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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2022; 70(S 03): e1-e6
DOI: 10.1055/s-0042-1747674
Pediatric and Congenital Cardiology

Coronary Artery Z-scores in Febrile Children with Suspected Kawasaki's Disease—The Value of Serial Echocardiography

Stephan Gerling 
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
,
Maria Hörl
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
,
Tobias Geis
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
,
Robert Zant
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
,
Markus-Johann Dechant
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
,
Michael Melter
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
,
Holger Michel
1   University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Campus St. Hedwig, Regensburg, Germany
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Abstract

Background Progressive enlargement of the coronary artery (CA) diameters on serial echocardiography can support diagnosis of Kawasaki's disease (KD) even CA dimensions are within the normal range.

Methods A single-center, retrospective study compared mean Z-scores of the proximal CA internal diameters in children hospitalized with non-KD febrile illnesses (FCs) with those of KD patients.

Results A total of 223 patients with suspicion of KD have been admitted over a period of 16 years and data were evaluable for 176 children. Distributions for age, sex, and body surface area were similar for both groups. FC had a significantly shorter duration of hospitalization, higher levels of hemoglobin, lower levels of liver transaminases, and segmented neutrophils, respectively. The majority of FC patients (75/82, 91.5%) had normal CA Z-scores (p < 0.001) and only 3 (3.7%) had CA Z-score ≥2.5 standard deviation (SD). In KD, subjects (46/94, 49.5%) had a CA dilation (Z-score ≥2.5 SD) and the maximum CA Z-score (Zmax) was significantly higher compared with FC patients (p < 0.001). On serial echocardiograms, FC patients showed a mild decrease, whereas KD patients developed a significant increase of CA Zmax (p < 0.001). Seven KD patients had a segmental dilation of a CA which has been confirmed by cardiac catheter. In FC, no segmental dilation of any CA was documented by echocardiography.

Conclusion This study found that mean CA dimensions in FCs were smaller and did not increase in serial echocardiograms compared with KD patients.

Keywords

Kawasaki's disease - aneurysm - coronary artery - serial echocardiography - Z-scores - febrile children

Note

The study was approved by the Institutional Review Board of the University of Regensburg (file number 14-101-0206).


Authors' Contribution

S.G. was responsible for examination and data collecting, wrote, and edited the manuscript. M.H. collected data, wrote, and edited the manuscript; T.G. wrote, reviewed, and edited the manuscript. R.Z. wrote, reviewed, and edited the manuscript. M.J.D. contributed to examination and data collection. M.M. and H.M. conceptualized the study design and reviewed and edited the manuscript. All authors contributed to manuscript revision, read, and approved the final version.




Publication History

Received: 29 June 2021

Accepted: 23 November 2021

Article published online:
06 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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