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

Rabinowitz, Edon J; Rubin, Lorry G.; Desai, Kinjal; Hayes, Denise A.; Tugertimur, Aykut; Kwon, Elena; Dhanantwari, Amar; Misra, Nilanjana; Stoffels, Guillaume; Blaufox, Andrew D.; Mitchell, Elizabeth

doi:10.1007/s00246-018-1971-z

Cited by 9 publications

(4 citation statements)

References 14 publications

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“…Os autores desse estudo não consideraram a hiperecogenicidade e o afunilamento das coronárias como fatores relevantes, visto que são achados subjetivos, pouco reprodutíveis e podem ser encontrados tanto em doenças febris como em crianças saudáveis. 23 Na fase crônica, um paciente manteve envolvimento do sistema de condução e dilatação do VE e outro ficou com hipertrofia do VE. As repercussões cardíacas a longo prazo na DK estão ainda pouco esclarecidas.…”

Section: Discussionunclassified

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

Faim¹,

Henriques²,

Brett

et al. 2021

Arquivos Brasileiros De Cardiologia

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Fundamento: A doença de Kawasaki (DK) é a principal causa de cardiopatia adquirida em idade pediátrica nos países desenvolvidos. Objetivos: Identificar fatores preditores de resistência à imunoglobulina intravenosa (IGIV), calcular a eficácia dos modelos preditores japoneses e caracterizar as complicações cardíacas. Métodos: Análise retrospectiva dos casos de DK entre janeiro de 2006 e julho de 2018 em um hospital pediátrico português. Foram construídas curvas ROC para encontrar fatores preditores de resistência e utilizada regressão logística multivariada para elaborar o modelo preditor. O nível de significância utilizado foi de 5%. Resultados: Foram incluídos 48 pacientes com mediana de idade de 36 meses. Verificou-se resistência à IGIV em 21%. Ocorreram alterações ecocardiográficas em 46%, com envolvimento coronário em 25%. Como variáveis preditoras de resistência, a proteína C-reativa (PC-R) apresentou uma AUC ROC = 0,789, ponto de corte = 15,1 mg/dL, sensibilidade (S) = 77,8% e especificidade (E) = 78,9%. A velocidade de sedimentação (VS) apresentou uma AUC ROC = 0,781, ponto de corte = 90,5 mm/h, S = 66,7% e E = 85,7%. O modelo com as duas variáveis apresentou valor p = 0,042 e AUC ROC = 0,790.

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Section: Discussionunclassified

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

Faim¹,

Henriques²,

Brett

et al. 2021

Arquivos Brasileiros De Cardiologia

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“…This can also mean that both sexes have the same chance of developing echocardiographic findings but boys are more at risk of a poor outcome when an abnormal echocardiographic feature is found [17]. The most common echocardiographic finding was perivascular brightness, which according to other studies is not considered as a proper sign for diagnosis of KD [18]. Aneurysms were discovered in around 35% of the patients with cardiovascular complications and counts as one of the most important cardiac finding in all studies [19].…”

Section: Discussionmentioning

confidence: 98%

Assessing the Association of Kawasaki Disease Symptoms and Echocardiographic Findings

et al. 2021

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Kawasaki disease is an acute systemic vasculitis which can cause cardiac involvement among other symptoms. In this study we aimed to assess the relationship between the echocardiographic findings of Kawasaki disease with the clinical and paraclinical findings of the patients. In this cross-sectional study, the symptoms of 307 Kawasaki patients were registered and the association of the symptoms with paraclinical findings and echocardiographic studies was assessed. 190 (61.9%) of the patients were male and 117 (38.1%) were female. 193 patients (62.9%) did not have any abnormalities in their echocardiography, while others showed coronary artery aneurysms, perivascular brightness, coronary artery dilatation, and trivial Mitral Regurgitation in their echocardiography. A significant inverse relationship was seen with echocardiographic findings and age. Thrombocytosis, conjunctivitis, and oral and/or pharyngeal erythema and/or strawberry tongue were associated with higher rates of echocardiographic abnormalities. Echocardiographic abnormalities are associated with younger age, higher platelets, and the existence of conjunctivitis and oral and/or pharyngeal erythema and/or strawberry tongue.

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“…Additionally, PB was suggested as a useful diagnostic sign of incomplete presentation of KD in the 2004 AHA diagnostic guideline [4]. However, Yu et al [8] did not confirm the utility of PB, and Rabinowitz et al [9] reported similar results. In the present study, among patients with ≤3 d-Features, two patients showed a small aneurysm and 17 patients showed PB.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Kawasaki Disease Presenting with Limited and Faint Principal Clinical Features

et al. 2022

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Background: We examined the characteristics of Kawasaki disease (KD) patients who presented with limited and faint principal clinical features. Methods: We retrospectively reviewed the clinical records of 62 KD patients who presented with limited and faint clinical features at admission. A clinical feature that was recognizable by even junior doctors was defined as a definite feature (d-Feature), and a feature that was faint and recognizable by only experienced doctors was defined as a faint feature (f-Feature). Results: At admission, 82% of patients presented with fever and ≤1 d-Feature. Two days later, the d-Features increased in number and diagnoses of KD were established in 32 patients with fever and ≥4 d-Features. In 30 patients with ≤3 d-Features, experienced doctors recognized f-Features and diagnosed KD in 22 patients because of fever and ≥4 features. Among eight patients with ≤3 features, experienced doctors diagnosed six patients as incomplete KD considering their faint abnormal echocardiographic findings. For the remaining two patients, experienced doctors decided to commence KD treatments considering the patients’ clinical course. Conclusions: Sufficient clinical experience is essential during the diagnosis of KD in patients presenting with limited and f-Features. Educational programs for junior doctors on how to recognize f-Features and evaluate faint abnormal coronary artery findings are necessary.

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

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

Cited by 9 publications

References 14 publications

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

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

Assessing the Association of Kawasaki Disease Symptoms and Echocardiographic Findings

Diagnosis of Kawasaki Disease Presenting with Limited and Faint Principal Clinical Features

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