Cargando…

Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease

Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which diffe...

Descripción completa

Detalles Bibliográficos
Autores principales: Liu, Jie, Yue, Qiaoyu, Qin, Suyuan, Su, Danyan, Ye, Bingbing, Pang, Yusheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505689/
https://www.ncbi.nlm.nih.gov/pubmed/36158849
http://dx.doi.org/10.3389/fcvm.2022.969495
_version_ 1784796535724179456
author Liu, Jie
Yue, Qiaoyu
Qin, Suyuan
Su, Danyan
Ye, Bingbing
Pang, Yusheng
author_facet Liu, Jie
Yue, Qiaoyu
Qin, Suyuan
Su, Danyan
Ye, Bingbing
Pang, Yusheng
author_sort Liu, Jie
collection PubMed
description Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which differ in size and emergence time, and track its regression within 3 years of onset. The laboratory data, clinical features, and coronary artery outcomes of patients, who were diagnosed with KD and received treatment from January 2003 to January 2019 were retrospectively analyzed. A total of 484 pediatric patients with KD were examined during the study period. Among them, 130 (26.9%) presented with CAA, including mid- to large-sized CAA in 38 patients (7.9%) and de novo CAA after intravenous immunoglobulin (IVIG) treatment in 22 patients (4.5%). Albumin-to-globin (A/G) ratio was significantly negatively associated with the absolute internal diameter of coronary artery at 1 month of onset and may be used as a predictor of mid- to large-sized CAA development in patients with KD. The area under the receiver operating characteristic curve was 0.637 (95% confidence interval: 0.551–0.724), and a cutoff of 1.32 yielded a sensitivity and specificity of 79 and 49%, respectively, for predicting mid- to large-sized CAA development. De novo CAA after IVIG may lead to an increased risk of developing progressive CAA [13 (59.1%) of 22 vs. 31 (28.7%) of 108; P = 0.006] and had significantly greater changes in both the magnitude of CAA dimension variation and maximum z-score of the coronary arteries at 2 and 4 weeks and then 3 months after onset (P < 0.001). Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in the progressive CAA group than in the non-progressive CAA group (25 vs. 4 months, P < 0.001), as well as among the three groups of patients (giant CAA > medium-sized CAA > small-sized CAA, P < 0.001). Children with KD who had low A/G ratio were more likely to develop mid- to large-sized CAA. Nevertheless, de novo CAA after IVIG treatment may increase the risk of more severe arterial damage and development of progressive coronary artery damage; and both mid- to large-sized and de novo CAA could dramatically prolong coronary artery normalization time. Thus, aggressive risk modifications should be employed, and close monitoring with frequent echocardiography is needed for this vulnerable patient population.
format Online
Article
Text
id pubmed-9505689
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-95056892022-09-24 Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease Liu, Jie Yue, Qiaoyu Qin, Suyuan Su, Danyan Ye, Bingbing Pang, Yusheng Front Cardiovasc Med Cardiovascular Medicine Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which differ in size and emergence time, and track its regression within 3 years of onset. The laboratory data, clinical features, and coronary artery outcomes of patients, who were diagnosed with KD and received treatment from January 2003 to January 2019 were retrospectively analyzed. A total of 484 pediatric patients with KD were examined during the study period. Among them, 130 (26.9%) presented with CAA, including mid- to large-sized CAA in 38 patients (7.9%) and de novo CAA after intravenous immunoglobulin (IVIG) treatment in 22 patients (4.5%). Albumin-to-globin (A/G) ratio was significantly negatively associated with the absolute internal diameter of coronary artery at 1 month of onset and may be used as a predictor of mid- to large-sized CAA development in patients with KD. The area under the receiver operating characteristic curve was 0.637 (95% confidence interval: 0.551–0.724), and a cutoff of 1.32 yielded a sensitivity and specificity of 79 and 49%, respectively, for predicting mid- to large-sized CAA development. De novo CAA after IVIG may lead to an increased risk of developing progressive CAA [13 (59.1%) of 22 vs. 31 (28.7%) of 108; P = 0.006] and had significantly greater changes in both the magnitude of CAA dimension variation and maximum z-score of the coronary arteries at 2 and 4 weeks and then 3 months after onset (P < 0.001). Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in the progressive CAA group than in the non-progressive CAA group (25 vs. 4 months, P < 0.001), as well as among the three groups of patients (giant CAA > medium-sized CAA > small-sized CAA, P < 0.001). Children with KD who had low A/G ratio were more likely to develop mid- to large-sized CAA. Nevertheless, de novo CAA after IVIG treatment may increase the risk of more severe arterial damage and development of progressive coronary artery damage; and both mid- to large-sized and de novo CAA could dramatically prolong coronary artery normalization time. Thus, aggressive risk modifications should be employed, and close monitoring with frequent echocardiography is needed for this vulnerable patient population. Frontiers Media S.A. 2022-09-09 /pmc/articles/PMC9505689/ /pubmed/36158849 http://dx.doi.org/10.3389/fcvm.2022.969495 Text en Copyright © 2022 Liu, Yue, Qin, Su, Ye and Pang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Liu, Jie
Yue, Qiaoyu
Qin, Suyuan
Su, Danyan
Ye, Bingbing
Pang, Yusheng
Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease
title Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease
title_full Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease
title_fullStr Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease
title_full_unstemmed Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease
title_short Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease
title_sort risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with kawasaki disease
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505689/
https://www.ncbi.nlm.nih.gov/pubmed/36158849
http://dx.doi.org/10.3389/fcvm.2022.969495
work_keys_str_mv AT liujie riskfactorsandcoronaryarteryoutcomesofcoronaryarteryaneurysmsdifferinginsizeandemergencetimeinchildrenwithkawasakidisease
AT yueqiaoyu riskfactorsandcoronaryarteryoutcomesofcoronaryarteryaneurysmsdifferinginsizeandemergencetimeinchildrenwithkawasakidisease
AT qinsuyuan riskfactorsandcoronaryarteryoutcomesofcoronaryarteryaneurysmsdifferinginsizeandemergencetimeinchildrenwithkawasakidisease
AT sudanyan riskfactorsandcoronaryarteryoutcomesofcoronaryarteryaneurysmsdifferinginsizeandemergencetimeinchildrenwithkawasakidisease
AT yebingbing riskfactorsandcoronaryarteryoutcomesofcoronaryarteryaneurysmsdifferinginsizeandemergencetimeinchildrenwithkawasakidisease
AT pangyusheng riskfactorsandcoronaryarteryoutcomesofcoronaryarteryaneurysmsdifferinginsizeandemergencetimeinchildrenwithkawasakidisease