Giant aneurysms: A gender-specific complication of Kawasaki disease?. Issue 4 (October 2017)

• Record Type: Journal Article
• Authors: Dietz, Sanne M.; Kuipers, Irene M.; Tacke, Carline E.A.; Koole, Jeffrey C.D.; Hutten, Barbara A.; Kuijpers, Taco W.
• Is Part Of: Journal of cardiology. Volume 70:Issue 4(2017:Oct.)
• Page Start: 359
• Page End: 365
• Publication Date: 2017-10
• Subjects: Kawasaki disease -- (Giant) coronary aneurysms -- Risk factors; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2016.12.014
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Kawasaki disease (KD) is a pediatric vasculitis of unknown origin. Its main complication is the development of coronary artery aneurysms (CAA) with giant CAA at the end of the spectrum. Methods: In this cohort study, we evaluated the association between patient characteristics and the development of giant CAA based on z -scores. Multivariable, multinomial logistic regression analysis was used to identify variables associated with giant CAA. Results: A total of 301 KD patients, comprising 216 patients without enlargement, 45 with small-sized, 19 with medium-sized, and 21 with giant CAA with all echocardiographies at our center were retrospectively included. Remarkably, 95% of patients with giant CAA were boys. In addition to 'no/late intravenous immunoglobulin (IVIG) treatment', 'male gender' (OR 16.23, 95% CI 1.88–140.13), 'age < 1 year' (OR 7.49, 95% CI 2.29–24.46), and 'IVIG re-treatment (9.79, 95% CI 2.79–34.37)' were significantly associated with an increased risk of giant CAA, with patients without enlargement as reference. Compared to patients with medium-sized CAA, 'IVIG re-treatment' was significantly associated with giant CAA. The majority of giant CAA continued to increase in size during the first 40 days. Conclusions: We identified risk factors associated with an increased risk of giant CAA. The difference in variables between the giant CAA group and the other CAA subgroups suggests a separation between patients with the treatment-resistant giant CAA and the other IVIG-responsive patients, in which gender may be factored as a most relevant genetic trait. The increase in size during the first 2 months indicates the need for repeated echocardiography.