de Ferranti SD, et al. - In patients with uncomplicated Kawasaki disease who had previously normal coronary arteries, researchers evaluated the benefit of additional echocardiographic imaging at 6 weeks. In patients with Kawasaki disease who have normal measurements at baseline and 2 weeks, new abnormalities in coronary arteries were rarely seen at 6 weeks of illness. In patients with uncomplicated Kawasaki disease and z scores less than 2.0 in the first 2 weeks of illness, the 6-week echocardiographic imaging might be needless.

Methods

• Patients with Kawasaki disease who were cared for between 1995 and 2014 in two academic pediatric referral practices were included in this retrospective review.
• Receiving intravenous immunoglobulin treatment for acute Kawasaki disease at a center; the absence of significant congenital heart disease; available echocardiographic measurements of both the right and left anterior descending coronary arteries at 10 days or less after diagnosis (baseline), 2 (±1) weeks, and 6 (±3) weeks of illness; and normal coronary arteries at baseline and 2 weeks, defined as maximum coronary artery z scores less than 2.0 and no distal aneurysms were the eligibility criteria.
• From March 2015 to November 2015, data analysis was completed.
• The number of patients with right coronary artery or left anterior descending coronary artery z scores of 2.0 or more at 6 weeks were the main outcomes and measures analyzed.

Results

• As per data, the median age of the 464 included subjects was 3.3 years (interquartile range, 1.8-5.4 years); 264 (56.9%) were male, 351 of 414 for whom data were available (84.8%) had complete Kawasaki disease, and 66 (14.2%) received additional intravenous immunoglobulin treatment.
• Four hundred fifty-six patients (98.3%) who had had normal coronary artery z scores at baseline and 2 weeks continued to have normal z scores at 6 weeks of illness.
• Of the rest of the 8 patients (1.7%), the maximum z score within 6 weeks was 2.0 to 2.4 in 5 patients (1.2%), 2.5 to 2.9 in 1 patient (0.2%), and 3.0 or more in 2 patients (0.4% [95% CI, 0.1%-1.5%]).
• It was observed that coronary artery dimensions ultimately normalized in all but one patient, who had minimal dilation at 6 weeks (right coronary artery z score, 2.1).
• Findings revealed that sensitivity analyses using less restrictive cut points (eg, a maximum zscore <2.5) or less restrictive timing windows (eg, considering patients with incomplete echocardiographic data within 21 days) gave similar outcomes.
• It was noted that 454 to 463 of 464 patients (98% to 99.7%) had coronary artery z scores of less than 2.5 at 6 weeks.