Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Long Term Follow-up Study of Patients with Kawasaki Disease

가와사키 환아의 장기 예후에 대한 연구

  • Park, Jee Won (Department of Pediatrics, Presbyterian Medical Center) ;
  • Chung, Euncho (Department of Pediatrics, Presbyterian Medical Center) ;
  • Park, Kichurl (Department of Pediatrics, Presbyterian Medical Center) ;
  • Jang, Young Taek (Department of Pediatrics, Presbyterian Medical Center) ;
  • Park, Sin-Ae (Department of Pediatrics, Presbyterian Medical Center)
  • 박지원 (전주 예수병원 소아청소년과) ;
  • 정은초 (전주 예수병원 소아청소년과) ;
  • 박기철 (전주 예수병원 소아청소년과) ;
  • 장영택 (전주 예수병원 소아청소년과) ;
  • 박신애 (전주 예수병원 소아청소년과)
  • Received : 2015.06.10
  • Accepted : 2015.08.11
  • Published : 2015.12.25
Download PDF
⟨ Previous Next ⟩

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.

목적: 국내 가와사키병 환아의 장기 예후에 대해 알아보고 장기 추적 관찰의 필요성에 대해 논의하고자하는 것이다. 방법: 가와사키병으로 입원한 354명에서 심초음파 검사와 운동부하검사에 동의한 환아 48명을 대상으로 하였다. 발병 후부터 재내원하여 추적검사를 받기까지 평균 11.6년(8.2-17.0년) 경과하였다. 발병 당시 관상동맥류가 없었던 환자군을 1군, 소동맥류가 있었던 환자군을 2군으로 구분하여 장기추적검사상 두 군의 차이와 이상소견여부를 분석하였다. 결과: 장기 추적목적의 초음파와 운동부하검사에서 대부분 이상 소견을 보이지 않았으나 2군에서 9세 남아 1명이 관상동맥 확장소견을 보였다. 운동부하검사는 두 군 모두 정상 소견을 보였고 심초음파 검사상 1군에서 100%, 2군에서 93.3%에서 이상이 없었다. 결론: 소동맥류가 있었던 환자군 중 일부에서 관상동맥 확장을 보였으므로 관상동맥 합병증이 발생한 환자에서 선택적으로 장기적인 추적검사가 필요할 것으로 보인다.

Keywords

References

  1. Taubert KA, Rowley AH, Shulman ST. Seven-year national survey of Kawasaki disease and acute rheumatic fever. Pediatr Infect Dis J 1994;13:704-8. https://doi.org/10.1097/00006454-199408000-00005
  2. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, et al. Diagnosis and theraphy of Kawasaki disease in children. Circulation 1993;87:1776-80. https://doi.org/10.1161/01.CIR.87.5.1776
  3. Melish ME. Kawasaki syndrome. Pediatr Rev 1996;17:153-62. https://doi.org/10.1542/pir.17-5-153
  4. JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2013). Digest version. Circ J 2014;78:2521-62. https://doi.org/10.1253/circj.CJ-66-0096
  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 assessed by intravascular ultrasound. J 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;83:307-11. https://doi.org/10.1136/heart.83.3.307
  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. J Pediatr 2003;142:149-54. https://doi.org/10.1067/mpd.2003.46
  8. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996;94: 1379-85. https://doi.org/10.1161/01.CIR.94.6.1379
  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. J Epidemiol 2013;23:429-34. https://doi.org/10.2188/jea.JE20130048
  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. https://doi.org/10.1161/CIRCULATIONAHA.110.978213
  11. Selamet Tierney ES, Gal D, Gauvreau K, Baker AL, Trevey S, O'Neill SR, et al. Vascular health in Kawasaki disease. J Am Coll Cardiol 2013;62:1114-21. https://doi.org/10.1016/j.jacc.2013.04.090
  12. Kim GB, Han JW, Park YW, Song MS, Hong YM, Cha SH, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011. Pediatr Infect Dis J 2014;33:24-7. https://doi.org/10.1097/INF.0000000000000010
  13. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, 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;114:1708-33. https://doi.org/10.1542/peds.2004-2182
  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 JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 1998;133: 254-8. https://doi.org/10.1016/S0022-3476(98)70229-X
  16. Armstrong WF, Pellikka PA, Ryan T, Crouse L, Zoghbi WA. Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress Echocardiography Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 1998;11:97-104. https://doi.org/10.1016/S0894-7317(98)70132-4
  17. Dajani AS, Taubert KA, Takahashi M, Bierman FZ, Freed MD, Ferrieri P, et al. Guidelines for long-term 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. https://doi.org/10.1161/01.CIR.89.2.916
  18. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16:178-222.
  19. Park JS, Seo CJ, Cho SH, Lee DB. Clinical observation of mucocutaneous lymph node syndrome: 5 cases. J Korean Pediatr Soc 1973;16:61-7.
  20. Rhim JW, Youn YS, Han JW, Lee SJ, Oh JH, Lee KY. Changes in Kawasaki disease during 2 decades at a single institution in Daejeon, Korea. Pediatr Infect Dis J 2014;33:372-5. https://doi.org/10.1097/INF.0000000000000123
  21. Kim JJ, 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. https://doi.org/10.1007/s00246-011-0143-1
  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. https://doi.org/10.1007/s00431-006-0251-8
  23. Kim JW, Goo HW. Coronary artery abnormalities in Kawasaki disease: comparison between CT and MR coronary angiography. Acta Radiol 2013;54:156-63. https://doi.org/10.1258/ar.2012.120484
  24. Ha KS, Jang 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 J Pediatr 2013;172:343-9. https://doi.org/10.1007/s00431-012-1891-5
  25. Joo HJ, Song MS, Kim CH. Follow-up method in patients with Kawasaki disease who had no coronary artery abnormalities in the convalescent period. Korean J Pediatr 2005; 48:165-73.
  26. Paridon SM, Galioto FM, Vincent JA, Tomassoni TL, Sullivan NM, Bricker JT. Exercise capacity and incidence of myocardial perfusion defects after Kawasaki disease in children and adolescents. J Am Coll Cardiol 1995;25:1420-4. https://doi.org/10.1016/0735-1097(95)00003-M
  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. https://doi.org/10.1007/s00246-012-0201-3
  28. Hohls A. Cardiovascular follow-up 10-15 years post Kawasaki disease. Heart Lung Circ 2012;21:S143-S316.
  29. Dunning DW, Hussey ME, Riggs T, Bestervelt R, Goerke C. Long-term follow-up with stress echocardiograms of patients with Kawasaki' disease. Cardiology 2002;97:43-8. https://doi.org/10.1159/000047418
  30. Rhodes J, Hijazi ZM, Marx GR, Fulton DR. Aerobic exercise function of patients with persistent coronary artery aneurysms secondary to Kawasaki disease. Pediatr Cardiol 1996; 17:226-30. https://doi.org/10.1007/BF02524798
  31. Zanon G1, Zucchetta P, Varnier M, Vittadello F, Milanesi O, Zulian F. Do Kawasaki disease patients without coronary artery abnormalities need a long-term follow-up? A myocardial single-photon emission computed tomography pilot study. J Paediatr Child Health 2009;45:419-24. https://doi.org/10.1111/j.1440-1754.2009.01531.x
  32. Burns JC, Shike H, Gordon JB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996;28:253-7. https://doi.org/10.1016/0735-1097(96)00099-X
  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. https://doi.org/10.1161/01.CIR.97.7.705
  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. https://doi.org/10.1136/hrt.2003.025338