title: Progressive Coronary Dilatation Predicts Worse Outcome in Kawasaki Disease.
abstract: OBJECTIVE
  To explore the implication of serial coronary changes on the late coronary outcomes in patients with Kawasaki disease (KD) with coronary aneurysms ≧ 4 mm.
  
  
  METHODS
  We performed a retrospective review of 78 patients with KD with large coronary aneurysms (1980-2013, male: 76.9%; 792 patient-years). Progressive coronary dilatation was defined for those with progressive enlargement of coronary arteries in 3 consecutive echocardiograms.
  
  
  RESULTS
  We studied 27 patients with KD with giant aneurysms (≧ 8 mm) and 51 patients with KD with medium aneurysms (4-8 mm). All the giant and 43.1% of medium aneurysms persisted during the study period. For the patients with giant aneurysms, their 10-year freedom from acute myocardial infarction/cardiovascular death and all ischemia was 66% and 52%, respectively. The median intervals for the aneurysm diameters reaching their peak were 3.3 months (giant) and 0.25 months (medium), respectively. In patients with giant aneurysms, the 10-year freedom from ischemia was much lower in those with progressive coronary dilatation (28% vs 59%, P = .021). In patients with medium aneurysms, the probability of 5-year persistence of aneurysm was much greater (67.2% vs 14.8%, P < 10(-3)) in those with progressive coronary dilatation. Male sex and intravenous immunoglobulin therapy were not associated with the late outcomes in the patients with KD who had aneurysms larger than 4 mm.
  
  
  CONCLUSIONS
  In addition to coronary diameters 1 month after the onset of KD, progressive coronary dilatation at 2 or more months after diagnosis may be an indicator of duration, and the severity of vasculitis and adverse dilative remodeling were associated with worse late coronary outcomes.
authors: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors: Wan-Ling
authors: WL
authors: Chih
authors: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors: Pei-Yuan
authors: PY
authors: Wu
authors: Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan.
authors: Li-Chuang
authors: LC
authors: Sun
authors: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan. Electronic address: mingtailin@ntu.edu.tw.
authors: Ming-Tai
authors: MT
authors: Lin
authors: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors: Jou-Kou
authors: JK
authors: Wang
authors: Department of Pediatrics, Cardinal Tien General Hospital, Taipei, Taiwan. Electronic address: wumh@ntu.edu.tw.
authors: Mei-Hwan
authors: MH
authors: Wu
mesh_terms: D000293:Adolescent; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000150:complications* / Q000628:therapy*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology; D004106:Dilatation; D004452:Echocardiography; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000737:chemistry; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000628:therapy*; D009203:Myocardial Infarction / Q000150:complications; D017202:Myocardial Ischemia / Q000150:complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous