Age Dependency of Stiffness of the Abdominal Aorta and the Mechanical Properties of the Aorta in Kawasaki Disease in Children

Okubo, Mataichi; Ino, Toshihiro; Takahashi, Ken; Kishiro, Masahiko; Akimoto, Katsumi; Yamashiro, Yuichiro

doi:10.1007/s002460010203

Cited by 32 publications

(27 citation statements)

References 31 publications

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“…In a study that compared 40 KD patients without coronary artery aneurysms to 168 healthy children, aortic diameter was measured at both minimum diastolic pressure and maximum systolic pressure by 2D echocardiography; this study found that aortic distensibility varies with age in normal children. 290 It was low in infants, increased gradually to peak during the ages 10 to 15 years, and decreased with age thereafter. For KD patients, aortic stiffness was increased during the acute illness and was normal during convalescence.…”

Section: Aortic Abnormalitiesmentioning

confidence: 96%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,582

3,844

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Aortic Abnormalitiesmentioning

confidence: 96%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,582

3,844

View full text Add to dashboard Cite

show abstract

“…In addition, limited echocardiographic evidence of aortic dilatation in the acute and subacute phases of the disease suggests that aortic wall inflammation may as well be present in non-lethal cases [23,26]. Several case studies have attempted to point out that KD is systemic in nature and may affect other than the coronary vessels, such as the aorta [1,3,24]. However, no study up until today has explored the clinical effects of aortitis in KD.…”

Section: Introductionmentioning

confidence: 97%

Ascending Aorta Elastography After Kawasaki Disease Compared to Systemic Hypertension

et al. 2015

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Kawasaki disease (KD) is a systemic vasculitis, classically affecting large- and medium-size arteries. The coronary arteries draw most of the clinical attention, whereas few studies have taken interest in the ascending aorta. Using a proprietary imaging-based mechanical biomarker (ImBioMark), we sought to determine aortic stiffness in KD compared to systemic hypertension (HTN) and healthy children. We evaluated parasternal long-axis views focused on the ascending aorta in 20 controls, 12 KD, and 8 HTN as a comparative clinical model of vascular stiffness. We calculated systolic and diastolic aortic wall strain with ImBioMark. Strain was tested for normality against height, systolic, and diastolic blood pressure in normal subjects. Strain from KD and HTN was normalized (Z score) accordingly. Z score comparisons were performed using nonparametric statistics. Age was similar between KD and HTN (9.1 ± 5.3 and 9.9 ± 5.3 years old; p = NS). Systolic and diastolic strain values were normally distributed against height, systolic blood pressure, and diastolic blood pressure in healthy subjects. HTN subjects had abnormal systolic and diastolic strain values (p < 0.0001). Whereas KD subjects had normal diastolic strain, systolic strain was significantly lower (p < 0.001), and systolic strain was intermediate between controls and HTN. There were no significant differences in aortic strain among KD, however, according to the presence of coronary artery aneurysms. Despite normal blood pressure, the ascending aorta in KD exhibits reduced strain during systole. This may reflect in situ rigidity of the aorta. The normal diastolic strain in KD may, in contrast, reflect normal peripheral vascular resistance.

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“…Also, the choice of method to pick up arterial stiffness may also have affected the results. It is also feasible that re-evaluation after a longer follow-up may be able to show differences better as documented by Okubo et al [16].…”

Section: Discussionmentioning

confidence: 76%

“…Previously, many authors have documented higher arterial stiffness in patients with KD using different methods to assess the same. Okubo et al [16] using twodimensional echocardiography showed that aortic stiffness was high during the acute phase of KD and became normal in subacute phase. This was postulated to be due to the inflammation of vessel wall during the acute phase.…”

Section: Discussionmentioning

confidence: 98%

Aortic stiffness studies in children with Kawasaki disease: preliminary results from a follow-up study from North India

et al. 2014

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Kawasaki disease (KD) is an acute medium vessel vasculitis seen in children. Coronary artery abnormalities are the most notable long-term complications. Intravenous immunoglobulin therapy has led to significant reduction in incidence of coronary aneurysms. However, higher risk of cardiovascular disease has been noted even in those children who have never been reported to develop coronary artery aneurysms during the subacute phase. Noninvasive estimation of this cardiovascular risk is useful in initiating timely preventive strategies. Arterial stiffness has been shown to be an independent predictor of cardiovascular events in general population. This study was aimed at measuring abdominal aorta stiffness in a cohort of children with KD from North India. Thirty children diagnosed to have KD at least 5 years prior to enrollment were evaluated by echocardiography for cardiac and abdominal aorta studies. Electrocardiographs were done in all patients for QT dispersion. There was a noticeable trend toward lower aortic strain, higher pressure strain elastic modulus and normalized pressure strain elastic modulus in children in the study group, though this difference did not reach statistical significance. Mean corrected QT dispersion was significantly higher in cases compared with controls. On cardiac evaluation, none of the subjects had any residual coronary artery involvement. A trend toward lower distensibility and higher stiffness of abdominal aorta was seen in cases compared with controls, though it was not found to be statistically significant. This could be a predictor of premature atherosclerosis in long term. Significantly higher QT dispersion was seen in cases compared with controls. More multicentric studies with larger sample size and longer follow-up periods are needed to clarify this issue.

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Age Dependency of Stiffness of the Abdominal Aorta and the Mechanical Properties of the Aorta in Kawasaki Disease in Children

Cited by 32 publications

References 31 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Ascending Aorta Elastography After Kawasaki Disease Compared to Systemic Hypertension

Aortic stiffness studies in children with Kawasaki disease: preliminary results from a follow-up study from North India

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