Utilization of Coronary Artery to Aorta for the Early Detection of Kawasaki Disease
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Timely diagnosis of coronary involvement is paramount in Kawasaki disease (KD) as it can be associated with long-term morbidity. However, echocardiographic measurements of coronary artery dilation in KD are inconsistent and not proficient for all abnormal arteries. The purpose of this study was to investigate more valuable indices and determine their sensitivity and specificity for early diagnosis of coronary involvement in KD. We performed this retrospective study in 218 children. All patients underwent laboratory and echocardiographic evaluations upon admission. We measured the size of the left main coronary artery (LMA), left anterior descending coronary artery (LAD), right coronary artery (RCA), and aorta (Ao), and calculated the LMA/Ao, LAD/Ao, and RCA/Ao ratios. We also calculated the cut-off values of each index using receiver operating characteristic curves. LMA, LAD, and RCA measurements did not correlate with white blood cell count, platelet count, erythrocyte sedimentation rate, C-reactive protein level, or brain natriuretic peptide level. The LMA measurement was associated with hemoglobin, hematocrit, and iron saturation. LAD/Ao was correlated with white blood cell and platelet counts (P < 0.05), whereas RCA/Ao was correlated with ferritin level (P < 0.05). The cut-off value of LMA/Ao was 0.2, with a sensitivity of 85% and specificity of 70%. Individual coronary artery/Ao ratios might provide helpful insight for detection of coronary abnormality in KD in the acute phase. Further investigation is essential to clarify prompt early diagnosis of coronary involvement in KD.
KeywordsKawasaki disease LMA/Ao LAD/Ao RCA/Ao z Score
Compliance with Ethical Standards
Conflict of interest
No potential conflict of interest relevant to this article was reported.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the by the institutional review board of Yonsei University College of Medicine and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- 4.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, American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention (2017) Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 135(17):e927–e999CrossRefGoogle Scholar
- 11.McCrindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, Vetter VL, Gersony WM, Mitchell PD, Newburger JW et al (2007) Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 116:174–179CrossRefPubMedGoogle Scholar
- 12.Dahdah N, Siles A, Fournier A, Cousineau J, Delvin E, Saint-Cyr C, Spiegelblatt L, Bonny Y, Vartian M, Montigny M (2009) Natriuretic peptide as an adjunctive diagnostic test in the acute phase of Kawasaki disease. Pediatr Cardiol 30:810–817. https://doi.org/10.1007/s00246-009-9441-2 CrossRefPubMedGoogle Scholar
- 19.Chen S, Dong Y, Kiuchi MG, Wang J, Li R, Ling Z, Zhou T, Wang Z, Martinek M, Purerfellner H, Liu S, Krucoff MW (2016) Coronary artery complication in Kawasaki disease and the importance of early intervention: a systematic review and meta-analysis. JAMA Pediatr 170(12):1156–1163CrossRefGoogle Scholar
- 20.Friedman KG, Gauvreau K, Hamaoka-Okamoto A, Tang A, Berry E, Tremoulet AH, Mahavadi VS, Baker A, deFerranti SD, Fulton DR, Burns JC, Newburger JW (2016) Coronary artery aneurysms in Kawasaki disease: risk factors for progressive disease and adverse cardiac events in the US population. J Am Heart Assoc 5(9):e003289CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Miura M, Kobayashi T, Kaneko T, Ayusawa M, Fukazawa R, Fukushima N, Fuse S, Hamaoka K, Hirono K, Kato T, Mitani Y, Sato S, Shimoyama S, Shiono J, Suda K, Suzuki H, Maeda J, Waki K, The Z-score Project 2nd Stage Study Group, Kato H, Saji T, Yamagishi H, Ozeki A, Tomotsune M, Yoshida M, Akazawa Y, Aso K, Doi S, Fukasawa Y, Furuno K, Hayabuchi Y, Hayashi M, Honda T, Horita N, Ikeda K, Ishii M, Iwashima S, Kamada M, Kaneko M, Katyama H, Kawamura Y, Kitagawa A, Komori A, Kuraishi K, Masuda H, Matsuda S, Matsuzaki S, Mii S, Miyamoto T, Moritou Y, Motoki N, Nagumo K, Nakamura T, Nishihara E, Nomura Y, Ogata S, Ohashi H, Okumura K, Omori D, Sano T, Suganuma E, Takahashi T, Takatsuki S, Takeda A, Terai M, Toyono M, Watanabe K, Watanabe M, Yamamoto M, Yamamura K (2018) Association of severity of coronary artery aneurysms in patients with Kawasaki disease and risk of later coronary events. JAMA Pediatr 172(5):e180030CrossRefPubMedGoogle Scholar