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Long-Term Cardiovascular Consequences of Kawasaki Disease

February 4, 2014

Long-Term Cardiovascular Consequences of Kawasaki Disease

  1. Robert S. Baltimore, MD

Follow-up of young children with Kawasaki disease demonstrated a very low rate of cardiovascular adverse events during the subsequent 15 years.

  1. Robert S. Baltimore, MD

The major adverse consequence of Kawasaki disease (KD) is coronary-artery aneurysm formation. Newburger and colleagues' study demonstrating that intravenous immune globulin (IVIG) treatment reduces the aneurysm rate was published in 1986 (N Engl J Med 1986; 315:341); subsequently, such treatment became the standard of care. Few data are available on the long-term outcomes of KD in a U.S. population during the post-IVIG treatment era.

In a recent retrospective cohort study, researchers used the medical records of Kaiser Permanente Northern California — a group health practice with >3.2 million members — to examine outcomes of KD survivors. Members aged ≥15 years with a history of KD at age ≤5 years were matched to controls without KD in a 4:1 ratio.

Among 546 KD case-patients with follow-up of ≥1 year, 79% were treated with IVIG. For most of the patients, KD was diagnosed between 1990 and 1998. Thirteen percent had some degree of coronary enlargement during the acute stage, but only 5% had persistent aneurysms. During a mean follow-up of 14.9 years, cardiovascular adverse event rates were similar between the KD patients and controls. Among the KD patients with persistent aneurysms were five children with serious long-term complications, including sudden cardiac death. KD patients were slightly more likely than controls to develop hypertension, which may be a result of arterial stiffness following inflammation.

Comment

Despite published cases of late cardiovascular complications from Kawasaki disease, the findings from this large study suggest that the rate of adverse cardiovascular events is quite low — at least through age 21 years. These data may be helpful for planning medical follow-up of children with acute KD.

  • Disclosures for Robert S. Baltimore, MD at time of publication Editorial boards Current Opinion in Pediatrics; Infectious Diseases in Children

Citation(s):

Reader Comments (4)

Raza Soomro FRCPI Physician, Cardiology, King Fahad Hospital at Al- Baha, Saudi Arabia

I followed up the first case diagnosed to have KD at KFH Baha, Saudi Arabia in early 1990s. He started with Coronary Arteries Aneurysms, went on to have recurrent Myocardial Infarctions followed by ischemic cardiomyopathy and Heart Failure at age 9 years.

Sunthorn Sumethasorn Physician, Pediatrics/Adolescent Medicine, Public Health

It would be interesting to look at the incidence of pre-hypertension, hypertension between the 2 groups. Also, revisit same outcomes 20-30 years after the diagnosis.

Jan M. Orenstein, MD, PhD Physician, Pathology, Retired

The PLoS ONE paper 2012:7(6):e38998 demonstrates that the long term vasculopathy of primary significance is not necessarily associated with coronary artery aneurysms (CAA). It appears to be the chronic arteritis and especially the unique luminal myofibroblastic proliferation which causes progressive stenosis that can extensively involve the main coronary arteries. The only way to understand the long term clinical significance, is by routinely autopsying individuals with a history of KD and/or sudden unexpected death.

luigi nespoli Physician, Pediatrics/Adolescent Medicine, varese -Italy

These data are very important and reassuring for the parents and for the patients.
Do we have any data on the late effects of ASA and steroids.?
Bets regards,

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