Extracardial Vasculopathy After Kawasaki Disease: A Long-Term Follow-up Study

Background: kawasaki disease (kd) is a pediatric vasculitis with coronary artery aneurysm (caa) as a major complication. controversy exists about cardiovascular risk later in life. the aim of our study was to evaluate whether kd patients are at increased risk,as assessed by carotid intima-media thickness (cimt).methods and results: we measured cimt over 15 years by b-mode ultrasonography in kd patients during follow-up and in unaffected controls (mostly siblings). a multilevel,repeated-measures,linear mixed-effects model was used to evaluate the association between kd and cimt. a total of 319 patients with 528 measurements were compared with 150 controls. in kd patients,the mean cimt was increased compared with controls (0.375 mm [95% ci 0.372-0.378 mm] versus 0.363 mm [95% ci 0.358-0.368 mm]; p<0.001). furthermore,mean cimt of caa-negative patients was 0.373 mm (p<0.01 compared with controls),of patients with small-medium caa was 0.374 mm (p<0.05 compared with controls),and of patients with giant caa was 0.381 mm (p<0.01 compared with controls). compared with controls,caa-negative participants started with an increased cimt (+0.0193±0.0053 mm,p<0.001) but showed slower progression (-0.0014±0.0006 mm/year,p=0.012). patients with giant caa showed a trend toward increased cimt progression (0.0013±0.0007 mm/year,p=0.058).conclusions: we observed a positive correlation between cimt and kd severity of coronary arteritis at the acute stage. although initially increased,the cimt in caa-negative patients normalized at a later age. in contrast,patients with a history of kd complicated by giant caa showed a trend toward persistently increased cimt. these patients may need cardiovascular counseling and follow-up beyond the heart. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.