Abstract O.53: Occult Coronary Artery Dilatation: An Unrecognized Category Of Coronary Involvement
Background: The current definition of Coronary artery dilatation (CAD), Z-score >2.5, in KD may omit patients at higher risk of later complications. We propose a category of occult CAD with a Z-score variation ≥ 2 for the same CA on 2 different echocardiograms, but absolute Z-score < 2.5. We compared this new category with cases of CAD and normal CA.
>Method: A retrospective review included 337 patients diagnosed with KD in our institution. Echographic data were retrieved for the fist year following diagnosis. Patients were classified in three categories: definite CA dilatation (dCAD) with Z-score ≥ 2.5, occult CA dilatation (oCAD) and normal CA (nCA). We compared inflammatory profile, IVIG treatment resistance, and timing of CA involvement.
Results: There were 26.3% patients with nCA, 32.2% with oCAD and 41.1% with dCAD.Patients with KD incomplete diagnostic criteria represented 35%, 14% and 17% for NCAD, OCAD and DCAD groups respectively (p=0.008). Median time for CAD was 7 and 9.5 days for dCAD and oCAD respectively (p=0.2). A Jonckheere trend test identified a progression of inflammatory parameters through the three groups for Platelet count (p< 0.001), Albumin (p = 0.007), ESR (p = 0.04), but not for CRP (p = 0.76) and WBC (p = 0.16). There was a significant difference in treatment resistance, with 5%, 19% and 31% for NCAD, OCAD and DCAD respectively (p=0,002).
Conclusion: OCAD group appears like a distinctive subgroup of KD patients showing intermediate inflammatory profiles and treatment respond in the NCAD to DCAD spectrum. Recent Z-score equations, more accurate for young patients’ CA size than former linear equations, may explain the high incidence of dCAD in this report. Further studies are needed to define the profile and propensity to complications of this subpopulation.
Author Disclosures: S. Rached-d'Astous: None. N. Rached-d'Astous: None. F. Dallaire: None. N. Dahdah: None.
- © 2015 by American Heart Association, Inc.