title: Usefulness of Calcium Scoring as a Screening Examination in Patients With a History of Kawasaki Disease.
abstract: Subsets of patients with a remote history of Kawasaki disease (KD) have coronary artery aneurysms with associated risks of late morbidity. In a pilot study, we previously showed that computed tomography (CT) coronary artery calcium (CAC) scoring detects late CAC in patients with aneurysms and a remote history of KD. We performed CT calcium volume scoring in 166 subjects (median age 19.5 years) with a remote history of KD (median interval from KD to CT 15.1 years). Coronary arteries were classified as normal (n = 100), transiently dilated (n = 23), persistently dilated (n = 10), remodeled aneurysm (n = 9), or aneurysm (n = 24) based on echocardiography. All subjects with coronary arteries classified as normal, persistently dilated, or remodeled aneurysm had zero CAC. Of the 24 subjects with coronary aneurysms, all but 5 had CAC (median volume 542 mm3; range 17 to 8,218 mm3). For subjects imaged ≥9 years after their acute KD (n = 144), the presence of CAC had a sensitivity of 95% and a specificity of 100% for detecting coronary artery abnormalities (defined as coronary artery aneurysm and/or stenosis). In conclusion, coronary calcification was not observed in subjects with a history of KD who had normal coronary arteries by echocardiography during the acute phase. Coronary calcification, which may be severe, occurs late in patients with coronary aneurysms. Therefore, CAC scanning may be a useful tool to screen patients with a remote history of KD or suspected KD and unknown coronary artery status.
authors.affiliation: Department of Medicine, University of California San Diego School of Medicine, La Jolla, California. Electronic address: akahn@ucsd.edu.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kahn
authors.affiliation: Department of Medicine, Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Department of Medicine, University of California San Diego School of Medicine, La Jolla, California.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California and Rady Children's Hospital San Diego, San Diego, California.
authors.forename: Jun
authors.initials: J
authors.lastname: Oyamada
authors.affiliation: San Diego Cardiac Center and Sharp Memorial Hospital, San Diego, California.
authors.forename: John B
authors.initials: JB
authors.lastname: Gordon
authors.affiliation: Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California and Rady Children's Hospital San Diego, San Diego, California.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002140:California / Q000453:epidemiology; D002648:Child; D000072226:Computed Tomography Angiography; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004452:Echocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000145:classification / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D002097:C-Reactive Protein