Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements.

Published

Journal Article

BACKGROUND: Most studies of coronary artery involvement and associated risk factors in Kawasaki disease have used the Japanese Ministry of Health dichotomous criteria. Analysis of serial normalized artery measurements may reveal a broader continuous spectrum of involvement and different risk factors. METHODS AND RESULTS: Clinical, laboratory, and echocardiographic measurements obtained at baseline and 1 week and 5 weeks after presentation were examined in 190 Kawasaki disease patients as part of a clinical trial of primary therapy with pulse steroids in addition to standard intravenous immunoglobulin. Maximum coronary artery z score normalized to body surface area was significantly greater than normal at all time points, decreasing significantly over time from baseline. A maximal z score > or = 2.5 at any time was noted in 26% of patients. Japanese Ministry of Health dimensional criteria were met by 23% of patients. Significant independent factors associated with greater z score at any time included younger patient age, longer interval from disease onset to treatment with intravenous immunoglobulin, lower serum IgM level at baseline, and lower minimum serum albumin level. z scores of the proximal right coronary artery were higher than those in the left anterior descending branch. CONCLUSIONS: Analyses of serial normalized coronary artery measurements in optimally treated Kawasaki disease patients demonstrated that for most patients, measurements are greatest at baseline and subsequently diminish; baseline measurements appear to be good predictors of involvement during early follow-up. When a more precise assessment is used, risk factors for coronary artery involvement are similar to those defined with arbitrary dichotomous criteria.

Full Text

Duke Authors

Cited Authors

  • McCrindle, BW; Li, JS; Minich, LL; Colan, SD; Atz, AM; Takahashi, M; Vetter, VL; Gersony, WM; Mitchell, PD; Newburger, JW; Pediatric Heart Network Investigators,

Published Date

  • July 10, 2007

Published In

Volume / Issue

  • 116 / 2

Start / End Page

  • 174 - 179

PubMed ID

  • 17576863

Pubmed Central ID

  • 17576863

Electronic International Standard Serial Number (EISSN)

  • 1524-4539

Digital Object Identifier (DOI)

  • 10.1161/CIRCULATIONAHA.107.690875

Language

  • eng

Conference Location

  • United States