Abstract
Kawasaki disease (KD) is the leading cause of acquired heart disease due to its complicated coronary artery lesions. Up to now, few studies were focused on the status of persistent coronary artery aneurysms (CAA) in KD patients. The present study was designed to identify the coronary artery outcomes and seek the risk factors associated with the regression of CAA in KD patients. One hundred and twenty KD patients with CAA hospitalized in Children’s Hospital of Soochow University from Jan 2008 to Dec 2013 were prospectively studied by a 3-year follow-up. Data regarding demographic, clinical, laboratory, and echocardiographic characteristics were documented and further analyzed. It was estimated that 39.2% of the patients had complete regression of CAA within 4 weeks, 59.2% within 8 weeks, and 70.0% within 16 weeks. No fatal cardiac events occurred. We found patients who aged ≤ 1 year, received initial intravenous immunoglobulin (IVIG) treatment after the 10th day of illness, and IVIG non-responders were associated with the regression of persistent CAA. The relative risks were 1.55, 1.87, and 1.88, respectively. Age, initial IVIG treatment, and IVIG response were risk factors of persistent CAA, and more attention should be paid on these patients.
Similar content being viewed by others
References
Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R (1996) Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 94(6):1379–1385. https://doi.org/10.1161/01.CIR.94.6.1379
BW M, AH R, JW N, JC B, AF B, M G, AL B, MA J, M T, PB S (2017) Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association
Holve TJ, Patel A, Chau Q, Marks AR, Meadows A, Zaroff JG (2014) Long-term cardiovascular outcomes in survivors of Kawasaki disease. Pediatrics 133(2):e305–e311. https://doi.org/10.1542/peds.2013-1638
Jang GY, Kang IS, Choi JY, Bae EJ, Kim YH, Kim SH, Ma JS (2015) Nationwide survey of coronary aneurysms with diameter >6 mm in Kawasaki disease in Korea. Pediatr Int Off J Jpn Pediatr Soc 57(3):367–372. https://doi.org/10.1111/ped.12536
Wu MH, Chen HC, Yeh SJ, Lin MT, Huang SC, Huang SK (2012) Prevalence and the long-term coronary risks of patients with Kawasaki disease in a general population <40 years: a national database study. Cir Cardiovas Qual Outcomes 5(4):566–570. https://doi.org/10.1161/CIRCOUTCOMES.112.965194
Kawai H, Takakuwa Y, Naruse H, Sarai M, Motoyama S, Ito H, Iwase M, Ozaki Y (2015) Two cases with past Kawasaki disease developing acute myocardial infarction in their thirties, despite being regarded as at low risk for coronary events. Heart Vessel 30(4):549–553. https://doi.org/10.1007/s00380-014-0541-4
Wei YJ, Zhao XL, Liu BM, Niu H, Li Q (2016) Cardiac complications in 38 cases of Kawasaki disease with coronary artery aneurysm diagnosed by echocardiography. Echocardiography 33(5):764–770. https://doi.org/10.1111/echo.13154
Uysal F, Bostan OM, Celebi S, Uysal B, Hamitoglu S, Cil E (2015) Outcomes of Kawasaki disease: a single-center experience. Clin Pediatr 54(6):579–584. https://doi.org/10.1177/0009922814561594
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA, Committee on Rheumatic Fever E, Kawasaki D, Council on Cardiovascular Disease in the Y, American Heart A, American Academy of P (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110(17):2747–2771. https://doi.org/10.1161/01.CIR.0000145143.19711.78
Kuramochi Y, Ohkubo T, Takechi N, Fukumi D, Uchikoba Y, Ogawa S (2000) Hemodynamic factors of thrombus formation in coronary aneurysms associated with Kawasaki disease. Pediatr Int Off J Japan Pediatr Soc 42(5):470–475. https://doi.org/10.1046/j.1442-200x.2000.01270.x
Giannouli G, Tzoumaka-Bakoula C, Kopsidas I, Papadogeorgou P, Chrousos GP, Michos A (2013) Epidemiology and risk factors for coronary artery abnormalities in children with complete and incomplete Kawasaki disease during a 10-year period. Pediatr Cardiol 34(6):1476–1481. https://doi.org/10.1007/s00246-013-0673-9
Ruan Y, Ye B, Zhao X (2013) Clinical characteristics of Kawasaki syndrome and the risk factors for coronary artery lesions in China. Pediatr Infect Dis J 32(10):397–402
Kuwabara M, Yashiro M, Kotani K, Tsuboi S, Ae R, Nakamura Y, Yanagawa H, Kawasaki T (2015) Cardiac lesions and initial laboratory data in Kawasaki disease: a nationwide survey in Japan. J Epidemiol 25(3):189–193. https://doi.org/10.2188/jea.JE20140128
Tacke CE, Breunis WB, Pereira RR, Breur JM, Kuipers IM, Kuijpers TW (2014) Five years of Kawasaki disease in the Netherlands: a national surveillance study. Pediatr Infect Dis J 33(8):793–797. https://doi.org/10.1097/INF.0000000000000271
Tang Y, Gao X, Shen J, Sun L, Yan W (2016) Epidemiological and clinical characteristics of Kawasaki disease and factors associated with coronary artery abnormalities in East China: nine years experience. J Trop Pediatr 62(2):86–93. https://doi.org/10.1093/tropej/fmv077
Ding YY, Ren Y, Feng X, Xu QQ, Sun L, Zhang JM, Dou JJ, Lv HT, Yan WH (2014) Correlation between brachial artery flow-mediated dilation and endothelial microparticle levels for identifying endothelial dysfunction in children with Kawasaki disease. Pediatr Res 75(3):453–458. https://doi.org/10.1038/pr.2013.240
Mueller F, Knirsch W, Harpes P, Pretre R, Valsangiacomo Buechel E, Kretschmar O (2009) Long-term follow-up of acute changes in coronary artery diameter caused by Kawasaki disease: risk factors for development of stenotic lesions. Clin Res Cardiol Off J Ger Card Soc 98(8):501–507. https://doi.org/10.1007/s00392-009-0032-2
Song D, Yeo Y, Ha K, Jang G, Lee J, Lee K, Son C, Lee J (2009) Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr 168(11):1315–1321. https://doi.org/10.1007/s00431-009-0925-0
Callinan LS, Tabnak F, Holman RC, Maddox RA, Kim JJ, Schonberger LB, Vugia DJ, Belay ED (2012) Kawasaki syndrome and factors associated with coronary artery abnormalities in California. Pediatr Infect Dis J 31(9):894–898. https://doi.org/10.1097/INF.0b013e31825c4d7c
Tang Y, Yan W, Sun L, Huang J, Qian W, Ding Y, Lv H (2016) Prediction of intravenous immunoglobulin resistance in Kawasaki disease in an East China population. Clin Rheumatol 35(11):2771–2776. https://doi.org/10.1007/s10067-016-3370-2
Makino N, Nakamura Y, Yashiro M, Ae R, Tsuboi S, Aoyama Y, Kojo T, Uehara R, Kotani K, Yanagawa H (2015) Descriptive epidemiology of Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwide survey. J Epidemiol 25(3):239–245. https://doi.org/10.2188/jea.JE20140089
Acknowledgements
This work was financially supported by the National Natural Science Foundation of China (Nos. 81570455, 81600391, 81400222, 81700439), the Science and Technology Support Program of Jiangsu Province (BK20150291, BE2017660), the Foundation of Suzhou government (SYS201443), and the Science and Technology Projects for the Youth of Suzhou (KJXW2016021).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
None.
Ethical standards
We confirmed that all study protocols were approved by the Ethics Committee of Children’s Hospital of Soochow University and were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all patients’ legal guardians.
Rights and permissions
About this article
Cite this article
Tang, Y., Yan, W., Sun, L. et al. Coronary artery aneurysm regression after Kawasaki disease and associated risk factors: a 3-year follow-up study in East China. Clin Rheumatol 37, 1945–1951 (2018). https://doi.org/10.1007/s10067-018-3977-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-018-3977-6