Retrospective study of the impact of unrecognised Kawasaki disease, coronary aneurysm and ectasia

Waterhouse, Benjamin R.; Tulloh, Robert; Kim, Yongcheol; Creasy, Will; Adlam, David; Johnson, Tom

doi:10.1016/j.ijcard.2017.08.018

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…It has been documented that if untreated, Kawasaki disease may progress to CAA in up to 25% of patients [13-14]. Remarkably, Kawasaki disease in our study was seen the least out of all the comorbidities associated with CAA, at a prevalence rate of almost one-quarter of that described in the literature.…”

Section: Discussionsupporting

confidence: 48%

Coronary Artery Aneurysms: Analysis of Comorbidities from the National Inpatient Sample

Tandon

Kumar

et al. 2019

Cureus

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Introduction Coronary artery aneurysms (CAA) are not commonly seen in the general population, with an incidence of approximately 0.37% to 2.53%. Patients are typically asymptomatic but symptomatic presentation varies from dyspnea and angina to myocardial infarction or even sudden cardiac death. Methods We conducted a retrospective analysis using the National Inpatient Sample Healthcare Cost and Utilization Project (NIS-HCUP) database to query individuals with the diagnosis of CAA with the International Classification of Disease (ICD) code 414.11 in all discharge diagnoses for the years 2006-2014. History of Kawasaki disease was determined by ICD code 446.1. Results From 2006 to 2014, there were 23,033 patients identified with CAA, correlating to approximately one case per 10,000 patients or an incidence of close to 0.01%. Of this, 1,405 or approximately 6.1% of these patients had Kawasaki disease. The mortality rate of CAA was 1.79%. In terms of demographics, Caucasians were the most likely to develop CAA, with 73.8% of cases. The mean age was 61.2 years, with a mean length of stay of 5.1 days. The average cost of admission was $70892. The presence of perivascular disease (15.5% vs 4.5% p<0.05), hypertension (66.1% vs 39.1% p<0.05), chronic lung disease (20.2% vs 15.1% p<0.05), diabetes (21.7% vs 15% p<0.05), renal failure (11% vs 8.8% p<0.05), coagulopathy (6.2% vs 3.4% p<0.05), and obesity (13.1% vs 8.2% p<0.05) were all risk factors for CAA as compared to those without. It was noted that weight loss (3.28% vs 1.91% p<0.05), electrolyte abnormalities (18.2% vs 15.5% p<0.05), and blood loss (2.1% vs 0.9% p<0.05) were protective of CAA. Conclusion CAA risk factors appear to be similar to those of coronary artery disease risk factors, with hypertension, diabetes, perivascular disease, and renal failure. Additionally, obesity was noted to be a risk factor but weight loss appeared to be protective. Interestingly, Kawasaki disease was seen at almost similar rates as these cardiac risk factors. The incidence of CAA we found, of almost 0.01%, is much less than in the quoted literature, however, previous studies did not have as many cases as our study.

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Section: Discussionsupporting

confidence: 48%

Coronary Artery Aneurysms: Analysis of Comorbidities from the National Inpatient Sample

Tandon

Kumar

et al. 2019

Cureus

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“…Previous studies have demonstrated that thrombosis and embolisation of the involved segments are the leading cause of acute MI in patients with coronary artery dilation 11,12 . In our previous report focusing on the abnormal cohort, despite low prevalence (3.4%) in patients under 50 years of age, 71.4% of all patients with coronary artery dilation presented with an acute ST-elevation myocardial infarction 3 . Furthermore, angiographic signs of turbulent and stagnant flow, have been demonstrated in patients with coronary artery dilation by using doppler velocity and thrombolysis in myocardial infarction (TIMI) frame count method, an index of coronary flow velocity 13,14 .…”

Section: Discussionmentioning

confidence: 83%

“…Study population and definitions of each group. We have previously reported the prevalence of aneurysmal and ectatic disease within an unselected population of 1437 patients, under 50 years-of-age, that underwent coronary angiography between 2011 and 2015, at the Bristol Heart Institute, Bristol, UK 3 . We have extended the analysis to include two further populations from this cohort: patients found to have angiographically normal arteries, with or without a history of diabetes mellitus.…”

Section: Methodsmentioning

confidence: 99%

“…2B). The absolute values produced by observer 1 versus observer 2 were very similar (867 ± 415 mm 3 vs. 893 ± 486 mm 3 for the diabetic group [n = 5], 1673 ± 494 mm 3 vs. 1668 ± 486 mm 3 for the normal group [n = 9], and 1644 ± 568 mm 3 vs. 1647 ± 608 mm 3 [n = 15] for the abnormal group). Furthermore, the intraclass correlation coefficient values for the measurements of LAD, LCX, and RCA were 0.963, 0.978, and 0.999, respectively, demonstrating excellent inter-observer measurement consistency (see Table S5 in supplementary material).…”

Section: Data Of Length and Lumen Diameter Of Coronary Arteries By 3dmentioning

confidence: 97%

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Quantitative evaluation and comparison of coronary artery characteristics by 3D coronary volume reconstruction

Kim

Bray

Waterhouse

et al. 2021

Sci Rep

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Non-atherosclerotic abnormalities of vessel calibre, aneurysm and ectasia, are challenging to quantify and are often overlooked in qualitative reporting. Utilising a novel 3-dimensional (3D) quantitative coronary angiography (QCA) application, we have evaluated the characteristics of normal, diabetic and aneurysmal or ectatic coronary arteries. We selected 131 individuals under 50 years-of-age, who had undergone coronary angiography for suspected myocardial ischaemia between 1st January 2011 and 31st December 2015, at the Bristol Heart Institute, Bristol, UK. This included 42 patients with angiographically normal coronary arteries, 36 diabetic patients with unobstructed coronaries, and 53 patients with abnormal coronary dilatation (aneurysm and ectasia). A total of 1105 coronary segments were analysed using QAngio XA 3D (Research Edition, Medis medical imaging systems, Leiden, The Netherlands). The combined volume of the major coronary arteries was significantly different between each group (1240 ± 476 mm3 diabetic group, 1646 ± 391 mm3 normal group, and 2072 ± 687 mm3 abnormal group). Moreover, the combined coronary artery volumes correlated with patient body surface area (r = 0.483, p < 0.01). Inter-observer variability was assessed and intraclass correlation coefficient of the total coronary artery volume demonstrated a low variability of 3D QCA (r = 0.996, p < 0.001). Dedicated 3D QCA facilitates reproducible coronary artery volume estimation and allows discrimination of normal and diseased vessels.

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“…Clinical consequences of missed KD can present as coronary ischemia in early adulthood[ 56 , 57 ]. Due to lack of adequate awareness amongst adult cardiologists, such patients may never get recognized as having had late complications due to missed childhood KD[ 57 ].…”

Section: Controversies In Diagnosis Of Kdmentioning

confidence: 99%

Controversies in diagnosis and management of Kawasaki disease

Pilania

Bhattarai

Singh

2018

WJCP

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Kawasaki disease (KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.

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Retrospective study of the impact of unrecognised Kawasaki disease, coronary aneurysm and ectasia

Cited by 9 publications

References 28 publications

Coronary Artery Aneurysms: Analysis of Comorbidities from the National Inpatient Sample

Coronary Artery Aneurysms: Analysis of Comorbidities from the National Inpatient Sample

Quantitative evaluation and comparison of coronary artery characteristics by 3D coronary volume reconstruction

Controversies in diagnosis and management of Kawasaki disease

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