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Risk factors associated with progression and persistence of small- and medium-sized coronary artery aneurysms in Kawasaki disease: a prospective cohort study

European Journal of Pediatrics volume 179, pages 891–900 (2020)Cite this article

Abstract

To identify the risk factors of progression and persistence of small- and medium-sized coronary artery aneurysm (CAA) in a contemporary cohort of patients with Kawasaki disease (KD) and to determine the relationship between CAA progression and persistence. A total of 89 KD patients with small- and medium-sized CAA were prospectively enrolled. All patients were followed up at least for 2 years by serial echocardiography. Multivariate logistic regression analysis was conducted to evaluate independent risk factors for CAA progression and persistence. A total of 46 (51.7%) and 73 (82.0%) patients showed echocardiographic CAA regression by 1 month and 24 months of follow-up, respectively. CAA progression was documented in 12 (13.5%) patients during follow-up. The initial aneurysm size according to CAA classification (OR 0.089, 95% CI 0.013–0.634, P = 0.016) and CAA progression (OR 42.618, 95% CI 3.740–485.6, P = 0.003) were independently associated with CAA persistence. The number of involved coronary arteries (OR 0.223, 95% CI 0.065–0.767, P = 0.015) and lymphocyte proportion (OR 1.327, 95% CI 1.019–1.727, P = 0.040) were independently associated with CAA progression.

Conclusion: Patients with KD and greater initial aneurysm size, CAA progression, more involved coronary arteries, and lower lymphocyte proportion may require intensive cardiac monitoring and adjuvant therapies.

What is Known:
• Long-term outcomes of patients with KD and CAA are primarily driven by the consequences of CAA regression and progression.
• Regression and progression occurs more frequently in patients with small- and medium-sized CAAs, and less frequently for giant CAAs.
What is New:
• The CAA size at diagnosis, NCAI, and the proportion of lymphocytes are presumably associated with the small- and medium-sized CAA persistence or CAA progression.
• The CAA progression was associated with CAA persistence.

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Abbreviations

ANs:

Small aneurysms

ANm:

Medium aneurysms

ANI:

Giant aneurysms

CAA:

Coronary artery aneurysm

IVIG:

Intravenous immunoglobulin

KD:

Kawasaki disease

NCAI:

Number of coronary arteries involved

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Funding

We thank the funding supporters [National Key R&D Program of China (No. 2018YFC1002301), National Natural Science Foundation of China (No. 81800288), Science-technology Support Plan Projects in Sichuan province (No. 2017SZ0117), and Technology Innovation Research and Development Project of Chengdu Science and Technology Bureau (No 2018-YF05-00249-SN)].

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Author notes

  1. Lei Liu and Chunyan Luo contributed equally to this article.

Affiliations

  1. Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China

    Lei Liu, Yimin Hua, Mei Wu, Shuran Shao, Xiaoliang Liu, Kaiyu Zhou & Chuan Wang

  2. West China Medical School of Sichuan University, Chengdu, Sichuan, China

    Lei Liu, Mei Wu & Shuran Shao

  3. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Chunyan Luo

  4. The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China

    Yimin Hua, Kaiyu Zhou & Chuan Wang

  5. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China

    Yimin Hua, Xiaoliang Liu, Kaiyu Zhou & Chuan Wang

  6. Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China

    Yimin Hua, Xiaoliang Liu, Kaiyu Zhou & Chuan Wang

  7. Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, China

    Chuan Wang

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  1. Lei Liu
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Contributions

Dr. Liu and Dr. Luo designed the study, wrote the statistical analysis plan, cleaned and analysed the data and drafted and revised the paper.

Dr. Wang and Dr. Zhou designed the study, wrote the statistical analysis plan, cleaned and analysed the data and drafted and revised the paper. They are the guarantors.

Dr Wu, Dr Liu (Liu xiaoliang) and Dr Shao cleaned and analysed the data and revised the paper.

Dr Hua designed the study and revised the paper.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Kaiyu Zhou or Chuan Wang.

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Liu, L., Luo, C., Hua, Y. et al. Risk factors associated with progression and persistence of small- and medium-sized coronary artery aneurysms in Kawasaki disease: a prospective cohort study. Eur J Pediatr 179, 891–900 (2020). https://doi.org/10.1007/s00431-019-03492-8

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Keywords

  • Risk factors
  • Coronary artery aneurysm
  • Progression
  • Regression
  • Kawasaki disease
  • Prospective study