title: Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1Division of Pediatric Cardiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Dionne
authors.affiliation: 1Division of Pediatric Cardiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Baher
authors.initials: B
authors.lastname: Hanna
authors.affiliation: 1Division of Pediatric Cardiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Frédérick
authors.initials: F
authors.lastname: Trinh Tan
authors.affiliation: 1Division of Pediatric Cardiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Desjardins
authors.affiliation: 3Division of Radiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Chantale
authors.initials: C
authors.lastname: Lapierre
authors.affiliation: 3Division of Radiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Déry
authors.affiliation: 1Division of Pediatric Cardiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Fournier
authors.affiliation: 1Division of Pediatric Cardiology,CHU Sainte-Justine,Montreal,Quebec,Canada.
authors.forename: Nagib
authors.initials: N
authors.lastname: Dahdah
mesh_terms: D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D011792:Quebec; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: Kawasaki disease; coronary artery dilatation; coronary artery dominance; vasculitis