Coronary artery abnormalities (CAAs) are a severe complication of Kawasaki disease (KD) that may lead to cardiovascular events. Given the evidence that brachial artery flow-mediated dilation (FMD) decreases in children after the onset of KD, we hypothesized that it could be an early marker of CAA development in the acute stage and investigated its relationship with variation in the coronary artery diameter. A total of 326 sex- and age-matched children were enrolled, including 120 with KD, 109 febrile children and 97 healthy controls. In this study, FMD was significantly decreased in the KD group compared with the febrile and healthy groups. FMD was lower in the CAA group than in the no coronary artery abnormality group. The comparison of FMD showed an obvious difference among the CAA subgroups. The FMD in the coronary aneurysm (CA) group showed a strong negative correlation with the pretreatment maximum coronary artery Z-score (preZmax). While preZmax was 2.5, the receiver operating characteristic curve indicated an optimal cutoff point of 3.44% for FMD. FMD ≤ 3.44% could be considered as a signal of coronary lesions in acute stage of KD.
Purpose Clinically, some children with Kawasaki disease (KD) who do not respond to the rst application of gamma globulin therapy have a longer course of disease and a higher risk of coronary artery damage. The characteristics of vascular endothelial dysfunction in intravenous immune globulin (IVIG)-resistant patients during the acute phase are not well described. We aimed to determine whether indicators that detect the situation of the endothelium are useful parameters that can accurately re ect subclinical dysfunction in resistant patients and may assist in differentiating patients with KD at a higher risk of IVIG resistance.Methods Fifty IVIG-resistant KD children, 120 IVIG-responsive KD children, 70 febrile children with acute upper respiratory infection and 100 healthy controls were recruited, and indicators re ecting endothelial in ammation, including ow-mediated dilation (FMD), were measured. Receiver operating characteristic (ROC) curve analysis was utilized to determine the threshold values of these parameters associated with IVIG resistance. Multiple logistic regression analysis was performed to determine whether FMD was an independent predictor of IVIG-resistant patients.Results Compared with normal children, febrile children and IVIG-sensitive KD patients, IVIG-resistant patients had lower FMD (P<0.05) and higher carotid artery intima-media (CIMT) (P<0.05). Laboratory data demonstrated that the percentage of neutrophils (N %) and the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and serum procalcitonin (PCT) were signi cantly higher in the IVIG-resistant group than in the IVIG-responsive group, while the levels of albumin (ALB) and serum sodium were signi cantly lower (P< 0.05). PCT, Na+ and FMD exhibited AUCs of 0.727, 0.653 and 0.698, respectively, in predicting IVIG resistance in KD through ROC analysis. PCT > 1.69 ng/ml, Na+ <133.2 mmol/l and FMD <5.79% were independent predictors of IVIG resistance in KD (OR, 95% CI, P< 0.05).Conclusion More severe endothelial dysfunction, especially lower FMD, was present in IVIG-resistant patients than in IVIGresponsive patients. It is a helpful diagnostic tool that provides supportive criteria to detect KD patients at a higher risk of IVIG resistance when FMD<5.79% in children. What Is KnownChildren with Kawasaki disease have declined FMD and Stiffness index (SI) values, as well as raised carotid intima media thickness (CIMT) which are related to the severity of endothelial dysfunction in later stage after the onset.What is new 1. FMD is lower and CIMT is higher in KD patients with IVIG-resistance than those without, in the acute stage. 2. FMD and PCT have a negative relationship with each other, and FMD<5.79% reminds a chance of IVIG-resistance.
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