Skip to main content

Advertisement

Log in

Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Background

In 2017, the AHA published revised guidelines for the diagnosis of Kawasaki disease (KD). In the absence of compelling data supporting or refuting the utility of lack of tapering (LT) and perivascular brightness (PB), expert panel consensus removed LT and PB from consideration. We hypothesize that LT and PB are unreliable, subjective findings, non-specific to KD, which can be seen in systemic febrile illnesses without KD and in normal controls.

Methods

We performed a single-center retrospective study from 1/2008 to 12/2016. De-identified coronary artery (CA) echocardiographic clips from patients 0–10 years old were interpreted blindly by six pediatric cardiologists. Subjects were grouped as follows: (1) healthy: afebrile with benign murmur, (2) KD: IVIG treatment, 4–5 clinical criteria at presentation, (3) incomplete KD (iKD): IVIG, 1–3 clinical criteria, (4) Febrile: ≥3 days of fever, no IVIG, KD not suspected. The presence or absence of LT and PB was recorded. Inter-rater and intra-rater reliabilities were analyzed using intra-class correlation coefficient, Fleiss’ Kappa and Cohen’s Kappa coefficients.

Results

We interpreted 117 echocardiograms from healthy (27), KD (30), iKD (32), and febrile (28) subjects. Analysis showed moderate agreement in CA z score measurements. LT and PB were observed by most readers in control groups. LT exhibited fair inter-reader agreement (reliability coefficient 0.36) and PB slight inter-reader agreement (reliability coefficient 0.13). Intra-rater reliability was inconsistent for both parameters.

Conclusions

LT and PB are subjective, poorly reproducible features that can be seen in febrile patients without KD and in healthy children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

KD:

Kawasaki disease

iKD:

Incomplete Kawasaki disease

LT:

Lack of tapering

PB:

Perivascular brightness

CA:

Coronary artery

IVIG:

Intravenous immunoglobulins

echo:

Echocardiogram

LMCA:

Left main coronary artery

LAD:

Left anterior descending artery

RCA:

Right coronary artery

BSA:

Body surface area

References

  1. Son MBF, Newburger JW (2013) Kawasaki disease. Pediatr Rev 34(4):151–162

    Article  PubMed  Google Scholar 

  2. Dajani AS, Taubert KA, Gerber MA et al (1993) Diagnosis and therapy of Kawasaki disease in children. Circulation 87(5):1776–1780

    Article  CAS  PubMed  Google Scholar 

  3. Kato H, Sugimura T, Akagi T et al (1996) Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 94(6):1379–1385

    Article  CAS  PubMed  Google Scholar 

  4. Fujiwara H, Hamashima Y (1978) Pathology of the heart in Kawasaki disease. Pediatrics 61(1):100–107

    CAS  PubMed  Google Scholar 

  5. Yutani C, Okano K, Kamiya T et al (1980) Histopathological study on right endomyocardial biopsy of Kawasaki disease. Br Heart J 43(5):589–592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. McCrindle BW, Rowley AH, Newburger JW et al (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–e999

    Article  PubMed  Google Scholar 

  7. Newburger JW, Takahashi M, Gerber MA et al (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 114(6):1708–1733

    Article  PubMed  Google Scholar 

  8. Baer AZ, Rubin LG, Shapiro CA et al (2006) Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome. Arch Pediatr Adolesc Med 160(7):686–690

    Article  PubMed  Google Scholar 

  9. Minich LL, Sleeper LA, Atz AM et al (2007) Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics 120(6):e1434–e1440

    Article  PubMed  Google Scholar 

  10. Sonobe T, Kiyosawa N, Tsuchiya K et al (2007) Prevalence of coronary artery abnormality in incomplete Kawasaki disease. Pediatr Int 49(4):421–426

    Article  PubMed  Google Scholar 

  11. Wyman L (2009) Echocardiography in pediatric and congenital heart disease: from fetus to adult. West Sussex, Hoboken

    Google Scholar 

  12. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  Google Scholar 

  13. Newburger JW, Taubert KA, Shulman ST et al (2003) Summary and abstracts of the seventh international Kawasaki disease symposium: December 4–7, 2001, Hakone, Japan. Pediatr Res 53:153

    PubMed  Google Scholar 

  14. Yu JJ, Jang WS, Ko HK et al (2011) Perivascular brightness of coronary arteries in Kawasaki disease. J Pediatr 159(3):454–457 e451

    Article  PubMed  Google Scholar 

  15. Abe O, Karasawa K, Hirano M et al (2010) Quantitative evaluation of coronary artery wall echogenicity by integrated backscatter analysis in Kawasaki disease. J Am Soc Echocardiogr 23(9):938–942

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Edon J. Rabinowitz.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest relevant to this article to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

A waiver of informed consent was obtained from the Northwell Health institutional review board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rabinowitz, E.J., Rubin, L.G., Desai, K. et al. Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease. Pediatr Cardiol 40, 147–153 (2019). https://doi.org/10.1007/s00246-018-1971-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-018-1971-z

Keywords

Navigation