Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-24T13:17:37.551Z Has data issue: false hasContentIssue false
  • English
  • Français

Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease

Published online by Cambridge University Press:  19 September 2016

Audrey Dionne ,
Baher Hanna ,
Frédérick Trinh Tan ,
Laurent Desjardins ,
Chantale Lapierre ,
Julie Déry ,
Anne Fournier  and
Nagib Dahdah
Audrey Dionne
Affiliation:
Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
Baher Hanna
Affiliation:
Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
Frédérick Trinh Tan
Affiliation:
Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
Laurent Desjardins
Affiliation:
Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada Division of Pediatrics, Centre Hospitalier Universitaire de Quebec, Quebec, Canada
Chantale Lapierre
Affiliation:
Division of Radiology, CHU Sainte-Justine, Montreal, Quebec, Canada
Julie Déry
Affiliation:
Division of Radiology, CHU Sainte-Justine, Montreal, Quebec, Canada
Anne Fournier
Affiliation:
Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
Nagib Dahdah*
Affiliation:
Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, Quebec, Canada
*
Correspondence to: N. Dahdah, MD, Division of Pediatric Cardiology (6 – Bloc 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montreal, Quebec, Canada, H3T 1C5. Tel: 514 345 4931 (5403); Fax: 514 345 4896; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the effect of myocardial inflammation is underestimated. Coronary dilatations are determined by Z-scores, which do not take into account dominance. The aim of the present study was to describe the impact of coronary dominance on dilatation in Kawasaki disease.

Methods

We performed a retrospective analysis of coronary dilatations according to angiography categorisation of dominance.

Results

Of 28 patients (2.6 [0.2–10.1] years), right dominance was present in 15 patients and left in 13. Early dilatation was present in all patients, of whom 11 were ipsilateral to the dominant segment and 17 contralateral. Ipsilateral dilatations were present at diagnosis (9/11 versus 6/17, p=0.02) compared with contralateral dilatations, which developed 2 weeks after diagnosis (9/11 versus 16/17, p=0.29). Coronary artery Z-scores of patients with contralateral dilatation increased at 2 weeks, before returning to baseline values (2.0±2.2 at diagnosis, 4.1±1.8 at 2 weeks, 1.8±1.2 at 3–6 months, p=0.001), compared with patients with ipsilateral dilatation in whom Z-scores were maximal at diagnosis and remained stable (3.0±0.9, 2.7±1.1 and 2.6±1.5, respectively, p=0.13). Dominant coronary artery Z-scores were higher compared with non-dominant segments at diagnosis (3.0±0.9 versus 1.0±0.8, p<0.001) and at late follow-up (2.6±1.5 versus 0.4±1.4, p=0.002) in patients with ipsilateral dilatation.

Conclusion

Progression of coronary dilatation after diagnosis may be a sign of dilatation secondary to vasculitis, as opposed to regression of Z-scores in ipsilateral dilatations, probably related to physiological vasodilatation in response to carditis. This needs to be validated in larger studies against vasculitic and myocardial inflammatory markers.

Keywords

Kawasaki diseasecoronary artery dilatationcoronary artery dominancevasculitis
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 5 , July 2017 , pp. 877 - 883
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004; 114: 1708–1733.CrossRefGoogle Scholar
2. Printz, BF, Sleeper, LA, Newburger, JW, et al. Noncoronary cardiac abnormalities are associated with coronary artery dilatation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol 2011; 57: 86–92.CrossRefGoogle ScholarPubMed
3. McCrindle, BW, Li, JS, Minich, LL, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116: 174–179.Google Scholar
4. Dallaire, F, Dahdah, N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011; 24: 60–74.Google Scholar
5. Muniz, JC, Dummer, K, Gauvreau, K, Colan, SD, Fulton, DR, Newburger, JW. Coronary artery dimensions in febrile children without Kawasaki disease. Circ Cardiovasc Imaging 2013; 6: 239–244.Google Scholar
6. Binstadt, BA, Levine, JC, Nigrovic, PA, et al. Coronary artery dilation among patients presenting with systemic-onset juvenile idiopathic arthritis. Pediatrics 2005; 116: e89–e93.Google Scholar
7. Cevik, C, Otahbachi, M, Nugent, K, Jenkins, LA. Coronary artery aneurysms in Behçet’s disease. Cardiovasc Revasc Med 2009; 10: 128–129.CrossRefGoogle ScholarPubMed
8. Kikuta, H, Taguchi, Y, Tomizawa, K, et al. Epstein-Barr virus genome-positive T lymphocytes in a boy with chronic active EBV infection associated with Kawasaki-like disease. Nature 1988; 333: 455–457.CrossRefGoogle Scholar
9. Konishi, N, Nishimura, SI, Ono, H, Satou, T, Ueda, K. Coronary dilatation in Epstein-Barr virus infection. Pediatr Res 2003; 53: 179.CrossRefGoogle Scholar
10. Duncker, DJ, Bache, RJ. Regulation of coronary blood flow during exercise. Physiol Rev 2008; 88: 1009–1086.CrossRefGoogle ScholarPubMed
11. Rached-d’Astous, S, Boukas, I, Fournier, A, Raboisson, MJ, Dahdah, N. Coronary artery dilatation in viral myocarditis mimics coronary artery findings in Kawasaki disease. Circulation 2015; 131: AO37.Google Scholar
12. Yutani, C, Go, S, Kamiya, T, et al. Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 1981; 105: 470–473.Google Scholar
13. McNeal-Davidson, A, Fournier, A, Spigelblatt, L, et al. Value of amino-terminal pro B-natriuretic peptide in diagnosing Kawasaki disease. Pediatr Int 2012; 54: 627–633.Google Scholar
14. Adjagba, PM, Desjardins, L, Fournier, A, Spigelblatt, L, Montigny, M, Dahdah, N. N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement. Cardiol Young 2012; 25: 1311–1318.CrossRefGoogle Scholar
15. Scott, JS, Ettedgui, JA, Neches, WH. Cost-effective use of echocardiography in children with Kawasaki disease. Pediatrics 1999; 104: e57.Google Scholar
16. Orenstein, JM, Shulman, ST, Fox, LM, et al. Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study. PLoS One 2012; 7: e38998.Google Scholar
17. Sakamoto, S, Takahashi, S, Coskun, AU, et al. Relation of distribution of coronary blood flow volume to coronary artery dominance. Am J Cardiol 2013; 111: 1420–1424.Google Scholar
18. Kaimkhani, ZA, Ali, MM, Farugi, AM. Pattern of coronary arterial distribution and its relation to coronary artery diameter. J Ayub Med Coll Abbottabad 2005; 17: 40–43.Google Scholar
19. Altin, C, Kanyilmaz, S, Koc, S, et al. Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study. Singapore Med J 2015; 56: 339–345.CrossRefGoogle ScholarPubMed