title: Extracardial Vasculopathy After Kawasaki Disease: A Long-Term Follow-up Study.
abstract: Kawasaki disease (KD) is a pediatric vasculitis with coronary artery aneurysm (CAA) as a major complication. Controversy exists about cardiovascular risk later in life. The aim of our study was to evaluate whether KD patients are at increased risk, as assessed by carotid intima-media thickness (cIMT).
  
  
  
  We measured cIMT over 15 years by B-mode ultrasonography in KD patients during follow-up and in unaffected controls (mostly siblings). A multilevel, repeated-measures, linear mixed-effects model was used to evaluate the association between KD and cIMT. A total of 319 patients with 528 measurements were compared with 150 controls. In KD patients, the mean cIMT was increased compared with controls (0.375 mm [95% CI 0.372-0.378 mm] versus 0.363 mm [95% CI 0.358-0.368 mm]; P<0.001). Furthermore, mean cIMT of CAA-negative patients was 0.373 mm (P<0.01 compared with controls), of patients with small-medium CAA was 0.374 mm (P<0.05 compared with controls), and of patients with giant CAA was 0.381 mm (P<0.01 compared with controls). Compared with controls, CAA-negative participants started with an increased cIMT (+0.0193±0.0053 mm, P<0.001) but showed slower progression (-0.0014±0.0006 mm/year, P=0.012). Patients with giant CAA showed a trend toward increased cIMT progression (0.0013±0.0007 mm/year, P=0.058).
  
  
  
  We observed a positive correlation between cIMT and KD severity of coronary arteritis at the acute stage. Although initially increased, the cIMT in CAA-negative patients normalized at a later age. In contrast, patients with a history of KD complicated by giant CAA showed a trend toward persistently increased cIMT. These patients may need cardiovascular counseling and follow-up beyond the heart.
authors.affiliation: Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands s.m.dietz@amc.uva.nl.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Dietz
authors.affiliation: Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Carline E
authors.initials: CE
authors.lastname: Tacke
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center (AMC), Amsterdam, The Netherlands Imagelabonline & Cardiovascular, Eindhoven and Lunteren, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: de Groot
authors.affiliation: Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Kuipers
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Hutten
authors.affiliation: Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Taco W
authors.initials: TW
authors.lastname: Kuijpers
mesh_terms: D000293:Adolescent; D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000453:epidemiology*; D012307:Risk Factors; D035781:Siblings; D014463:Ultrasonography; D055815:Young Adult
keywords: Kawasaki disease; coronary aneurysm; intima‐media thickness