February 15, 2020European Journal of Clinical Investigation

Clinical observation of noncoronary cardiac abnormalities in Chinese children with Kawasaki disease

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Why the study?

Kawasaki disease leads to several noncoronary cardiac abnormalities involving the pericardium, myocardium, and endocardium in addition to coronary artery aneurysms.

Structured PICO

Population

142 Chinese children with Kawasaki disease

Outcome

Prevalence of noncoronary cardiac abnormalities (NCA) and response to intravenous immunoglobulin (IVIG) therapysurrogate

Noncoronary cardiac abnormalities are highly prevalent in acute Kawasaki disease, primarily manifesting as valvular regurgitation, but do not impact the response to IVIG therapy.

Implication

High NCA prevalence supports echocardiography in acute Kawasaki disease; leaves open long-term prognostic implications.

Abstract

BACKGROUND: Kawasaki disease (KD) is an acute, self-limited vasculitis. Coronary artery aneurysm (CAA) serves as a major contributor to the long-term prognosis of KD. In addition, acute KD usually also leads to several kinds of noncoronary cardiac abnormalities (NCA) involving the pericardium, myocardium and endocardium. MATERIALS AND METHODS: A total of 142 Chinese children with KD were recruited from July 2015 to April 2018. Blood samples were collected at 24 hours pre-intravenous immunoglobulin (IVIG) therapy. Several inflammatory mediators and biomarkers for acute myocardial infarction were detected. Echocardiography and electrocardiography (ECG) were performed. RESULTS: Plasma white blood cell counts (WBC) were significantly increased in patients with IVIG-nonresponsive KD when compared with their IVIG-responsive counterparts. A total of 106 children (74.65%) suffered from NCA, including 8 patients (5.63%) with pericardial effusion, 23 patients (16.20%) with acute myocarditis, 101 patients (71.13%) with valvular regurgitation and 8 patients (5.63%) with abnormal ECG. No significant differences were observed in the distribution of clinical classification and the response to IVIG therapy regardless of NCA exhibited or not. CONCLUSIONS: Noncoronary cardiac abnormalities is almost universal in acute KD and mainly manifests as valvular regurgitation. However, it has no influence on clinical classification and the response to IVIG therapy.