Clinical Management
Yiting Gui, n/a
Ph.D
Children's hospital of Fudan university
Shanghai, United States
Background: Kawasaki disease (KD) is a common vasculitis syndrome in children, typically leading to coronary artery lesions (CALs) and resulting in myocardial ischemia. This study aimed to investigate the association between KD children with coronary artery aneurysms (CAA) but without significant coronary artery stenosis (isolated CAA) and the occurrence of myocardial ischemia. Additionally, the study sought to summarize the potential CAA characteristics that may contribute to a higher susceptibility to myocardial ischemia.
Methods: A total of 107 KD children with isolated CAA were enrolled in this study, confirmed to have coronary artery lessons (CAL) but without significant stenosis ( < 50%) through coronary angiography. Noninvasive clinical assessments, including 99mTc myocardial perfusion imaging (MPI), cardiovascular magnetic resonance imaging (CMRI), echocardiograms, and comprehensive electrocardiogram-related examinations (CEEs), were conducted to evaluate myocardial ischemia. Logistic univariate and multivariate analysis were employed to investigate the association between isolated CAA and myocardial ischemia, along with the identification of risk-related distinguishing features of CAA.
Results: Among the 107 subjects, 68 presented with giant coronary artery aneurysms (GCA) exhibiting a myocardial ischemia occurrence rate of 50%, significantly higher than the 28.2% rate in KD patients without GCA (p < 0.05). Further analysis revealed that the CAA diameter, z score, length, GCA number and thrombosis were influencing factors for myocardial ischemia. When the CAA diameter ≥ 15mm, or Z score ≥ 35 or length ≥ 40, even without stenosis, the ratio of myocardial ischemia in KD patients was almost 100%.
Conclusion: In this study, isolated CAA in KD children was found to potentially lead to myocardial ischemia, with its diameter, length, number and thrombosis being significant determinants. The relationship between CAA and myocardial ischemia and the determination of length and size hazard thresholds provided essential insights for the long-term management and therapy guidance of isolated CAA, which is significant for the prognosis of KD children.