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Yan R, Chen S, Lang X, Liu J, Zhou T. Identification of key ferroptosis‑related biomarkers in Kawasaki disease by clinical and experimental validation. Biomed Rep 2025; 22:16. [PMID: 39624783 PMCID: PMC11609609 DOI: 10.3892/br.2024.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 11/11/2024] [Indexed: 01/06/2025] Open
Abstract
Kawasaki disease (KD) is an acute febrile rash that is primarily characterized by systemic vasculitis and is the leading cause of childhood-acquired heart disease. At present, a KD diagnosis is solely dependent on clinical symptoms and effective diagnostic markers are unavailable. Ferroptosis, a novel form of programmed cell death, contributes to the pathophysiology of infectious diseases. The present study aimed to identify key ferroptosis-related genes (FRGs) involved in the pathological process of KD and thus potential diagnostic biomarkers for this disease. For this purpose, differentially expressed-FRGs (DE-FRGs) between patients with KD and healthy controls were screened. The least absolute shrinkage and selection operator (LASSO) algorithm and a logistic regression model combined with receiver operating characteristic analysis were then used to identify and assess ferroptosis-related markers. Additionally, immune cell infiltration landscapes in the KD and control groups were evaluated using CIBERSORT. Moreover, the predictive value of the identified markers was validated in the clinical samples as well as vascular endothelial cells. A total of 10 DE-FRGs were screened from the KD and control samples. These 10 DE-FRGs were then applied to the LASSO model and 6 key ferroptosis-related markers were obtained. The subsequent Gene Set Variation Analysis results suggested that high expression levels of these markers were closely associated with innate immune activation and metabolism, while low expression was mainly linked to adaptive immune-related pathways. In addition to validating each gene in the training and validation sets, the diagnostic potential of these markers was assessed utilizing KD samples obtained from Shenzhen Baoan Women's and Children's Hospital. As a result, MAPK14, SLC2A3 and PGD were selected as potential diagnostic markers for KD. Additionally, changes in the expression of marker genes during inflammatory activation of vascular endothelial cells were measured by reverse transcription-quantitative PCR. The results of the present study will help to understand the role of FRGs in the pathogenesis of KD. Moreover, the identified FRGs may serve as diagnostic biomarkers, providing new strategies for KD prediction and treatment.
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Affiliation(s)
- Rui Yan
- Department of Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong 518100, P.R. China
| | - Shuiwen Chen
- Department of Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong 518100, P.R. China
| | - Xinling Lang
- Department of Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong 518100, P.R. China
| | - Jimin Liu
- Department of Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong 518100, P.R. China
| | - Tao Zhou
- Department of Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong 518100, P.R. China
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Tsuge M, Uda K, Eitoku T, Matsumoto N, Yorifuji T, Tsukahara H. Roles of Oxidative Injury and Nitric Oxide System Derangements in Kawasaki Disease Pathogenesis: A Systematic Review. Int J Mol Sci 2023; 24:15450. [PMID: 37895129 PMCID: PMC10607378 DOI: 10.3390/ijms242015450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Kawasaki disease (KD) is an acute febrile vasculitis that occurs mostly in children younger than five years. KD involves multiple intricately connected inflammatory reactions activated by a cytokine cascade. Despite therapeutic advances, coronary artery damage may develop in some patients, who will be at risk of clinical cardiovascular events and even sudden death. The etiology of KD remains unclear; however, it may involve both genetic and environmental factors leading to aberrant inflammatory responses. Given the young age of onset, prenatal or perinatal exposure may be etiologically relevant. Multisystem inflammatory syndrome in children, a post-infectious hyper-inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2, has features that overlap with those of KD. Available evidence indicates that vascular endothelial dysfunction is a critical step in the sequence of events leading to the development of cardiovascular lesions in KD. Oxidative stress and the dysregulation of the nitric oxide (NO) system contribute to the pathogenesis of inflammatory responses related to this disease. This review provides current evidence and concepts highlighting the adverse effects of oxidative injury and NO system derangements on the initiation and progression of KD and potential therapeutic strategies for cardiovascular pathologies in affected children.
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Affiliation(s)
- Mitsuru Tsuge
- Department of Pediatrics, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.U.); (H.T.)
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.U.); (H.T.)
| | - Takahiro Eitoku
- Department of Pediatrics, Kawasaki Medical School, Kurashiki 701-0192, Japan;
| | - Naomi Matsumoto
- Department of Epidemiology, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (N.M.); (T.Y.)
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (N.M.); (T.Y.)
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.U.); (H.T.)
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Cannon L, Campbell MJ, Wu EY. Multisystemic Inflammatory Syndrome in Children and Kawasaki Disease: Parallels in Pathogenesis and Treatment. Curr Allergy Asthma Rep 2023:10.1007/s11882-023-01083-0. [PMID: 37171672 PMCID: PMC10176315 DOI: 10.1007/s11882-023-01083-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE OF REVIEW Since it first appeared, multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been compared to Kawasaki disease (KD). Although there were early parallels between MIS-C and KD, key differences emerged over time. Here, we aim to compare the pathogenesis, clinical presentation, treatment, and outcomes of MIS-C and KD. RECENT FINDINGS In this article, we review and compare MIS-C and KD, highlighting differentiating features. We discuss the epidemiological and immunological factors along with clinical and laboratory features which discern MIS-C from KD. We also compare treatment and our understanding of long-term outcomes. Though parallels exist between MIS-C and KD, distinguishing the two is important for clinical management of patients, counseling about natural history, and determining long-term monitoring. While both MIS-C and KD are characterized by profound inflammation and inflammatory vasculopathy, further study is needed to determine whether they are distinct immunopathogenic disorders.
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Affiliation(s)
- Laura Cannon
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Jay Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Eveline Y Wu
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, 030 MacNider Hall, CB #7231 Chapel Hill, NC, 27599-7231, Chapel Hill, USA.
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Latif A, Tran A, Ahsan J, Lateef N, Abusina W, Kapoor V, Ahsan Z, Ahmad S, Mirza M. Coronary Artery Aneurysms as a Cause of Acute Coronary Syndrome Presentation - A Focused Review. Curr Cardiol Rev 2023; 19:68-72. [PMID: 36999696 PMCID: PMC10518882 DOI: 10.2174/1573403x19666230331103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 04/01/2023] Open
Abstract
Coronary artery aneurysms (CAA) are defined as a dilation of a coronary vessel greater than 1.5 times the diameter of a local reference vessel. While CAAs tend to be incidental findings on imaging, they result in complications, such as thrombosis, embolization, ischemia, arrhythmias, and heart failure. Among symptomatic cases, chest pain has been the most common manifestation of CAAs. This necessitates an understanding of CAAs as a cause of acute coronary syndrome (ACS) presentation. However, due to the unclear pathophysiology of CAAs and their variable presentation complicated by similar ACS conditions, there is no clear strategy for CAA management. In this article, we will discuss the contribution of CAAs to ACS presentations and review the current management options for CAAs.
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Affiliation(s)
- Azka Latif
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Tran
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Junaid Ahsan
- Division of Cardiovascular Medicine, Mercy Medical Center, Iowa Heart Center, Des Moines, Iowa, USA
| | - Noman Lateef
- Division of Cardiovascular Medicine, University of Nebraska Medicine, Omaha, Nebraska, USA
| | - Waiel Abusina
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Vikas Kapoor
- Department of Medicine, CHI Health Good Samaritan Hospital, Kearney, Nebraska, USA
| | - Zoraiz Ahsan
- Department of Medicine, Pakistan Medical Center, Islamabad, Pakistan
| | - Soban Ahmad
- Department of Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Mohsin Mirza
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
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Venet M, Friedberg MK, Mertens L, Baranger J, Jalal Z, Tlili G, Villemain O. Nuclear Imaging in Pediatric Cardiology: Principles and Applications. Front Pediatr 2022; 10:909994. [PMID: 35874576 PMCID: PMC9301385 DOI: 10.3389/fped.2022.909994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Nuclear imaging plays a unique role within diagnostic imaging since it focuses on cellular and molecular processes. Using different radiotracers and detection techniques such as the single photon emission scintigraphy or the positron emission tomography, specific parameters can be assessed: myocardial perfusion and viability, pulmonary perfusion, ventricular function, flow and shunt quantification, and detection of inflammatory processes. In pediatric and congenital cardiology, nuclear imaging can add complementary information compared to other imaging modalities such as echocardiography or magnetic resonance imaging. In this state-of-the-art paper, we appraise the different techniques in pediatric nuclear imaging, evaluate their advantages and disadvantages, and discuss the current clinical applications.
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Affiliation(s)
- Maelys Venet
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark K. Friedberg
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jerome Baranger
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Zakaria Jalal
- Department of Congenital and Pediatric Cardiology, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghoufrane Tlili
- Department of Nuclear Medicine, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Olivier Villemain
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ishikawa T, Uchiyama H, Mogi S, Ohtani H. Case Report: Structural Changes in the Coronary Vessel Wall in a Patient With Incomplete Kawasaki Disease. Front Pediatr 2022; 10:845723. [PMID: 35311040 PMCID: PMC8927284 DOI: 10.3389/fped.2022.845723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis of infants and young children that affects medium-sized vessels. Conventional cardiac imaging techniques, such as cardiac catheterization, are useful for characterizing the coronary arterial lesion (CAL) size and luminal diameter of the diseased coronary artery segment in patients with KD, but there are limitations to the visualization of the detailed vascular anatomy. Optical coherence tomography (OCT) is a high-resolution intracoronary arterial imaging modality that can distinguish the three layers of the coronary arterial wall. Several studies have reported coronary artery wall abnormalities in KD patients with coronary arterial aneurysm or regressed aneurysm. However, there have been no reports on changes in the coronary artery wall in cases of incomplete KD without CAL. CASE PRESENTATION We herein report an 11-year-old girl with a history of incomplete KD without coronary arterial aneurysms. She had been diagnosed with perimembranous ventricular septal defect (VSD) after birth and had experienced incomplete KD at 1 year old. During her hospitalization for KD, she did not receive intravenous immunoglobulin (IVIG), because she did not meet the Harada score or criteria for treatment in patients with incomplete KD established by the American Heart Association. No dilatation or coronary artery aneurysm were observed on transthoracic echocardiography in the acute or follow-up period. At 11 years old, she received cardiac catheterization and coronary angiography (CAG) for the evaluation of a VSD and follow-up of KD. CAG demonstrated no aneurysm, dilatation, or significant stenosis of the coronary arteries. We performed an OCT study, which revealed the presence of intimal thickening, disruption of the media, and neovascularization in the left anterior descending artery. CONCLUSION OCT demonstrates the structural changes of CA even in the patient with incomplete KD who have not been treated with IVIG.
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Affiliation(s)
- Takamichi Ishikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Uchiyama
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Mogi
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Identifying Circulating MicroRNA in Kawasaki Disease by Next-Generation Sequencing Approach. Curr Issues Mol Biol 2021; 43:485-500. [PMID: 34202375 PMCID: PMC8929010 DOI: 10.3390/cimb43020037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/14/2022] Open
Abstract
Kawasaki disease (KD) typically occurs in children aged under 5 years and can cause coronary artery lesions (CALs). Early diagnosis and treatment with intravenous immunoglobulin can reduce the occurrence of CALs; therefore, identifying a good biomarker for diagnosing KD is essential. Here, using next-generation sequencing in patients with recurrent KD, those with viral infection, and healthy controls, we identified dysregulated circulating microRNAs as diagnostic biomarkers for KD. Pathway enrichment analysis illustrated the putative role of these miRNAs in KD progression. Their expression levels were validated using real-time polymerase chain reaction (qPCR). Fifteen dysregulated circulating miRNAs (fold changes >2 and <0.5) were differentially expressed in the recurrent KD group compared with the viral infection and control groups. These miRNAs were significantly involved in the transforming growth factor-β, epithelial-mesenchymal transition, and cell apoptosis signaling pathways. Notably, their expression levels were frequently restored after intravenous immunoglobulin treatment. Among the candidates, miR-24-3p expression level was significantly higher in patients with recurrent KD compared with healthy controls or viral infection controls (p < 0.001). Receiver operating characteristic analysis revealed that high miR-24-3p expression levels may be a potential biomarker for KD diagnosis. In conclusion, we identified miR-24-3p significantly higher in KD patients, which may be a potential diagnostic biomarker for KD.
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Kayabey Ö, Tuncer T, Deveci M, Başar EZ, Babaoğlu K. Is there myocardial involvement in children with long-term follow-up for Kawasaki disease? A study based on two-dimensional speckle tracking echocardiography. Turk Arch Pediatr 2021; 56:44-50. [PMID: 34013229 DOI: 10.5152/turkarchpediatr.2020.20193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to determine the possibility of subclinical myocardial dysfunction detected by strain echocardiography in the late period of children with Kawasaki disease. Material and Methods The study enrolled 30 patients with Kawasaki disease with a follow-up period of at least 12 months and 30 healthy age- and gender-matched children. During the follow-up period, standard echocardiography, pulsed and tissue Doppler, and strain echocardiography were recorded for both groups. Results The mean age at the time of the diagnosis was 2.6±2.3 years (2 months-11 years). The mean follow-up period after the diagnosis was 3.55±2.20 years. Conventional echocardiography, M mode, pulsed and tissue Doppler values, and myocard performance index did not reveal significant differences. Left ventricle strain and strain rate parameters obtained by apical four-, three-, and two-chamber views did not show statistical differences between patients and controls. There was a positive correlation between the duration of follow-up and global four- and three-chamber longitudinal strain and global longitudinal strain values (r=0.465, p=0.010; r=0.414, p=0.023; r=0.492, p=0.006, respectively), whereas global radial strain showed negative correlation (r=-0.517, p=0.003). Conclusion The analysis of systolic strain and strain rate did not detect a subclinical myocardial dysfunction in the long-term follow-up of Kawasaki disease. However, strain values showed variability with the follow-up periods, which indicates that Kawasaki disease might cause left ventricular dysfunction in the later phases. Therefore, a follow-up of children with a diagnosis of Kawasaki disease is of capital importance.
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Affiliation(s)
- Özlem Kayabey
- Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine Kocaeli, Turkey
| | - Tunç Tuncer
- Department of Pediatric Cardiology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, İstanbul, Turkey
| | - Murat Deveci
- Department of Pediatric Cardiology, Trakya University School of Medicine Edirne, Turkey
| | - Eviç Zeynep Başar
- Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine Kocaeli, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine Kocaeli, Turkey
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Zhang JY, Peng H, Gong ST, Zeng YM, Huang M, Liu PH, Wang LT, Dong GQ. The role of peroxisome proliferator-activated receptor gamma and adiponectin in children with Kawasaki disease. J Int Med Res 2021; 49:300060521994925. [PMID: 33729859 PMCID: PMC7975572 DOI: 10.1177/0300060521994925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between peroxisome proliferator-activated receptor gamma (PPARγ) mRNA, serum adiponectin (ADP) and lipids in paediatric patients with Kawasaki disease (KD). METHODS This prospective study enrolled paediatric patients with KD and grouped them according to the presence or absence of coronary artery lesions (CAL). A group of healthy age-matched children were recruited as the control group. The levels of PPARγ mRNA, serum ADP and lipids were compared between the groups. Receiver operating characteristic (ROC) curve analysis was undertaken to determine if the PPARγ mRNA level could be used as a predictive biomarker of CAL prognosis. RESULTS The study enrolled 42 patients with KD (18 with CAL [CAL group] and 24 without CAL [NCAL group]) and 20 age-matched controls. PPARγ mRNA levels in patients with KD were significantly higher than those in the controls; but significantly lower in the CAL group than the NCAL group. ROC curve analysis demonstrated that the PPARγ mRNA level provided good predictive accuracy for the prognosis of CAL. There was no association between PPARγ, ADP and lipid levels. CONCLUSION There was dyslipidaemia in children with KD, but there was no correlation with PPARγ and ADP. PPARγ may be a predictor of CAL in patients with KD with good predictive accuracy.
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Affiliation(s)
- Ji-Yong Zhang
- Department of Paediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,Department of Paediatrics, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
| | - Hong Peng
- Department of Infectious Disease, Shenzhen People's Hospital, Shenzhen, Guangdong Province, China
| | - Si-Tang Gong
- Department of Paediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Yong-Mei Zeng
- Department of Paediatrics, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
| | - Miao Huang
- Department of Paediatrics, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
| | - Pei-Hui Liu
- Department of Paediatrics, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
| | - Li-Ting Wang
- Department of Paediatrics, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
| | - Guo-Qing Dong
- Department of Paediatrics, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
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Li C, Du Y, Wang H, Wu G, Zhu X. Neonatal Kawasaki disease: Case report and literature review. Medicine (Baltimore) 2021; 100:e24624. [PMID: 33607798 PMCID: PMC7899894 DOI: 10.1097/md.0000000000024624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Kawasaki Disease (KD) is a self-limiting and acute systemic vasculitis of childhood that leads to coronary artery abnormality in about 25% of untreated cases. KD is extremely rare in neonates. The purpose of this paper is to explore the clinical features and diagnosis and treatment of Neonatal Kawasaki Disease for early identification. PATIENT CONCERNS A 24-day-old male with 3 hours fever and a rash was admitted to our hospital. DIAGNOSES He had a fever, rash, cracking of lips, lymph node enlargement in the neck, and distal extremity desquamation. INTERVENTIONS The patient was given intravenous immunoglobulin and aspirin with no complications. OUTCOMES After discharge, the patient was followed up to 1 year old, with good prognosis and no carditis or coronary artery abnormalities. LESSONS Neonatal Kawasaki disease is extremely rare, and its clinical manifestation is not typical and easy to be missed. If not treated early, it will potentially give rise to coronary artery aneurysms or expansion, ischemic heart disease, and sudden death. Early diagnosis and treatment are very important.
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Zhu KF, Tang LJ, Wu SZ, Tang YM. Out-of-hospital cardiac arrest in a young adult survivor with sequelae of childhood Kawasaki disease: A case report. World J Clin Cases 2019; 7:3583-3589. [PMID: 31750341 PMCID: PMC6854418 DOI: 10.12998/wjcc.v7.i21.3583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute type of systemic vasculitis involving small to medium-sized muscular arteries and outbreaks during childhood. KD can cause myocardial ischemia, infarction, and sudden cardiac arrest. We present a case of a young adult survivor of out-of-hospital cardiac arrest as late KD sequelae.
CASE SUMMARY A 29-year-old man with presumed acute KD history at the age of 5 suddenly lost consciousness while jogging and was diagnosed a sudden cardiac arrest by an emergency doctor. After about 10 min cardiopulmonary resuscitation, return of spontaneous circulation was achieved, and the patient was transferred to our hospital. A coronary computed tomography angiogram and coronary angiography revealed extensive calcifications of left anterior descending and right coronary artery aneurysms. The patient was an active individual who took exercise regularly and claimed no previous symptoms of chest pain or shortness of breath on exertion. The most possible cause of his sudden cardiac arrest could be presumed as a thrombus within the coronary artery aneurysms. After that, a thromboembolism induced extensive ischemia, and this ischemia-induced arrhythmia led to a cardiac arrest.
CONCLUSION Few patients who suffer a late sequela of KD can survive from out-of-hospital cardiac arrest. Medications, surgical intervention, and active follow-up are extremely important for this patient to prevent occurrence of adverse events in the future.
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Affiliation(s)
- Ke-Fu Zhu
- Department of Cardiology, Zhejiang Hospital, Hangzhou 310013, Zhejiang Province, China
| | - Li-Jiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou 310013, Zhejiang Province, China
| | - Shao-Ze Wu
- Department of Cardiology, Zhejiang Hospital, Hangzhou 310013, Zhejiang Province, China
| | - Yi-Min Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou 310013, Zhejiang Province, China
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Zhu KF, Tang LJ, Wu SZ, Tang YM. Out-of-hospital cardiac arrest in a young adult survivor with sequelae of childhood Kawasaki disease: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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FaisalUddin M, Iftikhar PM, Khayyat A, Khan J, Arastu AH. An Adult Kawasaki Disease with Coronary Artery Involvement: A Unique Case Report and Literature Review. Cureus 2019; 11:e5529. [PMID: 31687304 PMCID: PMC6819062 DOI: 10.7759/cureus.5529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
Kawasaki disease (KD) is an acute, febrile, vasculitis of mainly large to medium-sized vessels. KD is a self-limited illness of infancy and childhood and 80% of the patients are younger than four years of age with an incidence of 5.6/100,000 in the United States. We present an unusual case of an 18-year-old man with several unique features of KD. He was admitted to the hospital with fever, rash, and arthralgia for one week. KD was among the differentials for fever, rash, and arthralgia. Later all the laboratory diagnosis for bacterial and viral infections including blood and urine culture came out negative and he was further evaluated for KD with electrocardiography (EKG), echocardiography, and angiography which showed myocarditis. Based on typical features of fever, rash, arthralgia, bilateral conjunctival injection, cervical lymphadenopathy, and prominent tongue papillae he was diagnosed with KD.
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Affiliation(s)
| | | | - Azadeh Khayyat
- Internal Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Javidulla Khan
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Azeem H Arastu
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
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Matundan HH, Sin J, Rivas MN, Fishbein MC, Lehman TJ, Chen S, Gottlieb RA, Crother TR, Abe M, Arditi M. Myocardial fibrosis after adrenergic stimulation as a long-term sequela in a mouse model of Kawasaki disease vasculitis. JCI Insight 2019; 4:126279. [PMID: 30728329 DOI: 10.1172/jci.insight.126279] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Abstract
Kawasaki disease (KD), the leading cause of acquired cardiac disease among children, is often associated with myocarditis that may lead to long-term myocardial dysfunction and fibrosis. Although those myocardial changes develop during the acute phase, they may persist for decades and closely correlate with long-term myocardial sequelae. Using the Lactobacillus casei cell wall extract-induced (LCWE-induced) KD vasculitis murine model, we investigated long-term cardiovascular sequelae, such as myocardial dysfunction, fibrosis, and coronary microvascular lesions following adrenergic stimuli after established KD vasculitis. We found that adrenergic stimulation with isoproterenol following LCWE-induced KD vasculitis in mice was associated with increased risk of cardiac hypertrophy and myocardial fibrosis, diminished ejection fraction, and increased serum levels of brain natriuretic peptide. Myocardial fibrosis resulting from pharmacologic-induced exercise after KD development was IL-1 signaling dependent and was associated with a significant reduction in myocardial capillary CD31 expression, indicative of a rarefied myocardial capillary bed. These observations suggest that adrenergic stimulation after KD vasculitis may lead to cardiac hypertrophy and bridging fibrosis in the myocardium in the LCWE-induced KD vasculitis mouse model and that this process involves IL-1 signaling and diminished microvascular circulation in the myocardium.
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Affiliation(s)
- Harry H Matundan
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology
| | - Jon Sin
- Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center, and
| | - Magali Noval Rivas
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
| | - Michael C Fishbein
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Thomas J Lehman
- Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, New York, USA
| | - Shuang Chen
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
| | - Roberta A Gottlieb
- Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center, and
| | - Timothy R Crother
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
| | - Masanori Abe
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology
| | - Moshe Arditi
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center, and.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
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Unusual Clinical Sequelae of Kawasaki Disease-Symptomatic Extracranial Internal Carotid Stenosis in Young Adult. World Neurosurg 2018; 117:162-164. [PMID: 29920397 DOI: 10.1016/j.wneu.2018.06.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis that primarily affects the coronary artery, but it does not commonly affect the carotid artery. Cerebral infarction (CI) with internal carotid artery stenosis (ICS) in patients with KD has not been reported until now. We report a patient with CI as a remote-phase complication of KD. CASE PRESENTATION A 32-year-old man presented with impaired consciousness. Magnetic resonance imaging and digital subtraction angiography confirmed CI and ICS. He successfully underwent carotid endarterectomy. The resected plaque had pathologic findings of KD, which suggested that the internal carotid artery suffered from chronic inflammation. CONCLUSION KD in childhood may cause symptomatic ICS as a sequela of a remote phase.
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Abstract
"Resistant" Kawasaki disease is defined by the American Heart Association as failure to respond within 36 h following the first dose of intravenous immunoglobulin. The optimal management of resistant Kawasaki disease remains uncertain, the outcomes are potentially serious, and the cost of some treatments is considerable. We review the current evidence to guide treatment of resistant Kawasaki disease. Given the relative rarity, there are few trial data, and studies tend to be small and methodologically heterogeneous, making interpretation difficult and limiting generalisability. The literature on resistant Kawasaki disease should be interpreted with reference to current expert consensus guidelines.
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Advani N, Sastroasmoro S, Ontoseno T, Uiterwaal CS. Long-term outcome of coronary artery dilatation in Kawasaki disease. Ann Pediatr Cardiol 2018; 11:125-129. [PMID: 29922008 PMCID: PMC5963225 DOI: 10.4103/apc.apc_172_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis syndrome with a high incidence of coronary aneurysms in untreated children. The majority of aneurysms resulting from KD are known to regress with time. Aims This study aimed to determine the course and outcome of coronary artery dilatation in patients with KD and ascertain whether there are any differences in the outcomes in the different branches. Setting and Design This is a retrospective cohort study of patients diagnosed with KD with midterm follow-up data. Methods Serial echocardiography was performed in all KD patients with coronary dilatation for 1-10½ years. The Kaplan-Meier curve was used for statistical analysis. Results There were 154 patients with coronary dilatation studied. The frequency of coronary dilatation in acute phase was 33.3% and decreased to 7.9% 6-8 weeks later. Each patient could have dilatations at more than one branch, so the total number of dilatations was 245. The median time needed for regression was 2.6 months (mean: 10.5 months) while the median of follow-up duration was 41 months (mean: 23 months). Small- and medium-sized dilatations had more favorable outcomes compared to the giant ones. Location of dilatation did not influence the outcome. Conclusions The majority (77.4%) of small- and medium-sized dilatations regress within 2 years, but giant aneurysms tend to persist. The outcome of coronary dilatation is determined by the diameter and not by the location. Regression rate is faster in smaller dilatations. Left main coronary artery is the most frequent location for dilatation.
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Affiliation(s)
- Najib Advani
- Department of Child Health, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sudigdo Sastroasmoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Teddy Ontoseno
- Department of Child Health Faculty of Medicine, Universitas Airlangga-Sutomo Hospital, Surabaya, Indonesia
| | - Cuno Spm Uiterwaal
- Julius Center for Health Science and Primary Care, University of Medical Center Utrecht, Utrecht, The Netherlands
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19
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Fridman MD, Owada CY, Gregory RD, Birnbaum PL. Off-Pump Double Coronary Artery Bypass in a 14-Year-Old With Kawasaki Disease. Ann Thorac Surg 2017; 104:e307-e309. [PMID: 28935322 DOI: 10.1016/j.athoracsur.2017.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/20/2017] [Accepted: 04/15/2017] [Indexed: 11/20/2022]
Abstract
A 14-year-old male patient with a history of atypical Kawasaki disease at age 2 presents with triple vessel giant coronary aneurysms. Over the last several years, he began experiencing angina and dyspnea on exertion, which was a result of fully occluded right coronary and left circumflex arteries and 90% stenosis in the left anterior descending artery. He underwent off-pump coronary artery bypass using the left and right internal mammary arteries. At 18-month follow-up, there is no evidence of ischemia. Off-pump bypass is a feasible option for surgical management of the stenotic and occlusive complications of Kawasaki disease.
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Affiliation(s)
- Michael D Fridman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard D Gregory
- Department of Surgery, University of California, San Francisco-Fresno, Fresno, California; St. Agnes Medical Centre, Fresno, California
| | - Peter L Birnbaum
- Department of Surgery, University of California, San Francisco-Fresno, Fresno, California; St. Agnes Medical Centre, Fresno, California.
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20
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Dedeoglu R, Barut K, Oztunc F, Atik S, Adrovic A, Sahin S, Cengiz D, Kasapcopur O. Evaluation of myocardial deformation in patients with Kawasaki disease using speckle-tracking echocardiography during mid-term follow-up. Cardiol Young 2017; 27:1377-1385. [PMID: 28376935 DOI: 10.1017/s1047951117000580] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
UNLABELLED Speckle-tracking echocardiography is a recently developed technique for the evaluation of myocardial deformation or strain. Our objective was to examine strain through a mid-term follow-up of patients with Kawasaki disease. METHODS We explored left ventricular mechanics using speckle-tracking echocardiography in 35 patients with a history of Kawasaki disease at least 6 months after the acute phase. We also included 30 healthy children as controls. Strain data sets were acquired for the quantification of left ventricular global strain, segmental strain, and left ventricular ejection fraction. RESULTS The mean age of our patients was 25.6±15.4 months. At a median follow-up of 57.5 months (16.5-98.2), although both values were in the normal range, the mean left ventricular ejection proportion of patients (57.3%) was a little lower than that of controls (p⩽0.05). Patient strain values at the basal inferoseptal (20.0), basal anterolateral (19.5), apical septal (23.3), and apical inferior (24.0) segments were lower compared with controls. In all, seven patients had coronary aneurysms during follow-up. Kawasaki disease patients with pyuria had lower left ventricular strain at the mid anterior, mid anteroseptal, apical anterior, and apical inferior segments and global longitudinal strain compared with patients with no pyuria (p⩽0.05). CONCLUSION In children with a history of Kawasaki disease, impairment of left ventricular mechanics occurs especially within the left anterior descending artery territories.
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Affiliation(s)
- Reyhan Dedeoglu
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Kenan Barut
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Funda Oztunc
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Sezen Atik
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Amra Adrovic
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Sezgin Sahin
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Dicle Cengiz
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
| | - Ozgur Kasapcopur
- Pediatric Cardiology,Dr. Siyami Ersek Chest, Heart and Vessel Surgery Teaching and Research Hospital,Siyami Ersek Hospital,Istanbul,Turkey
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21
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Giant coronary aneurysms in infants with Kawasaki disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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MESH Headings
- Animals
- Aorta, Abdominal/metabolism
- Aorta, Abdominal/pathology
- Aorta, Abdominal/physiopathology
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortic Aneurysm, Abdominal/epidemiology
- Aortic Aneurysm, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/physiopathology
- Aortic Aneurysm, Thoracic/epidemiology
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/physiopathology
- Disease Models, Animal
- Humans
- Risk Factors
- Signal Transduction
- Vascular Remodeling
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Affiliation(s)
- Hong Lu
- From the Department of Physiology, Saha Cardiovascular Research Center, University of Kentucky, Lexington.
| | - Alan Daugherty
- From the Department of Physiology, Saha Cardiovascular Research Center, University of Kentucky, Lexington
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2396] [Impact Index Per Article: 299.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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Huang FC, Kuo HC, Huang YH, Yu HR, Li SC, Kuo HC. Anti-inflammatory effect of resveratrol in human coronary arterial endothelial cells via induction of autophagy: implication for the treatment of Kawasaki disease. BMC Pharmacol Toxicol 2017; 18:3. [PMID: 28069066 PMCID: PMC5223384 DOI: 10.1186/s40360-016-0109-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/06/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile vasculitis in childhood, which is the leading cause of acquired heart disease in children. If untreated, KD can result in coronary aneurysms in 25% of patients, and even under intravenous immunoglobulin (IVIG) treatment, 10-20% of children will have IVIG resistance and increased risk of developing coronary arteritis complication. Additional therapies should be explored to decrease the incidence of coronary artery lesions and improve the prognosis in KD. Autophagy has been reported to play a critical role in a variety of heart diseases. Resveratrol (RSV) confers cardio protection during ischemia and reperfusion in rats via activation of autophagy. Serum TNF-alpha levels are elevated in KD, which might activate the endothelial cells to express intercellular adhesion molecule-1 (ICAM-1), vascular cellular adhesion molecule-1(VCAM-1), inducible nitric oxide synthase (iNOS) and IL-1β. METHODS Human coronary arterial endothelial cells (HCAECs) were either untreated or treated by TNF-α 10 ng/ml for 2 h in the presence or absence of RSV or autophagy-related protein 16-like 1 (Atg16L1) siRNA. Total RNA was analyzed by real-time quantitative PCR for ICAM-1, VCAM-1, iNOS and IL-1β mRNA expressions. The involvement of autophagy proteins was investigated by Western blot. RESULTS Pretreatment with resveratrol significantly inhibited TNF-α-induced ICAM-1, iNOS and IL-1β mRNA expression in HCAECs. Western blot revealed the enhanced autophagy proteins LC3B and Atg16L1 expression by RSV. The suppressive effects of RSV were obviously counteracted by Atg16L1 siRNA. CONCLUSIONS We demonstrated RSV had anti-inflammatory effects on HCAECs via induction of autophagy. Our results suggest that resveratrol may modulate the inflammatory response of coronary artery in KD and explore the role of autophagy in the pathogenesis and alternative therapy of coronary arterial lesions in KD.
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Affiliation(s)
- Fu-Chen Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833 Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833 Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833 Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833 Taiwan
| | - Sung-Chou Li
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsing-Chun Kuo
- Institute of Nursing and Department of Nursing, Chang Gung University of Science and Technology; Chronic Diseases and Health Promotion Research Center, CGUST, Chiayi County, Taiwan
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Yanagisawa D, Ayusawa M, Kato M, Watanabe H, Komori A, Abe Y, Nakamura T, Kamiyama H, Takahashi S. Factors affecting N-terminal pro-brain natriuretic peptide elevation in the acute phase of Kawasaki disease. Pediatr Int 2016; 58:1105-1111. [PMID: 26991905 DOI: 10.1111/ped.12986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/16/2016] [Accepted: 03/09/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to investigate the clinical significance and factors that affect N-terminal pro-brain natriuretic peptide (NT-proBNP) elevation in the acute phase of Kawasaki disease (KD) despite the absence of apparent cardiac complications. METHODS The laboratory and echocardiography results of 44 KD patients in the acute and subacute phases were reviewed. RESULTS With preserved cardiac function, median NT-proBNP was significantly elevated in the acute phase compared with the subacute phase (343 pg/mL, IQR, 162-1182 pg/mL vs 98 pg/mL, IQR, 61-205 pg/mL, respectively; P < 0.0001). The respective levels of tumor necrosis factor (TNF)-α, soluble TNF receptor (sTNFR)1, and sTNFR2 were also significantly elevated in the acute phase compared with the subacute phase: TNF-α, 3.3 pg/mL (IQR, 2.6-4.8 pg/mL) versus 2.4 pg/mL (IQR 1.9-4.0 pg/mL; P < 0.01), sTNFR1, 2741 pg/mL (IQR, 2080-3183 pg/mL) versus 976 pg/mL (IQR, 814-1247 pg/mL; P < 0.0001), sTNFR2, 5644 pg/mL (IQR, 4693-7520 pg/mL) versus 3169 pg/mL (IQR, 2132-3878 pg/mL; P < 0.0001). Log-transformed NT-proBNP was correlated with TNF-α (r = 0.29, P = 0.056), sTNFR1 (r = 0.60, P < 0.0001), and sTNFR2 (r = 0.65, P < 0.0001). TNF-α was correlated with sTNFR1 (r = 0.35, P = 0.02) and sTNFR2 (r = 0.51, P < 0.001). CONCLUSION Tumor necrosis factor-α may cause NT-proBNP elevation in the acute phase of KD, and NT-proBNP level may be an indicator of TNF-α activity.
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Affiliation(s)
- Daisuke Yanagisawa
- Department of Pediatrics and Child Health, Nihon University Graduate School of Medicine, Tokyo, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Masataka Kato
- Department of Pediatrics and Child Health, Nihon University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Watanabe
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Akiko Komori
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Yuriko Abe
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Takahiro Nakamura
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Kamiyama
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.,Division of Medical Education Planning and Development, Nihon University School of Medicine, Tokyo, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Sánchez Andrés A, Salvador Mercader I, Seller Moya J, Carrasco Moreno JI. [Giant coronary aneurysms in infants with Kawasaki disease]. An Pediatr (Barc) 2016; 87:65-72. [PMID: 27649630 DOI: 10.1016/j.anpedi.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Kawasaki disease (KD) is an acute vasculitis of unknown origin and predominant in males. The long-term effects of the disease depend on whether there are coronary lesions, particularly aneurysms. The prognosis of patients with giant aneurysms is very poor due to their natural progression to coronary thrombosis or severe obstructive lesions. OBJECTIVES A series of 8 cases is presented where the epidemiology and diagnostic methods are described. The treatment of the acute and long-term cardiovascular sequelae is also reviewed. METHODS A descriptive analysis was conducted on patients admitted to the Paediatric Cardiology Unit of La Fe University Hospital (Valencia) with KD and a coronary lesion. RESULTS More than one artery was involved in all patients. Although early diagnosis was established in only two cases, none of the patients had severe impairment of ventricular function during the acute phase. Treatment included intravenous gammaglobulin and acetylsalicylic acid at anti-inflammatory doses during the acute phase. A combination of dual antiplatelet therapy and corticosteroids was given in cases of coronary thrombosis. The silent aneurysms continue to persist. CONCLUSIONS KD is the most common cause of acquired heart disease in children. The delay in diagnosis is associated with a greater likelihood of coronary lesions that could increase the risk of cardiovascular events in adulthood. Thus, this subgroup requires close clinical monitoring for a better control of cardiovascular risk factors over time.
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Affiliation(s)
- Antonio Sánchez Andrés
- Servicio de Cardiología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | | | - Julia Seller Moya
- Servicio de Cardiología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
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Abstract
Kawasaki disease (KD) is an acute childhood febrile disease of unknown etiology. It exhibits not only coronary artery aneurysms in some cases but also systemic vasculitis. Whether KD is associated with accelerated atherosclerosis remains debatable. The measurement of pulse wave velocity (PWV) is useful as a simple, noninvasive measurement of arterial stiffness, an atherosclerotic manifestation. We herein present a systematic review of clinical studies that focused on PWV in patients with KD. A PubMed-based search identified 8 eligible studies published until June 2015. The PWV of patients with KD, regardless of antecedent coronary artery lesions, was high relative to controls, even though their blood pressure appeared to be similar. Although definitive conclusions cannot be made with the limited information, patients with KD may be at risk of systemic atherosclerosis in association with arterial stiffness. Further research, including longitudinal and outcome studies, is needed to determine the clinical significance of a potential increase in PWV in patients with KD.
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Affiliation(s)
- Yoshitaka Iwazu
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
| | - Takaomi Minami
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
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Bachlava E, Loukopoulou S, Karanasios E, Chrousos G, Michos A. Management of coronary artery aneurysms using abciximab in children with Kawasaki disease. Int J Cardiol 2016; 220:65-9. [PMID: 27372045 DOI: 10.1016/j.ijcard.2016.06.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/19/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There are limited data regarding the possible benefits of abciximab in children with Kawasaki disease (KD), who developed serious cardiac abnormalities non-responsive to standard treatment. MATERIALS AND METHODS We retrospectively identified children with KD who were treated with abciximab from 2007 to 2015. Data regarding clinical course, treatment, echocardiographic data and follow-up at 1 and 6months were retrieved. RESULTS During the study period, fifteen children were identified who were diagnosed with KD and were given abciximab. The median age at onset of symptoms was 11months (range: 2months-6years). The median day of disease at admission was 10days (range: 4-26days) and the median day of administration of abciximab was 17days (range: 9-40). Twelve children were diagnosed with complete and three with incomplete KD. Aneurysms were found in 8 children: 2 had ectatic coronary arteries and 5 presented with both ectasia and aneurysms. At 1month follow-up, echocardiographic findings showed regression in the size of aneurysms in 11 children, resolution of the aneurysms or ectasia of coronary arteries in 3 children, while one child who could not take aspirin because of G6PD deficiency died. After 6months of follow-up, echocardiographic findings showed resolution of coronary abnormalities in 12 (80%) children, whereas 2 children (13.3%) presented with significant regression of aneurysms. CONCLUSIONS Abciximab may have an important role in the management of severe cardiac complications of KD, although prospective randomized controlled studies are needed to fully evaluate its role.
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Affiliation(s)
- Evangelia Bachlava
- First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Sophia Loukopoulou
- First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - George Chrousos
- First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece.
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N'Guetta R, Yao H, Ekou A, Boka B, Konin C, Coulibaly I, Anzouan-Kacou JB, Seka R, Adoh M. [Coronary artery aneurysms probably due to Kawasaki's disease]. JOURNAL DES MALADIES VASCULAIRES 2016; 41:224-227. [PMID: 27090101 DOI: 10.1016/j.jmv.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.
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Affiliation(s)
- R N'Guetta
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire.
| | - H Yao
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - A Ekou
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - B Boka
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - C Konin
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - I Coulibaly
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - J B Anzouan-Kacou
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - R Seka
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
| | - M Adoh
- Institut de cardiologie d'Abidjan, 01 BP V206, Abidjan, Côte d'Ivoire
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Doan S, Maehara CK, Chaparro JD, Lu S, Liu R, Graham A, Berry E, Hsu CN, Kanegaye JT, Lloyd DD, Ohno-Machado L, Burns JC, Tremoulet AH. Building a Natural Language Processing Tool to Identify Patients With High Clinical Suspicion for Kawasaki Disease from Emergency Department Notes. Acad Emerg Med 2016; 23:628-36. [PMID: 26826020 DOI: 10.1111/acem.12925] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/29/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delayed diagnosis of Kawasaki disease (KD) may lead to serious cardiac complications. We sought to create and test the performance of a natural language processing (NLP) tool, the KD-NLP, in the identification of emergency department (ED) patients for whom the diagnosis of KD should be considered. METHODS We developed an NLP tool that recognizes the KD diagnostic criteria based on standard clinical terms and medical word usage using 22 pediatric ED notes augmented by Unified Medical Language System vocabulary. With high suspicion for KD defined as fever and three or more KD clinical signs, KD-NLP was applied to 253 ED notes from children ultimately diagnosed with either KD or another febrile illness. We evaluated KD-NLP performance against ED notes manually reviewed by clinicians and compared the results to a simple keyword search. RESULTS KD-NLP identified high-suspicion patients with a sensitivity of 93.6% and specificity of 77.5% compared to notes manually reviewed by clinicians. The tool outperformed a simple keyword search (sensitivity = 41.0%; specificity = 76.3%). CONCLUSIONS KD-NLP showed comparable performance to clinician manual chart review for identification of pediatric ED patients with a high suspicion for KD. This tool could be incorporated into the ED electronic health record system to alert providers to consider the diagnosis of KD. KD-NLP could serve as a model for decision support for other conditions in the ED.
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Affiliation(s)
- Son Doan
- Department of Biomedical Informatics; University of California; San Diego CA
| | - Cleo K. Maehara
- Department of Biomedical Informatics; University of California; San Diego CA
| | - Juan D. Chaparro
- Department of Biomedical Informatics; University of California; San Diego CA
| | - Sisi Lu
- Department of Computer Science; University of Pittsburgh; Pittsburgh PA
| | - Ruiling Liu
- The University of Texas Health Science Center at Houston; Houston TX
| | | | - Erika Berry
- Department of Pediatrics; University of California at San Diego; La Jolla CA
| | - Chun-Nan Hsu
- Department of Biomedical Informatics; University of California; San Diego CA
| | - John T. Kanegaye
- Department of Pediatrics; University of California at San Diego; La Jolla CA
- Rady Children's Hospital San Diego; San Diego CA
| | - David D. Lloyd
- Children's Healthcare of Atlanta; Atlanta GA
- Emory University School of Medicine; Atlanta GA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics; University of California; San Diego CA
| | - Jane C. Burns
- Department of Pediatrics; University of California at San Diego; La Jolla CA
- Rady Children's Hospital San Diego; San Diego CA
| | - Adriana H. Tremoulet
- Department of Pediatrics; University of California at San Diego; La Jolla CA
- Rady Children's Hospital San Diego; San Diego CA
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Wakita D, Kurashima Y, Crother TR, Noval Rivas M, Lee Y, Chen S, Fury W, Bai Y, Wagner S, Li D, Lehman T, Fishbein MC, Hoffman HM, Shah PK, Shimada K, Arditi M. Role of Interleukin-1 Signaling in a Mouse Model of Kawasaki Disease-Associated Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2016; 36:886-97. [PMID: 26941015 DOI: 10.1161/atvbaha.115.307072] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is the most common cause of acquired cardiac disease in US children. In addition to coronary artery abnormalities and aneurysms, it can be associated with systemic arterial aneurysms. We evaluated the development of systemic arterial dilatation and aneurysms, including abdominal aortic aneurysm (AAA) in the Lactobacillus casei cell-wall extract (LCWE)-induced KD vasculitis mouse model. METHODS AND RESULTS We discovered that in addition to aortitis, coronary arteritis and myocarditis, the LCWE-induced KD mouse model is also associated with abdominal aorta dilatation and AAA, as well as renal and iliac artery aneurysms. AAA induced in KD mice was exclusively infrarenal, both fusiform and saccular, with intimal proliferation, myofibroblastic proliferation, break in the elastin layer, vascular smooth muscle cell loss, and inflammatory cell accumulation in the media and adventitia. Il1r(-/-), Il1a(-/-), and Il1b(-/-) mice were protected from KD associated AAA. Infiltrating CD11c(+) macrophages produced active caspase-1, and caspase-1 or NLRP3 deficiency inhibited AAA formation. Treatment with interleukin (IL)-1R antagonist (Anakinra), anti-IL-1α, or anti-IL-1β mAb blocked LCWE-induced AAA formation. CONCLUSIONS Similar to clinical KD, the LCWE-induced KD vasculitis mouse model can also be accompanied by AAA formation. Both IL-1α and IL-1β play a key role, and use of an IL-1R blocking agent that inhibits both pathways may be a promising therapeutic target not only for KD coronary arteritis, but also for the other systemic arterial aneurysms including AAA that maybe seen in severe cases of KD. The LCWE-induced vasculitis model may also represent an alternative model for AAA disease.
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Affiliation(s)
- Daiko Wakita
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Yosuke Kurashima
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Timothy R Crother
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Magali Noval Rivas
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Youngho Lee
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Shuang Chen
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Wen Fury
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Yu Bai
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Shawn Wagner
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Debiao Li
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Thomas Lehman
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Michael C Fishbein
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Hal M Hoffman
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Prediman K Shah
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Kenichi Shimada
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Moshe Arditi
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.).
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[Left ventricular longitudinal systolic strain in children with history of Kawasaki disease]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:196-202. [PMID: 26361707 DOI: 10.1016/j.acmx.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/30/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is a systemic vasculitis that affects young children. Coronary artery aneurisms, ectasia and stenosis are its main complications and may lead to ischemic heart disease or sudden death. Echocardiography evaluation it's mandatory in all patients with history of KD. Left ventricular longitudinal systolic strain (LVLSS) measured by speckle tracking it's an accurate tool to evaluate global and segmental left ventricle mechanics. Clinical utility of LVLSS in children with KD hasn't been established. The goal of this study was to analyse if the presence of coronary lesions alters segmental LVLSS and if there is a relationship with the affected coronary territory. METHOD Case series. A complete transthoracic echocardiography with LVLSS was performed in children with history of KD with at least 6 months after the acute phase. RESULTS Nine patients where studied, with a median age of 6 years (minimum 2 and maximum 17). A percentage of 56 were male, and 77% had coronary aneurisms. An abnormal LVLSS was found in 56% of the population studied. All of the patients that had an abnormal LVLSS had coronary aneurisms with stenosis or complete occlusion confirmed by invasive coronary angiography and abnormal Nuclear Medicine perfusion scans. CONCLUSIONS On the population studied, all patients with an abnormal LVLSS had obstructive coronary lesions and ischemic heart disease.
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Tajima M, Shiozawa Y, Kagawa J. Early Appearance of Principal Symptoms of Kawasaki Disease is a Risk Factor for Intravenous Immunoglobulin Resistance. Pediatr Cardiol 2015; 36:1159-65. [PMID: 25753685 DOI: 10.1007/s00246-015-1136-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/04/2015] [Indexed: 12/19/2022]
Abstract
It is difficult to accurately predict treatment resistance in Kawasaki disease (KD). Patients considered to be low-risk cases often develop resistance to intravenous immunoglobulin (IVIG). We herein examined whether information from the clinical course of KD could improve the prediction accuracy of a previously reported risk score. We retrospectively reviewed the clinical records of 100 KD patients. The clinical characteristics and laboratory data were compared between IVIG-sensitive and IVIG-resistant patients and also between patients with and without coronary artery aneurysm (CAA). The total incidence of IVIG resistance and CAA development was 34 and 13 %, respectively. Multiple regression analysis identified the early appearance of principal symptoms (≤day 2 of the illness) as a risk factor for IVIG resistance (OR 2.88, 95 % CI 1.11-7.44, p = 0.0041), whereas delayed IVIG administration (≥day 6) (OR 2.23, 95 % CI 0.66-7.64, p = 0.018) and IVIG resistance (OR 9.05, 95 % CI 2.27-36.10, p = 0.015) were independent predictors for CAA development. The addition of the first appearance day of principal symptoms into a previously reported scoring system improved its prediction accuracy for IVIG resistance. KD patients who had presented with any principal symptoms within 2 days of fever onset were at a high risk for IVIG resistance regardless of previously reported risk score. A careful medical history-taking that is focused on the clinical course enables a better prediction of IVIG resistance.
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Affiliation(s)
- Miyu Tajima
- Department of Cardiology, University of Tokyo, Tokyo, Japan,
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Arterial stiffness in patients after Kawasaki disease without coronary artery involvement: Assessment by performing brachial ankle pulse wave velocity and cardio-ankle vascular index. J Cardiol 2015; 66:130-4. [DOI: 10.1016/j.jjcc.2014.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 09/10/2014] [Accepted: 10/01/2014] [Indexed: 01/10/2023]
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Greco A, De Virgilio A, Rizzo MI, Tombolini M, Gallo A, Fusconi M, Ruoppolo G, Pagliuca G, Martellucci S, de Vincentiis M. Kawasaki disease: An evolving paradigm. Autoimmun Rev 2015; 14:703-9. [DOI: 10.1016/j.autrev.2015.04.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
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Motozawa Y, Uozumi H, Maemura S, Nakata R, Yamamoto K, Takizawa M, Kumagai H, Ikeda Y, Komuro I, Ikenouchi H. Acute Myocardial Infarction That Resulted From Poor Adherence to Medical Treatment for Giant Coronary Aneurysm. Int Heart J 2015; 56:551-4. [PMID: 26155999 DOI: 10.1536/ihj.15-155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coronary arterial complications associated with Kawasaki disease (KD), such as a giant coronary aneurysm, determine the relative risk of future cardiac events and require lifelong medical treatment. Here, we describe a 24-year-old man who developed myocardial infarction due to poor adherence to medical treatment for a giant coronary aneurysm in the chronic phase of KD. He was hospitalized two hours after the onset of chest pain. The presence of the giant coronary aneurysm made primary percutaneous coronary intervention (PCI) difficult. However, we were able to perform primary PCI successfully utilizing previous coronary computed tomography (CT) angiographic pictures as a reference. This case provides valuable insight for the management of coronary arterial complications associated with KD. Patients in the chronic phase of KD are usually asymptomatic, even in the presence of giant coronary aneurysms which have been reported to have a high risk of morbidity and mortality. Therefore, patient education is critical for preventing poor adherence to medical treatment for coronary arterial complications. In preparation for potential coronary intervention in the future, it is also useful to perform coronary CT angiography, coronary magnetic resonance (MR) angiography, and/or coronary angiography on a regular basis while patients remain free from serious cardiac events.
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Affiliation(s)
- Yoshihiro Motozawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Saneeymehri S, Baker K, So TY. Overview of Pharmacological Treatment Options for Pediatric Patients with Refractory Kawasaki Disease. J Pediatr Pharmacol Ther 2015; 20:163-77. [PMID: 26170768 DOI: 10.5863/1551-6776-20.3.163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kawasaki disease is an autoimmune disease found predominantly in children under the age of 5 years. Its incidence is higher in those who live in Asian countries or are of Asian descent. Kawasaki disease is characterized as an acute inflammation of the vasculature bed affecting mainly the skin, eyes, lymph nodes, and mucosal layers. Although the disease is usually self-limiting, patients may develop cardiac abnormalities that can lead to death. The exact cause of the disease is unknown; however, researchers hypothesize that an infectious agent is responsible for causing Kawasaki disease. Initial treatment options with intravenous immune globulin and aspirin are sufficient to cure most patients who acquire this disease. Unfortunately, in up to one-quarter of patients, the disease will be refractory to initial therapy and will require further management with corticosteroid, immunomodulatory, or cytotoxic agents. The lack of randomized, controlled trials makes treatment of refractory disease difficult to manage. Until larger randomized, controlled trials are published to give more guidance on therapy for this stage of disease, clinicians should use the data available from observational studies and case reports in conjunction with their clinical expertise to make treatment decisions.
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Affiliation(s)
| | - Katherine Baker
- Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tsz-Yin So
- Department of Pharmacy, Moses H. Cone Hospital, Greensboro, North Carolina
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Abstract
Kawasaki disease (KD) is the archetypal pediatric vasculitis, exemplifying the unique aspects and challenges of vascular inflammation in children. The condition is almost unheard of in adults, is closely associated with infections, and is self-limited, with fever resolving after an average of 12 days even without treatment. Yet KD is also a potentially fatal disease and the most common cause of acquired heart disease in the developed world. Unraveling of the developmental, immunologic, and genetic secrets of Kawasaki disease promises to improve our understanding of vasculitis in particular, and perhaps also to provide a window on the fundamental mysteries of inflammatory diseases in general.
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Affiliation(s)
- Robert P Sundel
- Boston Children's Hospital, Rheumatology Program, 300 Longwood Avenue, and Harvard Medical School, Department of Pediatrics, 25 Shattuck Street, Boston, MA 02115, USA.
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Ye Q, Shao WX, Shang SQ, Zhang T, Hu J, Zhang CC. A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease. Arthritis Rheumatol 2015; 67:1943-50. [PMID: 25778686 DOI: 10.1002/art.39112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/05/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Qing Ye
- The Children's Hospital of Zhejiang University School of Medicine and Zhejiang Key Laboratory for the Diagnosis and Treatment of Neonatal Diseases; Hangzhou China
| | - Wen-xia Shao
- Hangzhou First People's Hospital; Hangzhou China
| | - Shi-qiang Shang
- The Children's Hospital of Zhejiang University School of Medicine; Hangzhou China
| | - Ting Zhang
- Zhejiang Chinese Medical University; Hangzhou China
| | - Jian Hu
- The Children's Hospital of Zhejiang University School of Medicine; Hangzhou China
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Kontopoulou T, Kontopoulos DG, Vaidakis E, Mousoulis GP. Adult Kawasaki disease in a European patient: a case report and review of the literature. J Med Case Rep 2015; 9:75. [PMID: 25890055 PMCID: PMC4403952 DOI: 10.1186/s13256-015-0516-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/07/2015] [Indexed: 12/15/2022] Open
Abstract
Introduction Kawasaki disease is an acute necrotising vasculitis of the medium- and small-sized vessels, occurring mainly in Japanese and Korean babies and children, aged 6 months to 5 years. Its main complication is damage of coronary arteries, which has the potential to be fatal. Here we report a rare case of Kawasaki disease that occurred in a 20-year-old Greek adult. Case presentation A 20-year-old Greek man presented with high fever, appetite loss, nausea and vomiting, headache and significant malaise. He had an erythema of the palms and strikingly red lips and conjunctiva. As he did not respond to broad-spectrum antibiotics and after having excluded other possible diagnoses, the diagnosis of Kawasaki disease was set. He was treated with intravenous immunoglobulin and oral aspirin on the 10th day since the onset of the illness. His clinico-laboratory response was excellent and no coronary artery aneurysms were detected in coronary artery computed tomography performed 1 month later. Conclusions This report of an adult case of European Kawasaki disease may be of benefit to physicians of various specialties, including primary care doctors, hospital internists, intensivists and cardiologists. It demonstrates that a case of prolonged fever, unresponsive to antibiotics, in the absence of other diagnoses may be an incident of Kawasaki disease. It is worth stressing that such a diagnosis should be considered, even if the patient is adult and not of Asian lineage.
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Affiliation(s)
- Theano Kontopoulou
- 3rd Department of Internal Medicine, Evangelismos Hospital, Ipsilantou 45-47, 10676, Athens, Greece.
| | | | - Emmanouel Vaidakis
- Department of Internal Medicine, Metropolitan Hospital, Ethnarchou Makariou 9 & El. Venizelou 1, 18547, N. Faliro, Athens, Greece.
| | - George P Mousoulis
- 3rd Department of Internal Medicine, Evangelismos Hospital, Ipsilantou 45-47, 10676, Athens, Greece.
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Lin MC, Lai MS, Jan SL, Fu YC. Epidemiologic features of Kawasaki disease in acute stages in Taiwan, 1997-2010: effect of different case definitions in claims data analysis. J Chin Med Assoc 2015; 78:121-6. [PMID: 25636582 PMCID: PMC7105041 DOI: 10.1016/j.jcma.2014.03.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/31/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kawasaki disease is the leading cause of pediatric acquired cardiac disease in many industrialized countries. The aim of this study was to estimate the incidence of Kawasaki disease in acute stages in Taiwan, by linking the diagnosis code to medication and comparing the differences in epidemiological features with those of previous reports that used the diagnosis code alone. METHODS We searched the National Health Insurance Research Database from 1997 to 2010. For the International Classification of Diseases, Ninth Revision (ICD-9) set, all inpatients with a main diagnosis of Kawasaki disease (ICD-9, 446.1) were retrieved. For the ICD-9 + intravenous immunoglobulin (IVIG) set, Kawasaki disease in acute stages was defined as the disease stages requiring IVIG. The epidemiologic features were calculated and compared by both methods. RESULTS The incidence rates for children under 5 years ranged from 21.5 to 68.5 per 100,000 person-years (average 49.1) for the ICD-9 + IVIG set and from 48.5 to 82.8 per 100,000 person-years (average 74.9) for the ICD-9 set. Significant discrepancy in peak season estimation occurred in summer. The 5-year recurrence rate was 1.1% for the ICD-9 + IVIG set and 4.5% for the ICD-9 set. The coronary complication rates were around 7.24% (ICD-9 + IVIG) and 6.48% (ICD-9). CONCLUSION Discrepancies occurred when different case definitions were used in claims data analysis. Previous reports might have overestimated the incidence, recurrence rate, and complication rate in older children. The new method might slightly underestimate them. The true incidence might lie in between.
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Affiliation(s)
- Ming-Chih Lin
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Sheng-Ling Jan
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yun-Ching Fu
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
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Lin J, Jain S, Sun X, Liu V, Sato YZ, Jimenez-Fernandez S, Newfield RS, Pourfarzib R, Tremoulet AH, Gordon JB, Daniels LB, Burns JC. Lipoprotein particle concentrations in children and adults following Kawasaki disease. J Pediatr 2014; 165:727-31. [PMID: 25039043 PMCID: PMC4207833 DOI: 10.1016/j.jpeds.2014.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/20/2014] [Accepted: 06/06/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To test the hypothesis that children and adults with a history of Kawasaki disease (KD) are more likely to have abnormal lipoprotein particle profiles that could place them at increased risk for developing atherosclerosis later in life. STUDY DESIGN Fasting serum samples were obtained from 192 children and 63 adults with history of KD and 90 age-similar healthy controls. Lipoprotein particle concentrations and sizes were measured by nuclear magnetic resonance spectroscopy (LipoScience Inc, Raleigh, North Carolina), and serum was assayed for total cholesterol (TC), triglycerides, and high-density lipoprotein (HDL) cholesterol (HDL-C). Low-density lipoprotein (LDL) cholesterol was estimated using the Friedewald formula. Data were analyzed in a least-square means model, with adjustment for age and sex and with the use of Holm correction for multiple comparisons. RESULTS Compared with respective control groups, both adult and pediatric subjects with KD had significantly lower mean very low-density lipoprotein-chylomicron particles, intermediate-density lipoproteins, triglycerides, and TC concentrations. Pediatric subjects with KD had significantly lower LDL particle and LDL cholesterol concentrations and lower mean TC/HDL-C ratio (P < .001). In contrast, the adult subjects with KD had significantly lower HDL particle, small HDL particle, and HDL-C concentrations (P < .001), but HDL-C was within normal range. CONCLUSIONS Nuclear magnetic resonance lipoprotein particle analysis suggests that pediatric and adult subjects with KD, regardless of their aneurysm status, are no more likely than age-similar, healthy controls to have lipid patterns associated with increased risk of atherosclerosis.
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Affiliation(s)
- Jonathan Lin
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
| | - Sonia Jain
- Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093
| | - Xiaoying Sun
- Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093
| | - Victoria Liu
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
| | - Yuichiro Z. Sato
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
| | - Susan Jimenez-Fernandez
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
| | - Ron S. Newfield
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
| | - Ray Pourfarzib
- Department of Medical Affairs, Liposcience, Inc., Raleigh, NC 27616
| | - Adriana H. Tremoulet
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
| | - John B. Gordon
- Sharp Memorial Hospital and San Diego Cardiac Center, San Diego, CA 92123
| | - Lori B. Daniels
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037-7411
| | - Jane C. Burns
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093; and Rady Children's Hospital San Diego, San Diego, CA 92123
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Xu QQ, Ding YY, Lv HT, Zhou WP, Sun L, Huang J, Yan WH. Evaluation of left ventricular systolic strain in children with Kawasaki disease. Pediatr Cardiol 2014; 35:1191-7. [PMID: 24859168 DOI: 10.1007/s00246-014-0915-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/25/2014] [Indexed: 11/25/2022]
Abstract
The current study aimed to assess left ventricular (LV) longitudinal systolic strains in children with KD using two-dimensional speckle-tracking imaging and to analyze the relationship of LV myocardial deformation to coronary lesions and laboratory markers. The study enrolled 101 children with acute KD. An additional 50 age- and gender-matched normal children were enrolled as control subjects. During different phases of KD, echocardiograms were recorded for 61 children. Two-dimensional strain analysis software was used to track myocardial movement and obtain the strain from each LV segment. The LV longitudinal systolic strain decreased significantly in children with acute KD but increased immediately after intravenous immunoglobulin therapy. At 6-8 weeks after the onset of KD, all LV strains had recovered to normal. The LV systolic strain was not associated with coronary dilation in either acute or convalescent KD. In acute KD, aspartate transaminase, alanine transaminase, erythrocyte sedimentation rate, C-reactive protein (CRP), and hemoglobin (Hb) were found to be associated with coronary dilation, whereas LV systolic strains were found to be correlated with elevated CRP and decreased Hb. Speckle-tracking imaging of LV systolic strain was simple and accurate in evaluating LV function during different phases of KD. No association between LV dysfunction and coronary dilation was observed, but a relationship with CRP and Hb was found. Further studies are recommended to validate the current study results and explore further how these findings can improve clinical practice.
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Affiliation(s)
- Qiu-Qin Xu
- Department of Pediatric Cardiology, Children's Hospital Affiliated of Soochow University, 303 Jingde Road, Suzhou, 215003, Jiangsu, China
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Takahashi S, Takada A, Saito K, Hara M, Yoneyama K, Nakanishi H, Takahashi K, Moriya T, Funayama M. Sudden death of a child from myocardial infarction due to arteritis of the left coronary trunk. Leg Med (Tokyo) 2014; 17:39-42. [PMID: 25239164 DOI: 10.1016/j.legalmed.2014.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/08/2014] [Accepted: 08/30/2014] [Indexed: 11/28/2022]
Abstract
An eight-year-old Japanese boy developed abdominal pain, followed by convulsion and loss of consciousness. He was taken to an emergency room but could not be resuscitated. At autopsy, the left main coronary trunk (LMT) demonstrated an increase in caliber with severe luminal narrowing, and the left anterior descending branch (LAD) subsequent to the LMT showed severe stenosis. Microscopically, the intima of the LMT demonstrated severe fibrosis and infiltration of lymphocytes and histiocytes suggesting vasculitis, and the small lumen was occupied by a fresh thrombus. The LAD showed significant intimal thickening with strong lymphocytic inflammation at the edge of the thickening. The left ventricle showed widespread myocardial infarction in the recovery stage. There were no findings of atherosclerosis, vasculitis or fibrocellular changes in the ascending aorta or intravisceral arteries other than the LMT and the LAD under investigation. The increase in the caliber of the LMT and the limitation of arteritis to the LMT and the subsequent branch suggested Kawasaki disease (KD), but it was atypical that the patient had no clinical history consistent with KD. The present case showed no findings suggesting classical polyarteritis nodosa (cPAN) at the acute or scar stage in the other vessels being investigated, and cPAN in childhood is rare compared to KD. A nonspecific inflammatory reaction (single organ vasculitis, SOV) was also considered as a possible cause, but it is difficult to determine whether the cause of the coronary stenosis in the present case was SOV because the sampling of arteries was insufficient. If forensic pathologists make unusual findings suggesting vasculitis at autopsy, the collection of a sufficient number of vessels of various sizes is warranted.
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Affiliation(s)
- Shirushi Takahashi
- Department of Forensic Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, Japan.
| | - Aya Takada
- Department of Forensic Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, Japan
| | - Kazuyuki Saito
- Department of Forensic Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, Japan; Department of Forensic Medicine, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Masaaki Hara
- Department of Forensic Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, Japan
| | - Katsumi Yoneyama
- Department of Forensic Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, Japan
| | - Hiroaki Nakanishi
- Department of Forensic Medicine, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, Japan
| | - Takuya Moriya
- Department of Pathology 2, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Masato Funayama
- Division of Forensic Medicine, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
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Yoshikane Y, Koga M, Imanaka-Yoshida K, Cho T, Yamamoto Y, Yoshida T, Hashimoto J, Hirose S, Yoshimura K. JNK is critical for the development of Candida albicans-induced vascular lesions in a mouse model of Kawasaki disease. Cardiovasc Pathol 2014; 24:33-40. [PMID: 25242023 DOI: 10.1016/j.carpath.2014.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/29/2014] [Accepted: 08/21/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the most common systemic vasculitis of unknown etiology in children, and can cause the life-threatening complication of coronary artery aneurysm. Although a novel treatment strategy for patients with KD-caused vascular lesions is eagerly awaited, their molecular pathogenesis remains largely unknown. c-Jun N-terminal kinase (JNK) is a signaling molecule known to have roles in inflammation and tissue remodeling. The aim of this study was to elucidate significant involvement of JNK in the development of vascular lesions in a mouse model of KD. METHODS AND RESULTS We injected Candida albicans cell wall extract (CAWE) into 4-week-old C57BL/6 mice. Macroscopically, we found that CAWE caused the development of bulging lesions at coronary artery, carotid artery, celiac artery, iliac artery and abdominal aorta. Histological examination of coronary artery and abdominal aorta in CAWE-treated mice showed marked inflammatory cell infiltration, destruction of elastic lamellae, loss of medial smooth muscle cells and intimal thickening, which are similar to histological features of vascular lesions of patients with KD. To find the role of JNK in lesion formation, we evaluated the effects of JNK inhibitor, SP600125, on abdominal aortic lesions induced by CAWE. Interestingly, treatment with SP600125 significantly decreased the incidence of lesions and also protected against vascular inflammation and tissue destruction histologically, compared with the placebo treatment. CONCLUSIONS Our findings suggest that JNK is crucial for the development of CAWE-induced vascular lesions in mice, and potentially represents a novel therapeutic target for KD.
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Affiliation(s)
- Yukako Yoshikane
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan.
| | - Mitsuhisa Koga
- Department of Pharmaceutical Care and Health Sciences, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, 514-8507, Japan; Mie University Research Center for Matrix Biology, Mie University, Tsu, 514-8507, Japan
| | - Tamaki Cho
- Section of Infection Biology, Department of Functional Bioscience, Fukuoka Dental College, Fukuoka, 814-0193, Japan
| | - Yumi Yamamoto
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, 755-8505, Japan
| | - Toshimichi Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, 514-8507, Japan; Mie University Research Center for Matrix Biology, Mie University, Tsu, 514-8507, Japan
| | - Junichi Hashimoto
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Shinichi Hirose
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Koichi Yoshimura
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, 755-8505, Japan; Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, 753-8502, Japan
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Su D, Wang K, Qin S, Pang Y. Safety and Efficacy of Warfarin plus Aspirin Combination Therapy for Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease: A Meta-Analysis. Cardiology 2014; 129:55-64. [DOI: 10.1159/000363732] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 11/19/2022]
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Two cases of new coronary aneurysms that developed in the late period after Kawasaki disease. Pediatr Cardiol 2014; 34:1992-5. [PMID: 23052675 DOI: 10.1007/s00246-012-0543-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
Two cases of coronary aneurysm developed in the late period after Kawasaki disease (KD). Case 1 involved a 13-year-old boy who had aneurysms develop after a diagnosis of complete regression. Case 2 involved a 29-year-old man who had a new aneurysm develop after he was older than 20 years. Physicians need to be aware that coronary aneurysms can develop in patients with antecedent KD even after regression or in adulthood.
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Matsushita K, Tamura T, Nishiga M, Kaitani K, Izumi C, Nakagawa Y. Acute myocardial infarction and 30-year coronary aneurysm follow-up by serial angiography in a young adult with Kawasaki disease. Cardiovasc Interv Ther 2014; 30:142-6. [DOI: 10.1007/s12928-014-0262-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/26/2014] [Indexed: 11/28/2022]
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Wu TH, Kuo HC, Tain YL, Lin KM, Kuo HC, Chien SJ. Common carotid artery intima-media thickness is useful for diagnosis of the acute stage of Kawasaki disease. BMC Pediatr 2014; 14:98. [PMID: 24721010 PMCID: PMC3996255 DOI: 10.1186/1471-2431-14-98] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/13/2014] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to investigate intima-media thickness (IMT) of the common carotid arteries in children with acute Kawasaki disease (KD). Methods Between 2009 and 2011, patients fulfilling the criteria for KD, including a fever lasting >5 days, were prospectively enrolled in this study. Laboratory data, echocardiography, and IMT were measured and compared with matched controls. Results A total of 70 common carotid IMTs were measured in 35 children. We studied 21 patients aged 3–60 months old with acute KD and 14 febrile patients aged 3–194 months old with acute infection and similar characteristics to those of KD patients. Children with KD had a significantly higher IMT compared with the controls (0.550 ± 0.081 mm vs. 0.483 ± 0.046 mm, P = 0.01). Conclusions IMT during the acute stage of KD is increased, suggesting that IMT could be a useful diagnostic tool in the early diagnosis of KD.
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Affiliation(s)
| | | | | | | | | | - Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, 123 Ta-Pei Road, Niaosung, Kaohsiung, Taiwan.
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