title: Cardiovascular imaging in children and adults following Kawasaki disease.
abstract: Kawasaki disease (KD) is a paediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. Two guidelines exist regarding the follow-up of patients after KD, by the American Heart Association and the Japanese Circulation Society. After the acute phase, CAA-negative patients are checked for cardiovascular risk assessment or with ECG and echocardiography until 5 years after the disease. In CAA-positive patients, monitoring includes myocardial perfusion imaging, conventional angiography and CT-angiography. However, the invasive nature and high radiation exposure do not reflect technical advances in cardiovascular imaging. Newer techniques, such as cardiac MRI, are mentioned but not directly implemented in the follow-up. Cardiac MRI can be performed to identify CAA, but also evaluate functional abnormalities, ischemia and previous myocardial infarction including adenosine stress-testing. Low-dose CT angiography can be implemented at a young age when MRI without anaesthesia is not feasible. CT calcium scoring with a very low radiation dose can be useful in risk stratification years after the disease. By incorporating newer imaging techniques, detection of CAA will be improved while reducing radiation burden and potential complications of invasive imaging modalities. Based on the current knowledge, a possible pathway to follow-up patients after KD is introduced. Key Points • Kawasaki disease is a paediatric vasculitis with coronary aneurysms as major complication. • Current guidelines include invasive, high-radiation modalities not reflecting new technical advances. • Cardiac MRI can provide information on coronary anatomy as well as cardiac function. • (Low-dose) CT-angiography and CT calcium score can also provide important information. • Current guidelines for follow-up of patients with KD need to be revised.
authors.affiliation: Department of Paediatric Haematology, Immunology and Infectious diseases, Emma Children's Hospital, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Dietz
authors.affiliation: Department of Paediatric Haematology, Immunology and Infectious diseases, Emma Children's Hospital, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Tacke
authors.affiliation: Department of Paediatric Cardiology, Emma Children's Hospital, AMC, Amsterdam, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Kuipers
authors.affiliation: Department of Paediatric Metabolic Diseases, Emma Children's Hospital, AMC, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Wiegman
authors.affiliation: Department of Cardiology, AMC, Amsterdam, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Department of Paediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Burns
authors.affiliation: Department of Interventional Cardiology, San Diego Cardiac Centre and Sharp Memorial Hospital, San Diego, CA, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Gordon
authors.affiliation: Department of Cardiology, AMC, Amsterdam, The Netherlands.|Department of Radiology, AMC, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Groenink
authors.affiliation: Department of Paediatric Haematology, Immunology and Infectious diseases, Emma Children's Hospital, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. t.w.kuijpers@amc.uva.nl.
authors.forename: T W
authors.initials: TW
authors.lastname: Kuijpers
keywords: (Cardiac) MRI; Cardiac imaging; Coronary aneurysm; Kawasaki disease; MDCT