Coronary artery dilation after Kawasaki disease for children within the normal range

Abstract

Background: Kawasaki disease is an acute, self-limited vasculitis of unknown etiology. Coronary artery involvement is the predominant complication, ranging from no involvement to dilation through to aneurysm formation. We sought to determine trends over time and associated factors for normalized coronary artery dimensions for patients with acute KD.

Methods: Clinical data and echocardiographic studies were reviewed for patients with acute Kawasaki disease over a 3 year period having standardized assessments and management strategies. Patients with echocardiograms from the initial, 6-8 week, and 1 year post-Kawasaki disease assessments were included. Coronary artery measurements were normalized for body surface area. A mixed linear regression analysis for repeated measures was used to determine trends over time.

Results: We included 176 patients. Based on the Japanese Ministry of Health measurement criteria 11% of patients were classified as having coronary artery abnormalities. Normalized initial measurements showed Z-scores greater than +2 for 23% of patients for any of the coronary artery branches. Particularly for initial measurements, Japanese Ministry of Health measurement criteria underestimated the prevalence of abnormalities defined by Z-scores. Time trends were noted, such that Z-scores decreased from initial values in a logarithmic manner, mostly in the first 2 to 3 months. Greater than 50% of patients with initial Z-scores within the normal range showed a decrease over time, suggesting previously unrecognized dilation.

Conclusion: A longitudinal assessment of normalized coronary artery measurements may identify further patients with subtle coronary artery abnormalities after acute Kawasaki disease.