Chbeir D, et al. - Experts gauged whether or not the presence of any abnormalities, other than high z-scores in first echocardiogram, were related to resistance to IV immunoglobulins and/or subsequent development of coronary artery aneurysms (CAA). Data from children diagnosed with Kawasaki disease between 2006 and 2016 was assessed. In European populations with mixed ethnic backgrounds, patients with severe disease could be identified early by the presence of any abnormalities (coronary artery dilatation, CAA, pericardial effusion, perivascular brightness of the coronary arteries, left-ventricular dysfunction and mitral insufficiency) at the initial echocardiogram. Low sensitivity (0–33%) and low specificity (71–82%) for predicting immunoglobulin resistance or cardiac involvement were seen in severity scoring systems from Japan.