Dataset Information

Association of Severity of Coronary Artery Aneurysms in Patients With Kawasaki Disease and Risk of Later Coronary Events.

ABSTRACT: Importance:Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). Objective:To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. Design, Setting, and Participants:This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. Main Outcomes and Measures:The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score, ?5 to <10; actual internal diameter, <8 mm), and large (z score, ?10 or ?8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. Results:Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52% in men (P?

SUBMITTER: Miura M

PROVIDER: S-EPMC5875323 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Association of Severity of Coronary Artery Aneurysms in Patients With Kawasaki Disease and Risk of Later Coronary Events.

Miura Masaru M Kobayashi Tohru T Kaneko Tetsuji T Ayusawa Mamoru M Fukazawa Ryuji R Fukushima Naoya N Fuse Shigeto S Hamaoka Kenji K Hirono Keiichi K Kato Taichi T Mitani Yoshihide Y Sato Seiichi S Shimoyama Shinya S Shiono Junko J Suda Kenji K Suzuki Hiroshi H Maeda Jun J Waki Kenji K Kato Hitoshi H Saji Tsutomu T Yamagishi Hiroyuki H Ozeki Aya A Tomotsune Masako M Yoshida Makiko M Akazawa Yohei Y Aso Kentaro K Doi Shouzaburoh S Fukasawa Yoshi Y Furuno Kenji K Hayabuchi Yasunobu Y Hayashi Miyuki M Honda Takafumi T Horita Norihisa N Ikeda Kazuyuki K Ishii Masahiro M Iwashima Satoru S Kamada Masahiro M Kaneko Masahide M Katyama Hiroshi H Kawamura Yoichi Y Kitagawa Atushi A Komori Akiko A Kuraishi Kenji K Masuda Hiroshi H Matsuda Shinichi S Matsuzaki Satoshi S Mii Sayaka S Miyamoto Tomoyuki T Moritou Yuji Y Motoki Noriko N Nagumo Kiyoshi K Nakamura Tsuneyuki T Nishihara Eiki E Nomura Yuichi Y Ogata Shohei S Ohashi Hiroyuki H Okumura Kenichi K Omori Daisuke D Sano Tetsuya T Suganuma Eisuke E Takahashi Tsutomu T Takatsuki Shinichi S Takeda Atsuhito A Terai Masaru M Toyono Manatomo M Watanabe Kenichi K Watanabe Makoto M Yamamoto Masaki M Yamamura Kenichiro K

JAMA pediatrics 20180507 5

<h4>Importance</h4>Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA).<h4>Objective</h4>To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA.<h4>Design, setting, and participants</h4>This multicenter, collaborative retrospective cohort study of 44 participating inst ...[more]

PMID: 29507955

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Project description:Kawasaki Disease (KD) is the leading cause of acquired pediatric heart disease. A subset of KD patients develops aneurysms in the coronary arteries, leading to increased risk of thrombosis and myocardial infarction. Currently, there are limited clinical data to guide the management of these patients, and the hemodynamic effects of these aneurysms are unknown. We applied patient-specific modeling to systematically quantify hemodynamics and wall shear stress in coronary arteries with aneurysms caused by KD. We modeled the hemodynamics in the aneurysms using anatomic data obtained by multi-detector computed tomography (CT) in a 10-year-old male subject who suffered KD at age 3 years. The altered hemodynamics were compared to that of a reconstructed normal coronary anatomy using our subject as the model. Computer simulations using a robust finite element framework were used to quantify time-varying shear stresses and particle trajectories in the coronary arteries. We accounted for the cardiac contractility and the microcirculation using physiologic downstream boundary conditions. The presence of aneurysms in the proximal coronary artery leads to flow recirculation, reduced wall shear stress within the aneurysm, and high wall shear stress gradients at the neck of the aneurysm. The wall shear stress in the KD subject (2.95-3.81 dynes/sq cm) was an order of magnitude lower than the normal control model (17.10-27.15 dynes/sq cm). Particle residence times were significantly higher, taking 5 cardiac cycles to fully clear from the aneurysmal regions in the KD subject compared to only 1.3 cardiac cycles from the corresponding regions of the normal model. In this novel quantitative study of hemodynamics in coronary aneurysms caused by KD, we documented markedly abnormal flow patterns that are associated with increased risk of thrombosis. This methodology has the potential to provide further insights into the effects of aneurysms in KD and to help risk stratify patients for appropriate medical and surgical interventions.

Dataset Information

Association of Severity of Coronary Artery Aneurysms in Patients With Kawasaki Disease and Risk of Later Coronary Events.

Publications

Association of Severity of Coronary Artery Aneurysms in Patients With Kawasaki Disease and Risk of Later Coronary Events.

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