Coronary artery dimensions may be misclassified as normal in Kawasaki disease,☆☆,,★★,

https://doi.org/10.1016/S0022-3476(98)70229-XGet rights and content

Abstract

Background: Current American Heart Association guidelines indicate that patients with Kawasaki disease and no coronary artery abnormalities on echocardiography at any stage of illness may be discharged from cardiologic follow-up 1 year after onset of illness. Methods and Results: To determine whether coronary artery dimensions in patients with Kawasaki disease whose vessels are classified as “normal” by Japanese Ministry of Health criteria have a distribution similar to expected population norms when adjusting for body surface area, we studied 125 patients during 4 intervals from onset of illness: (1) 10 days or less, (2) 2 weeks (11 to 21 days), (3) 6 weeks (22 days to 3 months), and (4) 1 year (4 months to 1.5 years). Using two-dimensional echocardiography, we measured the internal lumen diameter of the left main, proximal left anterior descending, and proximal right coronary arteries. Mean body surface area–adjusted dimensions of the proximal left anterior descending and right coronary arteries were significantly larger (P < .01) in patients with Kawasaki disease than those in subjects in all periods, except for a marginal difference at 6 weeks for the proximal right coronary artery (P = .02); for the left main coronary artery, this difference achieved statistical significance in the period of 10 days or less, with a trend at 2 weeks (P = .02). Among patients classified as having normal coronary arteries on all echocardiograms by the Japanese Ministry of Health criteria, 27% had at least 1 body surface area–adjusted coronary dimension more than 2 standard deviations above the expected mean. Conclusions: Coronary artery dilation in Kawasaki disease is thus more prevalent than previously reported, highlighting the need for systematic long-term surveillance of this population. (J Pediatr 1998;133:254-8)

Section snippets

Subjects

Subjects were children who met criteria for Kawasaki disease4; were evaluated at Children’s Hospital, Boston, between December 1989 and March 1994; and had normal coronary arteries, as determined by Japanese Ministry of Health criteria, on all of their echocardiograms. A comparison group was comprised of children of comparable age (range, 0.5 to 14.6 years) who had been referred to the noninvasive laboratory at Boston Children’s Hospital for echocardiographic evaluation during the years 1987 to

Demographic Data

Subjects were 125 patients with Kawasaki disease who had no coronary abnormalities, as determined by Japanese Ministry of Health criteria, on any echocardiogram. Their median age at the onset of illness was 2.9 years (range, 0.3 to 11.2 years), and 70 (56%) were male. The majority of children (87, 70%) were white; 24 (19%) were black; 6 (5%) were Hispanic; 5 (4%) were Asian; and 3 (2%) were of mixed or other racial groups. A single infusion (2 g/kg) of intravenous gamma globulin was

Discussion

Recent guidelines of the American Heart Association3 suggest that patients with Kawasaki disease who have no coronary artery abnormalities at any stage of illness may be discharged from cardiac follow-up at 1 year after onset of illness. Of note, the guidelines do not specify criteria for abnormality. Coronary artery dimensions have been shown to increase linearly with indices of body size, such as BSA or body length.2 However, the most widely used criteria for coronary artery abnormality in

Acknowledgements

We thank Kathleen M. O’Brien for manuscript preparation.

References (16)

There are more references available in the full text version of this article.

Cited by (0)

From the Departments of Cardiology and Medicine, Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

☆☆

Dr. de Zorzi is currently affiliated with the Department of Cardiology, Ospedale Bambino Gesu, Rome, Italy.

Supported in part by the Kobren Fund.

★★

Reprint requests: Jane W. Newburger, MD, Department of Cardiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115.

0022-3476/98/$5.00 + 0  9/21/91490

View full text