The significance of early subtle coronary arterial lesions on echocardiogram in Kawasaki disease.
Intensive echocardiographic studies were undertaken in 37 patients with Kawasaki disease (KD) and 12 febrile controls during the acute stages. Video-tape recordings were read doubly-blinded by 3 pediatric cardiologists at 2 hospitals. Three characteristics of subtle coronary arterial lesions, including contour of lumen, smoothness of endothelium and sono-homogeneity of the surrounding tissue were particularly described. Seven of the 37 KD patients (19%) were found to have coronary arterial aneurysms (CAA) at the end of the convalescent stage. The 3 cardiologists agreed in the diagnosis of the subtle lesions by 72%. More patients with Kawasaki disease were found to have an irregular endothelium than the controls (P < 0.001). KD patients later complicated with CAA were more likely to have had the three characteristics of subtle coronary lesions during the acute stage than the KD patients without aneurysms (P < 0.001). Also, the coronary arterial size measured during the acute stage were found to be positively correlated with their largest dilatation at the convalescent stage (P = 0.0001, r = 0.61). We conclude that early subtle coronary arterial lesions can herald the development of coronary arterial aneurysms.
Department of Pediatrics, China Medical College Hospital, Taichung, Taiwan.
J S
JS
Chang
C H
CH
Tsai
M H
MH
Wu
J K
JK
Wang
D000208:Acute Disease; D016022:Case-Control Studies; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D014463:Ultrasonography