Skip to main content Accessibility help
×
Home

Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease

  • Audrey Dionne (a1), Baher Hanna (a1), Frédérick Trinh Tan (a1), Laurent Desjardins (a1) (a2), Chantale Lapierre (a3), Julie Déry (a3), Anne Fournier (a1) and Nagib Dahdah (a1)...

Abstract

Introduction

In Kawasaki disease, although coronary dilatation is attributed to vasculitis, the effect of myocardial inflammation is underestimated. Coronary dilatations are determined by Z-scores, which do not take into account dominance. The aim of the present study was to describe the impact of coronary dominance on dilatation in Kawasaki disease.

Methods

We performed a retrospective analysis of coronary dilatations according to angiography categorisation of dominance.

Results

Of 28 patients (2.6 [0.2–10.1] years), right dominance was present in 15 patients and left in 13. Early dilatation was present in all patients, of whom 11 were ipsilateral to the dominant segment and 17 contralateral. Ipsilateral dilatations were present at diagnosis (9/11 versus 6/17, p=0.02) compared with contralateral dilatations, which developed 2 weeks after diagnosis (9/11 versus 16/17, p=0.29). Coronary artery Z-scores of patients with contralateral dilatation increased at 2 weeks, before returning to baseline values (2.0±2.2 at diagnosis, 4.1±1.8 at 2 weeks, 1.8±1.2 at 3–6 months, p=0.001), compared with patients with ipsilateral dilatation in whom Z-scores were maximal at diagnosis and remained stable (3.0±0.9, 2.7±1.1 and 2.6±1.5, respectively, p=0.13). Dominant coronary artery Z-scores were higher compared with non-dominant segments at diagnosis (3.0±0.9 versus 1.0±0.8, p<0.001) and at late follow-up (2.6±1.5 versus 0.4±1.4, p=0.002) in patients with ipsilateral dilatation.

Conclusion

Progression of coronary dilatation after diagnosis may be a sign of dilatation secondary to vasculitis, as opposed to regression of Z-scores in ipsilateral dilatations, probably related to physiological vasodilatation in response to carditis. This needs to be validated in larger studies against vasculitic and myocardial inflammatory markers.

Copyright

Corresponding author

Correspondence to: N. Dahdah, MD, Division of Pediatric Cardiology (6 – Bloc 9), CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montreal, Quebec, Canada, H3T 1C5. Tel: 514 345 4931 (5403); Fax: 514 345 4896; E-mail: nagib.dahdah.hsj@ssss.gouv.qc.ca

References

Hide All
1. Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004; 114: 17081733.
2. Printz, BF, Sleeper, LA, Newburger, JW, et al. Noncoronary cardiac abnormalities are associated with coronary artery dilatation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol 2011; 57: 8692.
3. McCrindle, BW, Li, JS, Minich, LL, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116: 174179.
4. Dallaire, F, Dahdah, N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011; 24: 6074.
5. Muniz, JC, Dummer, K, Gauvreau, K, Colan, SD, Fulton, DR, Newburger, JW. Coronary artery dimensions in febrile children without Kawasaki disease. Circ Cardiovasc Imaging 2013; 6: 239244.
6. Binstadt, BA, Levine, JC, Nigrovic, PA, et al. Coronary artery dilation among patients presenting with systemic-onset juvenile idiopathic arthritis. Pediatrics 2005; 116: e89e93.
7. Cevik, C, Otahbachi, M, Nugent, K, Jenkins, LA. Coronary artery aneurysms in Behçet’s disease. Cardiovasc Revasc Med 2009; 10: 128129.
8. Kikuta, H, Taguchi, Y, Tomizawa, K, et al. Epstein-Barr virus genome-positive T lymphocytes in a boy with chronic active EBV infection associated with Kawasaki-like disease. Nature 1988; 333: 455457.
9. Konishi, N, Nishimura, SI, Ono, H, Satou, T, Ueda, K. Coronary dilatation in Epstein-Barr virus infection. Pediatr Res 2003; 53: 179.
10. Duncker, DJ, Bache, RJ. Regulation of coronary blood flow during exercise. Physiol Rev 2008; 88: 10091086.
11. Rached-d’Astous, S, Boukas, I, Fournier, A, Raboisson, MJ, Dahdah, N. Coronary artery dilatation in viral myocarditis mimics coronary artery findings in Kawasaki disease. Circulation 2015; 131: AO37.
12. Yutani, C, Go, S, Kamiya, T, et al. Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 1981; 105: 470473.
13. McNeal-Davidson, A, Fournier, A, Spigelblatt, L, et al. Value of amino-terminal pro B-natriuretic peptide in diagnosing Kawasaki disease. Pediatr Int 2012; 54: 627633.
14. Adjagba, PM, Desjardins, L, Fournier, A, Spigelblatt, L, Montigny, M, Dahdah, N. N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement. Cardiol Young 2012; 25: 13111318.
15. Scott, JS, Ettedgui, JA, Neches, WH. Cost-effective use of echocardiography in children with Kawasaki disease. Pediatrics 1999; 104: e57.
16. Orenstein, JM, Shulman, ST, Fox, LM, et al. Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study. PLoS One 2012; 7: e38998.
17. Sakamoto, S, Takahashi, S, Coskun, AU, et al. Relation of distribution of coronary blood flow volume to coronary artery dominance. Am J Cardiol 2013; 111: 14201424.
18. Kaimkhani, ZA, Ali, MM, Farugi, AM. Pattern of coronary arterial distribution and its relation to coronary artery diameter. J Ayub Med Coll Abbottabad 2005; 17: 4043.
19. Altin, C, Kanyilmaz, S, Koc, S, et al. Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study. Singapore Med J 2015; 56: 339345.

Keywords

Importance of anatomical dominance in the evaluation of coronary dilatation in Kawasaki disease

  • Audrey Dionne (a1), Baher Hanna (a1), Frédérick Trinh Tan (a1), Laurent Desjardins (a1) (a2), Chantale Lapierre (a3), Julie Déry (a3), Anne Fournier (a1) and Nagib Dahdah (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed