Key result
Multimodal echocardiography structures Kawasaki disease coronary surveillance but cannot independently determine IVIG resistance.
Why the study?
Kawasaki disease with IVIG non-response is a high-risk state where fever response, coronary evolution, and myocardial dysfunction may diverge, requiring examination of echocardiography across the disease-management lifecycle.
While multimodal echocardiography is valuable for coronary and myocardial surveillance in IVIG-resistant Kawasaki disease, it requires prospective multicenter standardization and external validation before it can independently guide treatment decisions.
Answers are grounded in this paper and cite their sources.
Serial echocardiography may refine KD risk stratification and surveillance; leaves open prospective validation of standardized protocols in IVIG non-responders.
Kawasaki disease (KD) with intravenous immunoglobulin (IVIG) non-response is a high-risk state in which fever response, coronary evolution, and myocardial dysfunction may diverge. This narrative review, appraised against SANRA after drafting, examines echocardiography across the disease-management lifecycle, from pre-treatment risk enrichment to long-term surveillance. PubMed/MEDLINE searches were supplemented by cross-source discovery and metadata verification. Standardized serial coronary measurement with consistent use of one Z-score system remains the management core. Initial composite echocardiographic abnormalities, myocardial deformation, and tissue-Doppler indices may enrich risk assessment, but current discrimination is moderate and thresholds lack external validation. IVIG non-response and coronary aneurysm are related but non-interchangeable; defervescence does not establish coronary safety, whereas definite baseline coronary artery aneurysm is a treatment-relevant high-risk phenotype. Deformation, myocardial work, right-heart indices, coronary flow reserve, and complementary imaging can refine selected clinical questions but should not trigger treatment in isolation. Echocardiography can therefore structure coronary and myocardial surveillance, but cannot yet independently determine treatment resistance or support a universal multimodal treatment score. Prospective multicenter standardization, external validation, and clinical-utility testing are required before multimodal imaging-guided treatment decisions are adopted.
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Xu et al. (2026) conducted a review in Kawasaki disease with intravenous immunoglobulin (IVIG) non-response. Multimodal echocardiographic assessment was evaluated. Multimodal echocardiography structures coronary surveillance in Kawasaki disease but cannot independently determine IVIG resistance, requiring further standardization and validation.
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