Long Term Follow-up Study of Patients with Kawasaki Disease

Jee Won Park; Euncho Chung; Kichurl Park; Young Taek Jang; Sin-Ae Park

doi:10.14776/piv.2015.22.3.164

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Park, Chung, Park, Jang, and Park: Long Term Follow-up Study of Patients with Kawasaki Disease

Original Article

Pediatr Infect Vaccine 2015;22(3):164-171.

Published online: 21 January 2015

DOI: https://doi.org/10.14776/piv.2015.22.3.164

Long Term Follow-up Study of Patients with Kawasaki Disease

Jee Won Park, Euncho Chung, Kichurl Park, Young Taek Jang, Sin-Ae Park

Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea

Received 10 June 201510 August 2015 Accepted 11 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the longterm prognosis of patients with Kawasaki disease in Korea, and discuss the need for longterm follow-up. Methods: The subjects were 48 patients among 354 who had been hospitalized due to Kawasaki disease, and who consented to echo-cardiography 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 longterm follow-up may be selectively required in patients with coronary artery complications.

Keywords: Kawasaki disease, Longterm prognosis, Coronary aneurysm, Echocardiogram, Exercise challenge testing

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Table 1.

ClinicaI Charteristics of Subjects at the Time of Diag nosis with Kawasaki Disease

Characteristics	Number (%)
Total number
Age
<6 months	48 (100%)
6 months to 1 years	3 (6.3%)
>1 years	12 (25.0%)
Sex	33 (68.8%)
Male
Female	33 (68.8%)
IVIG	15 (31.3%)
1 dose
2 doses	46 (95.8%)
CA	2 (4.2%)
Present
Absent	15 (31.3%)
Pricardial effusion	33 (68.8%)
Valve regurgitation	5 (10.4%)
MR(grade 1)	11 (22.9%)
TR (grade 1)	6 (12.5%)
AR (grade 1)	5 (10.4%)

Abbreviations: IVIG, Intravenous immune globulin; CA, Coronary artery aneurysn MR, Mitral regurgitation; TR, Trivial regurgitation; AR, Aortic regurgitation

Table 2.

Comparison of Clinical Characteristics of Patients with Coronary Artery Aneurysm Versus without Coronary Artery Aneurysm at the Time of Diagnosis with Kawasaki Disease

Characteristics	Group 1 (n=33)	Group 2 (n=15)	P-value
Age (months)	22.91±13.49	31.33±24.20	0.223
Male	19 (57.6%)	14 (93.3%)	0.032
Atypical KD	8 (24.2%)	5 (33.3%)	0.759
Duration of fever (day)	6.00±1.44	7331±4.43	0.273
Hemog\|obin (g/mL)	11.05±0.86	10.77±0.91	0.309
Hematocrit (%)	31.53±5.54	31.47±2.26	0.965
White blood cell (/mm)	13670±3801	14233+7324	0.782
Segment neutrophil (%)	57.42±17.87	59.07±18.14	0.770
PIatelet (×10³/mm³)	300.18±68.17	357.00±123.58	0.046
CRP (mg/dL)	6.09±3.27	7.18±3.56	0.303
ESR (mm/hr)	64.24±28.72	87.27±33.07	0.018
AST (IU/L)	65.33+65.94	121.47±162.39	0.093
ALT (lU/L)	80.39±103.13	115.07±166.68	0.381
Albumin (g/L)	3.65±0.48	3.56±0.32	0.488
Pyuria	9 (27.3%)	6 (40.0%)	0.585

Abbreviations: KD, Kawasaki disease; CRP, C-reactive protein; ESR, Erythrocyte sedimentation rate; AST, aspartate aminotransferase; ALT, alanine aminotransferase

Table 3.

Comparison 01' FOIIOW-Up Clinical Characteristics and Echocardiogram 01 Patients With Coronary Artery Aneurysm Versus without Coronary Artery Aneurysm

Characteristics	Mean±SD		Adjusted Mean±SD∗		P-Value^†
Characteristics	Group 1 (n-33)	Group 2 (n=15)	Group 1 (n=33)	Group 2 (n=15)	P-Value^†
Age (months)	166.39±38.36	162.13±36.68			0.719^‡
Interval (months)J	143.48±32.81	130.80±30.54	142.48±2.60	133.01±3.86	0.048
Height (cm)	157.61±13.58	158.07±14.91	157.21+1.44	158.94±2.14	0.505
Weight (kg)	51.06±13.43	52.67±15.40	50.75±1.93	53.35±2.86	0.456
BMI	20.24±3.14	20 76±90	20.22±0.59	20.81±0.87	0.578
Body surface area(m¹)	1.49±0.25	1.51±0.28	1.48±0.03	1.52±0.05	0.460
SBP (mmHg)	115.09±10.44	114.13±11.13	114.97±1.78	114.40±2.64	0.857
DBP (mmHg)	66.39±10.40	65. 00±8.80	66.31±1.70	65.18±2.53	0.711
Heart rate (min)	99.88±18.05	96.20±14.37	100.09±2.81	95.75+4.17	0.393
LCA diameter (mm)	3.30±0.37	3.49±0.48	3.30±0.07	3.50±0.10	0.089
Z-score	-0.08±0.63	0.20±0.69	-0.08±0.11	0.20±0.17	0.178
RCA diameter (mm)	2.80±035	3.00±0.44	2.80±0.06	3.01±0.10	0.070
Z-score	0.06±0.61	0.45±0.83	0.06±0.12	0.44±0.17	0.084

^∗ Adjusted for age Mean:SD by ANCOVA: Covariance Analysis.

^† P-value are confined to Adjusted Mean±SD.

^‡ Values are not adjusted for age.

^∫ Interval means duration from the onset of Kawasaki disease to follow-up testing after rehospitalization.

Abbreviations; BMI, Body mass index; SBP, Systolic blood presure; DBP, Diastolic blood presure; LCA, left main coronary aetery; RCA, Right coronary artery.

Table 4.

Comparison of Exercise Test of Patients with Coronarv Arterv Aneurvsm Versus without Coronarv Arterv Aneurvsm

Characteristics	Mean+SD		Adjusted Mean+SD∗		P-value^†
Characteristics	Group 1 (n=33)	Group 2 (n=15)	Group 1 (n=33)	Group 2 (n=15)	P-value^†
Endurance time (min)	10. 76±0.60	10.57±1.01	10.75±0.14	10.58±0.20	0.478
Peak heart rate	186.67±18.18	178.00±19.71	186.81±3.21	177.70+4.77	0.120
Percntage PHR	90.41±8.95	85.84±8.93	90.43±1.57	85.80±2.33	0.107
HR baseline	103.45±18.56	98.13±15.79	103.66±2.96	97.69±4.39	0.288
HR stage1	120.97±17.30	119.67±19.94	121.18±3.02	119.20±4.48	0.716
HR stage2	138.45±17.79	135.33±24.22	138.63±3.40	134.95±5.05	0.549
HR stage3	161.09±19.73	154.27±24.45	161.22±3.69	153.98±5.47	0.279
HR stage4	182.55±21.87	176.33±21.40	182.61±3.81	176.19±5.66	0.352
Systolic BP Pre	114.42±10.76	113.20±13.97	114.29±1.98	113.49±2.93	0.822
Systolic BP Recoverv	134.91±25.72	128.93±22.99	134.63±4.16	129.54±6.18	0.498
Diastolic BP pre	66.58±10.73	66.13±11.49	66.47±1.85	66.97±2.75	0.978
Diastolic BP Recovery	69.67±8.00	66.93±10.09	69.6±1.53	66.97±2.27	0.337

^∗ Adjusted for age MeaniSD by ANCOVA: Covariance Analysis.

^† P-values are adjusted for age.

Abbreviations: PHR, Peak heart rate: HR, Heart rate: BP. blood pressure.

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