Abstract O.67: Carotid Intima-media Thickness In Patients With A History Of Kawasaki Disease
Aims: Kawasaki disease (KD) is an acute pediatric vasculitis with the development of coronary artery aneurysms (CAA) being recognized as a serious clinical complication of KD. It has been suggested that KD predisposes to premature cardiovascular disease (CVD) later in life, however, conflicting results have been reported. We therefore assessed the risk of CVD in patients with a history of KD.
Methods and results: Carotid B-mode ultrasound scans and measurements of carotid intima-media thickness (cIMT), a validated marker of CVD risk, were performed in 161 KD patients (119 with CAA, 42 without CAA based on worst-ever z-score; age range: 7-20 years). CIMT measurements were also performed in 82 unaffected family controls in the same age range.
Differences in cIMT between patients and controls were evaluated by linear regression analyses while correcting for confounders by stepwise backward elimination. Mean cIMT (±SD) was increased in patients with KD (0.378 ± 0.030 mm versus 0.360 ± 0.027 mm; P adjusted < 0.0001). If the difference in cIMT between patients and controls was plotted against age, in patients without CAA, increased cIMT was only apparent at young age, whereas in patients with CAA increased cIMT was observed over the entire age range.
Conclusion: Our findings in KD patients show significant arterial wall changes in patients with a history of KD, in particular in those with CAA. In contrast to the cIMT findings at young age - irrespective of the absence or presence of CAA, the data demonstrate that - with age - the cIMT in KD patients without CAA became indistinguishable from controls but remained increased in the patients with CAA. The age-dependency of cIMT values could in part explain the variable and conflicting results of previous reports in KD. Furthermore, these explicit differences in cIMT between CAA-negative and CAA-positive patients may suggest that the pathophysiology of the arterial wall changes in KD differ from atherosclerosis. Finally, our results indicate that follow-up in patients with KD seems justified in patients with CAA, but may not be necessary in children without CAA.
Author Disclosures: S. Dietz: None. C. Tacke: None. J. Gort: None. I. Kuipers: None. E. de Groot: None. A. Wiegman: None. B. Hutten: None. T. Kuijpers: None.
- © 2015 by American Heart Association, Inc.