
Shock Group ◽  
Uncommon Presentation ◽  
The Us ◽  
Acquired Heart Disease

Kawasaki disease (KD) is the leading cause of acquired heart disease in children with a subset presenting in shock. We sought to describe the incidence and outcomes of KD shock in the US. Methods: The Pediatric Health Information Systems (PHIS), 1/2004-12/2013, dataset including all hospitalizations at 44 of the largest freestanding children’s hospitals in the US was used. We assumed KD shock patients were admitted to the ICU. Results: KD admissions included 16,417 patients, 1,179 requiring ICU care, KD shock, with an annual incidence of 8 - 13%, Figure 1. Among KD shock admissions (versus non-ICU KD), the length of stay (10 vs 4 days, P<0.001) and mortality (10 vs 1 death) is higher in the shock group. The rate of coronary artery (CA) changes during initial admission for KD shock was higher than non-shock, Figure 2 (P<0.001). Conclusions: KD shock may not be an uncommon presentation given 8-13% of KD admissions required ICU care. KD shock patients are more likely to have complications including coronary artery changes, mechanical ventilation, ECMO, and longer hospitalizations than non-ICU admissions.

An update on the epidemiology, length of stay, and cost of Kawasaki disease hospitalisation in the United States

2019 ◽  
Vol 29 (06) ◽  
pp. 828-832 ◽  
Author(s):  
Laxmi V. Ghimire ◽  
Fu-Sheng Chou ◽  
Narayan B. Mahotra ◽  
Sharan P. Sharma
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Length Of Stay ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Developed Countries ◽  
The United States ◽  
Hospital Charge ◽  
Acquired Heart Disease ◽  
The Developed Countries

AbstractBackground:Kawasaki disease is an acute vasculitis of childhood and is the leading cause of acquired heart disease in the developed countries.Methods:Data from hospital discharge records were obtained from the National Kids Inpatient Database for years 2009 and 2012. Hospitalisations by months, hospital regions, timing of admission, insurance types, and ethnicity were analysed. Length of stay and total charges were also analysed.Results:There were 10,486 cases of Kawasaki disease from 12,678,005 children hospitalisation. Kawasaki disease was more common between 0 and 5 years old, in male, and in Asian. The January–March quarter had the highest rate compared to the lowest in the July–September quarter (OR=1.62, p &lt; 0.001). Admissions on the weekend had longer length of stay [4.1 days (95 % CI: 3.97–4.31)] as compared to admissions on a weekday [3.72 days (95 % CI: 3.64–3.80), p &lt; 0.001]. Blacks had the longest length of stay and whites had the shortest [4.33 days (95 % CI: 4.12–4.54 days) versus 3.60 days (95 % CI: 3.48–3.72 days), p &lt; 0.001]. Coronary artery aneurysm was identified in 2.7 % of all patients with Kawasaki disease. Children with coronary artery aneurysm were hospitalised longer and had higher hospital charge. Age, admission during weekend, and the presence of coronary artery aneurysm had significant effect on the length of stay.Conclusions:This report provides the most updated epidemiological information on Kawasaki disease hospitalisation. Age, admissions during weekend, and the presence of coronary artery aneurysm are significant contributors to the length of stay.

Lymphadenitis as the Dominant Manifestation of Kawasaki Disease

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. 525-528
Author(s):  
Julie Kim Stamos ◽  
Kathleen Corydon ◽  
James Donaldson ◽  
Stanford T. Shulman
Keyword(s):  
Kawasaki Disease ◽  
Cervical Lymphadenopathy ◽  
Febrile Illness ◽  
The United States ◽  
Acute Febrile Illness ◽  
Conjunctival Injection ◽  
Coronary Abnormalities ◽  
Acquired Heart Disease ◽  
Mucosal Changes ◽  
Infants And Young Children

Kawasaki disease (KD) is an acute febrile illness primarily affecting infants and young children. Its importance relates to the fact that 20% to 25% of untreated patients develop coronary abnormalities that can lead to myocardial infarction or even to death.1 KD is a leading cause of acquired heart disease in children in many regions, including the United States.2 Because there are no specific diagnostic tests for KD, the diagnosis is established by the presence of fever and four of five criteria without other explanation for the illness: (1) nonexudative conjunctival injection; (2) oral mucosal changes; (3) changes of the peripheral extremities; (4) rash, primarily truncal; and (5) cervical lymphadenopathy.

scholarly journals The emergence of Kawasaki disease in India and China

2018 ◽  
Vol 2017 (3) ◽  
Author(s):  
Ankur Kumar Jindal ◽  
Vingesh Pandiarajan ◽  
Raju Khubchandani ◽  
Nutan Kamath ◽  
Tapas Sabui ◽  
...  
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
Kawasaki Disease ◽  
Developed Countries ◽  
Resource Constrained ◽  
Diagnosis And Management ◽  
China And India ◽  
The World ◽  
Acquired Heart Disease ◽  
India And China

Kawasaki disease (KD) is recognized as a leading cause of acquired heart disease in children in developed countries. Although global in distribution, Japan records the highest incidence of KD in the world. Epidemiological reports from the two most populous countries in the world, namely China and India, indicate that KD is now being increasingly recognized. Whether this increased reporting is due to increased ascertainment, or is due to a true increase in incidence, remains a matter of conjecture. The diagnosis and management of KD in developing countries is a challenging proposition. In this review we highlight some of the difficulties faced by physicians in managing children with KD in resource-constrained settings. 

Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
John W McEvoy ◽  
Faisal Rahman ◽  
Mahmoud Al Rifai ◽  
Michael Blaha ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Diastolic Blood Pressure ◽  
Coronary Artery Calcium ◽  
J Curve ◽  
Increased Risk ◽  
All Cause Mortality

Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.

Intraoperative echocardiographic coronary artery imaging in congenital and acquired heart disease

2020 ◽  
Vol 30 (2) ◽  
pp. 153-161
Author(s):  
Deane Yim ◽  
Luc Mertens ◽  
Osami Honjo ◽  
Lynne E. Nield
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Intraoperative Imaging ◽  
Doppler Imaging ◽  
Extrinsic Compression ◽  
Coronary Artery Patency ◽  
Acquired Heart Disease ◽  
Spectral Doppler ◽  
Epicardial Echocardiography

AbstractTransoesophageal and epicardial echocardiography are indispensible intraoperative imaging modalities to guide paediatric heart disease surgeries and influence surgical decision-making. A less well-described role of intraoperative imaging is its utility in evaluating coronary artery patency and flow. Focused two-dimensional, colour, and spectral Doppler imaging of the coronary arteries should be performed during surgeries involving coronary manipulation or re-implantation, or in cases where there is unexpected ventricular dysfunction or electrographic signs concerning for ischaemia. Intraoperative imaging allows for any anatomical issues to be detected and addressed promptly in the operating room. Imaging of the coronary arteries should identify unobstructed coronary ostia and proximal course without kinking, angulation, narrowing, or significant calibre change to suggest stenosis or extrinsic compression from neighbouring structures. The aim of this review is to highlight the usefulness of transoesophageal and epicardial echocardiography in evaluating coronary artery patency and flow, provide a how-to guide for optimal imaging, and to introduce a practical guideline to achieve best clinical practice.

scholarly journals CD8 T Lymphocytes and Macrophages Infiltrate Coronary Artery Aneurysms in Acute Kawasaki Disease

2001 ◽  
Vol 184 (7) ◽  
pp. 940-943 ◽  
Author(s):  
Timothy J. Brown ◽  
Susan E. Crawford ◽  
Mona L. Cornwall ◽  
Francesca Garcia ◽  
Stanford T. Shulman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
T Lymphocytes ◽  
Kawasaki Disease ◽  
Coronary Artery Aneurysms ◽  
Cd8 T Lymphocytes ◽  
Acute Kawasaki Disease

scholarly journals Kawasaki Disease: A Clinician’s Update

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Nathan Jamieson ◽  
Davinder Singh-Grewal
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Reference Lists ◽  
Systemic Vasculitis ◽  
Clinical Criteria ◽  
Treatment Practices ◽  
Fever Onset ◽  
Environmental Trigger ◽  
Acquired Heart Disease ◽  
Developed World

Aims. Kawasaki disease is an acute systemic vasculitis and is the most common cause of acquired heart disease in children in the developed world. This review aims to synthesise recent insights into the disease and provide an update for clinicians on diagnostic and treatment practices.Methods. We conducted a review of the literature exploring epidemiology, aetiology, diagnosis, and management of Kawasaki disease. We searched MEDLINE, Medline In-Process, Embase, Google Scholar, and reference lists of relevant articles.Conclusions. Kawasaki disease is a febrile vasculitis which progresses to coronary artery abnormalities in 25% of untreated patients. The disease is believed to result from a genetically susceptible individual’s exposure to an environmental trigger. Incidence is rising worldwide, and varies widely across countries and within different ethnic groups. Diagnosis is based on the presence of fever in addition to four out of five other clinical criteria, but it is complicated by the quarter of the Kawasaki disease patients with “incomplete” presentation. Treatment with intravenous immunoglobulin within ten days of fever onset improves clinical outcomes and reduces the incidence of coronary artery dilation to less than 5%. Given its severe morbidity and potential mortality, Kawasaki disease should be considered as a potential diagnosis in cases of prolonged paediatric fever.

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