日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: The prevention of coronary artery aneurysm is important in the treatment of Kawasaki disease (KD). Thus, the ability to predict the risk of coronary dilation before initiating therapy would be very useful. In this study, patients suspected of KD underwent echocardiography and were evaluated for specific findings. We observed for specific changes that occurred in the course of KD, including when they appeared and their association with coronary dilation (Z ≥2.5).

Methods: We evaluated 169 patients diagnosed with KD. We analyzed the associations of coronary dilation with specific echocardiogram findings, including tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, aortic regurgitation (AR), pericardial effusion (PE), left ventricular end-diastolic diameter, and left ventricular ejection fraction, during hospitalization using univariate and multivariate analyses.

Results: Univariate and multivariate analyses showed that AR, PE, and left ventricular dilation were significantly associated with coronary dilation. Specifically, AR preceded coronary dilation, and its positive predictive value for coronary dilation was 30％, sensitivity was 42％, and specificity was 76％.

Conclusions: AR, PE, and left ventricular dilation were associated with coronary dilation, with AR preceding its occurrence. Therefore, patients with KD with AR early in the diagnosis require careful follow-up. Furthermore, prompt intravenous immunoglobulin therapy should be considered.