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. 2016 Jul 5;5(7):e003414.
doi: 10.1161/JAHA.116.003414.

Extracardial Vasculopathy After Kawasaki Disease: A Long-Term Follow-up Study

Sanne M Dietz  1 , Carline E Tacke  2 , Eric de Groot  3 , Irene M Kuipers  4 , Barbara A Hutten  5 , Taco W Kuijpers  2 ; Dutch Kawasaki Study Groupten BergeMaartjeBiezeveldMaarten H.BruijnMartijnDelemarreLuçan C.DolmanKoert M.FilippiniLuc H.P.M.HendriksTomMaingay‐VisserDianne A.P.G.F.NoordzijJeroen G.NuboerRoosPlötzFrans B.RozendaalLieketen TusscherGavin W.StarreveldSanderVerhoevenJennifer J.WeggelaarNielske M.WeijerOlivierde WinterPeter
Collaborators, Affiliations

Extracardial Vasculopathy After Kawasaki Disease: A Long-Term Follow-up Study

Sanne M Dietz et al. J Am Heart Assoc. .

Abstract

Background: Kawasaki disease (KD) is a pediatric vasculitis with coronary artery aneurysm (CAA) as a major complication. Controversy exists about cardiovascular risk later in life. The aim of our study was to evaluate whether KD patients are at increased risk, as assessed by carotid intima-media thickness (cIMT).

Methods and results: We measured cIMT over 15 years by B-mode ultrasonography in KD patients during follow-up and in unaffected controls (mostly siblings). A multilevel, repeated-measures, linear mixed-effects model was used to evaluate the association between KD and cIMT. A total of 319 patients with 528 measurements were compared with 150 controls. In KD patients, the mean cIMT was increased compared with controls (0.375 mm [95% CI 0.372-0.378 mm] versus 0.363 mm [95% CI 0.358-0.368 mm]; P<0.001). Furthermore, mean cIMT of CAA-negative patients was 0.373 mm (P<0.01 compared with controls), of patients with small-medium CAA was 0.374 mm (P<0.05 compared with controls), and of patients with giant CAA was 0.381 mm (P<0.01 compared with controls). Compared with controls, CAA-negative participants started with an increased cIMT (+0.0193±0.0053 mm, P<0.001) but showed slower progression (-0.0014±0.0006 mm/year, P=0.012). Patients with giant CAA showed a trend toward increased cIMT progression (0.0013±0.0007 mm/year, P=0.058).

Conclusions: We observed a positive correlation between cIMT and KD severity of coronary arteritis at the acute stage. Although initially increased, the cIMT in CAA-negative patients normalized at a later age. In contrast, patients with a history of KD complicated by giant CAA showed a trend toward persistently increased cIMT. These patients may need cardiovascular counseling and follow-up beyond the heart.

Keywords: Kawasaki disease; coronary aneurysm; intima‐media thickness.

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Figures

Figure 1
Figure 1
The mean carotid IMT regression line (95% CI) of patients and controls against age. The mean regression line is represented by the continuous line, and the 95% CIs are indicated by dashed lines, after adjusting for sex, body mass index z score, mean arterial pressure, and family relations. IMT indicates intima‐media thickness.
Figure 2
Figure 2
The mean carotid IMT regression line (95% CIs) of the different patient groups based on CAA worst‐ever z score and controls against age. The mean regression line is represented by the continuous line, and the 95% CIs are indicated by dashed lines after adjusting for sex, body mass index z score, mean arterial pressure, and family relations. CAA indicates coronary artery aneurysm; IMT, intima‐media thickness.
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