This Article Free upon publication Full Text Full Text (PDF) Data Supplement All Versions of this Article: 116/2/174    most recent CIRCULATIONAHA.107.690875v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCrindle, B. W. Search for Related Content PubMed PubMed Citation Articles by McCrindle, B. W. Pubmed/NCBI databases Medline Plus Health Information Kawasaki Disease Related Collections Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2007;116:174-179.)
© 2007 American Heart Association, Inc.

Pediatric Cardiology

Coronary Artery Involvement in Children With Kawasaki Disease

Risk Factors From Analysis of Serial Normalized Measurements

Brian W. McCrindle, MD, MPH; Jennifer S. Li, MD; L. LuAnn Minich, MD; Steven D. Colan, MD; Andrew M. Atz, MD; Masato Takahashi, MD; Victoria L. Vetter, MD; Welton M. Gersony, MD; Paul D. Mitchell, MSc; Jane W. Newburger, MD, MPH, for the Pediatric Heart Network Investigators

From the University of Toronto (B.W.M.), The Hospital for Sick Children, Toronto, Canada; Duke University Medical Center (J.S.L.), Durham, NC; University of Utah (L.L.M.), Salt Lake City, Utah; New England Research Institutes (S.D.C., P.D.M.), Watertown, Mass; Medical University of South Carolina (A.M.A.), Charleston, SC; Children’s Hospital of Los Angeles (M.T.), Los Angeles, Calif; Children’s Hospital of Philadelphia (V.L.V.), Philadelphia, Pa; Columbia University Medical Center (W.M.G.), New York, NY; and Children’s Hospital Boston (J.W.N.), Boston, Mass.

Correspondence to Dr Brian McCrindle, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail brian.mccrindle{at}sickkids.ca

Received January 17, 2007; accepted April 17, 2007.

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 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.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				J. B. Gordon, A. M. Kahn, and J. C. Burns When children with kawasaki disease grow up myocardial and vascular complications in adulthood. J. Am. Coll. Cardiol., November 17, 2009; 54(21): 1911 - 1920. [Abstract] [Full Text] [PDF]

				C. Manlhiot, R. S. M. Yeung, N. A. Clarizia, N. Chahal, and B. W. McCrindle Kawasaki Disease at the Extremes of the Age Spectrum Pediatrics, September 1, 2009; 124(3): e410 - e415. [Abstract] [Full Text] [PDF]

				J. T. Kanegaye, M. S. Wilder, D. Molkara, J. R. Frazer, J. Pancheri, A. H. Tremoulet, V. E. Watson, B. M. Best, and J. C. Burns Recognition of a Kawasaki Disease Shock Syndrome Pediatrics, May 1, 2009; 123(5): e783 - e789. [Abstract] [Full Text] [PDF]