Pediatr Infect Vaccine.  2015 Dec;22(3):164-171. 10.14776/piv.2015.22.3.164.

Long Term Follow-up Study of Patients with Kawasaki Disease

• Park JW
• Chung E
• Park K
• Jang YT
• Park SA

• KMID: 2315681
• DOI: http://doi.org/10.14776/piv.2015.22.3.164

Abstract

PURPOSE
To investigate the long-term prognosis of patients with Kawasaki disease in Korea, and discuss the need for long-term follow-up.
METHODS
The subjects were 48 patients among 354 who had been hospitalized due to Kawasaki disease, and who consented to echocardiography and exercise challenge testing. The mean duration from the onset of disease to follow-up testing after rehospitalization was 11.6 years (8.2-17.0). Patients without coronary artery aneurysms at the initial presentation of the disease were classified in group 1, and patients with small aneurysms were in group 2. Test abnormalities and differences between the two groups were analyzed. RESULT: There were no significant differences in the results of follow-up echocardiography and exercise challenge testing between the two groups. Although no abnormal findings were noted at follow-up in most patients, a 9-year-old boy in group 2 showed coronary artery dilation. The exercise test indicated normal results in both groups, and echocardiography results were also normal in 100% of cases in group 1 and 93.3% of cases in group 2.
CONCLUSIONS
As some patients with coronary aneurysms showed coronary artery dilation, we believe that long-term follow-up may be selectively required in patients with coronary artery complications.

Keyword

Kawasaki disease; Long-term prognosis; Coronary aneurysm; Echocardiogram; Exercise challenge testing

MeSH Terms

Aneurysm
Child
Coronary Aneurysm
Coronary Vessels
Echocardiography
Exercise Test
Follow-Up Studies*
Humans
Korea
Male
Mucocutaneous Lymph Node Syndrome*
Prognosis

Reference

1. Taubert KA, Rowley AH, Shulman ST. Seven—year national survey of Kawasaki disease and acute rheumatic fever. Pediatr Infect Dis I. 1994; 13:704–8.

2. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, et al. Diagnosis and theraphy 0f Kawasaki disease in Children. Circulation. 1993; 87:1776–80.

3. Melish ME. Kawasaki syndrome. Pediatr Rev. 1996; 17:153–62.

4. ICS 10th Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2013). Digest version. Circ I. 2014; 78:2521–62.

5. Suzuki A, Yamagishi M, Kimura K, Sugiyma H, Arakaki Y, Kamiya T, et al. Functional behavior and morphology of the coronary artery wall in patients with Kawasaki disease as-sessed by intravascular ultrasound. I Am Coll Cardiol. 1996; 27:291—6.

6. Iemura M, Ishii M, Sugimura T, Akagi T, Kato H. Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart. 2000; 83:307–1.

7. Furuyama H, Odagawa Y, Katoh C, Iwado Y, Ito Y, Noriyasu K, et al. Altered myocardial flow reserve and endothelial function late after Kawasaki disease. I Pediatr. 2003; 142:149–54.

8. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Longterm consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996; 94:1379–85.

9. Nakamura Y, Aso E, Yashiro M, Tsuboi S, Kojo T, Aoyama Y, et al. Mortality among Japanese with a history of Kawasaki disease: results at the end of 2009. I Epidemiol. 2013; 23:429–34.

10. Suda K, Iemura M, Nishiono H, Teramachi Y, Koteda Y, Kishimoto S, et al. Long—term prognosis of patients with Kawasaki disease complicated by giant coronary aneurysms: a single—institution experience. Circulation. 2011; 123:1836–42.

11. Selamet Tierney ES, Gal D, Gauvreau K, Baker AL, Trevey S, O'Neill SR, et al. Vascular health in Kawasaki disease. I Am Coll Card101. 2013; 62:1114–21.

12. Kim GB, Han IW, Park YW, Song MS, Hong YM, Cha SH, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009—201 1. Pediatr Infect Dis I. 2014; 33:24–7.

13. Newburger IW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns IC, et al. Diagnosis, treatment, and longterm management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endo-carditis, and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Pediatrics. 2004; 114:1708–33.

14. Kamiya T, Kawasaki T, Okuni M, Kato H, Baba K, Nakano H. Report of subcommittee on standardization of diagnostic criteria and report of coronary artery lesions in Kawasaki disease. Research committee on Kawasaki disease of the Ministry of Health and Welfare. 1984. pp.1–10.

15. de Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger W. Coronary artery dimensions may be mis—classified as normal in Kawasaki disease. I Pediatr. 1998; 133:254–8.

16. Armstrong WF, Pellikka PA, Ryan T, Crouse L, Zoghbi WA. Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress Echo—cardiography Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. I Am Soc Echocardiogr. 1998; 11:97–104.

17. Dajani AS, Taubert KA, Takahashi M, Bierman FZ, Freed MD, Ferrieri P, et al. Guidelines for longterm management of patients with Kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki disease, Council on Cardiovascular Disease in the young, American Heart Association. Circulation. 1994; 89:916–22.

18. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation 0f the fingers and toes in children. Arerugi. 1967; 16:178–222.

19. Park 18, Seo C], Cho SH, Lee DB. Clinical observation of mucocutaneous lymph node syndrome: 5 cases. I Korean Pediatr Soc. 1973; 16:61–7.

20. Rhim 1W. Youn YS, Han 1W, Lee S], Oh IH, Lee KY. Changes in Kawasaki disease during 2 decades at a single institution in Daejeon, Korea. Pediatr Infect Dis J. 2014; 33:372–5.

21. Kim 1. Hong YM, Yun SW, Han MK, Lee KY, Song MS, et al. Assessment of risk factors for Korean children with Kawasaki disease. Pediatr Cardiol. 2012; 33:513–20.

22. Kim T, Choi W, Woo CW, Choi B, Lee J, Lee K, et al. Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr. 2007; 166:421–5.

23. Kim IW, G00 HW. Coronary artery abnormalities in Kawasaki disease: comparison between CT and MR coronary angio—graphy. Acta Radiol. 2013; 54:156–63.

24. Ha KS, Iang G, Lee J, Lee K, Hong Y, Son C, et al. Incomplete clinical manifestation as a risk factor for coronary artery abnormalities in Kawasaki disease: a meta—analysis. Eur I Pediatr. 2013; 172:343–9.

24. H}. Song MS, Kim CH. Follow—up method in patients with Kawasaki disease Who had no coronary artery abnor—malities in the convalescent period. Korean I Pediatr. 2005; 48:165–73.

26. Paridon SM, Galioto FM, Vincent IA, Tomassoni TL, Sul—livan NM, Bricker IT. Exercise capacity and incidence of myocardial perfusion defects after Kawasaki disease in children and adolescents. I Am Coll Cardiol. 1995; 25:1420–4.

27. Gravel H, Dahdah N, Fournier A, Mathieu ME, Curnier D. Ventricular repolarisation during exercise challenge occurring late after Kawasaki disease. Pediatr Cardiol. 2012; 33:728–34.

28. Hohls A. Cardiovascular follow-up 10-15 years post Kawasaki disease. Heart Lung Circ. 2012; 21:8143–8316.

29. Dunning DW, Hussey ME, Riggs T, Bestervelt R, Goerke C. Longterm follow-up with stress echocardiograms of patients With Kawasaki’ disease. Cardiology. 2002; 97:43–8.

30. Rhodes I, Hijazi ZM, Marx GR, Fulton DR. Aerobic exercise function of patients with persistent coronary artery aneurysms secondary to Kawasaki disease. Pediatr Cardiol. 1996. 172226–30.

31. Zanon G1. Zucchetta P, Varnier M, Vittadello F, Milanesi O, Zulian F. Do Kawasaki disease patients without coronary artery abnormalities need a longterm follow-up? A myocardial single—photon emission computed tomography pilot study. I Paediatr Child Health. 2009; 45:419–24.

32. Burns IC, Shike H, Gordon IB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae 0f Kawasaki disease in adolescents and young adults. I Am Coll Cardiol. 1996; 28:253–7.

33. Satoda M, Tatsukawa H, Katoh S. Images in cardiovascular medicine. Sudden death due to rupture of coronary aneurysm in a 26-year—old man. Circulation. 1998; 97:705–6.

34. Tsuda E, Kamiya T, Ono Y, Kimura K, Echigo S. Dilated coronary arterial lesions in the late period after Kawasaki disease. Heart. 2005; 91:177–82.