Acute Kawasaki disease with emphasis on the echocardiographic profile: A single center experience

Abstract

Background: Echocardiographic features of acute Kawasaki disease (KD) have not been well characterized in Egyptian children. This study aimed to provide insight into the pattern of cardiac involvement in Egyptian children with Kawasaki disease, focusing on echocardiographic coronary abnormalities and their associated risk predictors.Methods and Results: Medical records of 64 KD patients from 2012 to 2016 were retrospectively analyzed with recalculation of coronary artery z-scores during the first eight weeks after fever onset. All patients received intravenous immunoglobulin (IVIG) and 57.8% were treated within 10 days of illness onset. Coronary abnormalities were found in 53.1% of all patients, and in 43.2% of those who received IVIG within 10 days. Giant aneurysms (z-score>10) comprised 23.5% of all coronary abnormalities. Coronary thrombosis occurred in two patients (5%), both of whom developed myocardial infarction, and one succumbed to heart failure with eventual in-hospital death. Overall, 7% of patients had mitral regurgitation (n = 5), 1.5% had aortic regurgitation (n = 1), and 7.8% had pericardial effusion (n = 5). Among a number of laboratory and clinical predictors, platelet count had the strongest association with coronary abnormalities (Area under Receiver-operating characteristic (ROC) curve: 0.794; 95% confidence interval 0.678–0.910; P < 0.001).Conclusion: Coronary abnormalities occur in a substantial percentage of KD in Egypt, with associated evidence of severe inflammation. Further efforts are required to increase awareness of the disease and to emphasize the importance of early IVIG administration. Future studies should also be undertaken to characterize the long term progression profile of the disease as well as the possible genetic background of the disease in Egypt.

Doença de Kawasaki: Preditores de Resistência à Imunoglobulina Intravenosa e Complicações Cardíacas

“…Das complicações cardíacas em fase aguda mais graves destacaram-se três casos de disfunção ventricular esquerda, um com choque cardiogénico e um BAV de 1º grau, complicações essas também descritas na literatura. 2,7 Na fase aguda, foi ainda possível observar 10 pacientes com derrame pericárdico sem compromisso hemodinâmico e três com insuficiência valvular mitral ligeira. Em Paris, Chbeir et al 22 obtiveram relação estatisticamente significativa entre resistência à IGIV, AAC e achados na ecografia cardíaca inicial, tais como derrame pericárdico, hiperecogenicidade das coronárias e dilatação coronária.…”

“…2 Apesar de o envolvimento coronário ser a consequência mais temida da doença, são possíveis outras complicações cardíacas. 2,[6][7][8] O tratamento com imunoglobulina intravenosa (IGIV) na fase aguda continua a ser a principal terapêutica e, se administrada nos primeiros 10 dias de doença, diminui a incidência de AAC para 4%. 2 A resistência à IGIV ocorre em 10% a 20% dos casos, aumentado a probabilidade de envolvimento coronário.…”

Evaluation of high-dose aspirin elimination in the treatment of Kawasaki disease in the incidence of coronary artery aneurysm

“…meta-analysis was lower than our study. However, in the study of Hamza et al .,[ 19 ] the CAA incidence was 53.8%, and in Zhang's coherent study,[ 20 ] the incidence was 63.3%. Hence, Zhang's coherent trial had a higher CAA incidence than our study.…”

Clinical observation of noncoronary cardiac abnormalities in Chinese children with Kawasaki disease

“…In Mexico, Garrido‐García et al 19 analysed the data of 508 KD patients and revealed that pericardial effusion was observed in 15% of patients, myocardial involvement occurred in 9.9% of patients, and electrographic abnormalities were present in 5.5% of patients. In Egypt, Hamza et al 20 retrospectively reviewed the medical records of 64 KD patients and found that endocardial dysfunction was identified in 8.5% of patients and pericardial effusion was detected in 7.8% of patients. During a 5‐year period (1998 to 2002), another prospective study from Shanghai, China, indicated that myocarditis and pericardial effusion were identified in 9% and 7% of 768 KD patients, respectively 21 .…”