Abstract
Previous studies that used carotid ultrasound have been largely conflicting in regards to whether or not patients after Kawasaki disease (KD) have a greater carotid intima-media thickness (CIMT) than controls. To test the hypothesis that there are significant differences between the values of CIMT expressed as absolute values and standard deviation scores (SDS) in children and adolescents after KD and controls, we reviewed 12 published articles regarding CIMT on KD patients and controls. The mean ± SD of absolute CIMT (mm) in the KD patients and controls obtained from each article was transformed to SDS (CIMT-SDS) using age-specific reference values established by Jourdan et al. (J: n = 247) and our own data (N: n = 175), and the results among these 12 articles were compared between the two groups and the references for comparison of racial disparities. There were no significant differences in mean absolute CIMT and mean CIMT-SDS for J between KD patients and controls (0.46 ± 0.06 mm vs. 0.44 ± 0.04 mm, p = 0.133, and 1.80 ± 0.84 vs. 1.25 ± 0.12, p = 0.159, respectively). However, there were significant differences in mean CIMT-SDS for N between KD patients and controls (0.60 ± 0.71 vs. 0.01 ± 0.65, p = 0.042). When we assessed the nine articles on Asian subjects, the difference of CIMT-SDS between the two groups was invariably significant only for N (p = 0.015). Compared with the reference values, CIMT-SDS of controls was within the normal range at a rate of 41.6 % for J and 91.6 % for N. These results indicate that age- and race-specific reference values for CIMT are mandatory for performing accurate assessment of the vascular status in healthy children and adolescents, particularly in those after KD considered at increased long-term cardiovascular risk.
Highlights
Several studies showed that carotid intima-media thickness (CIMT), a surrogate of atherosclerotic vessel wall changes, is sensitive to risk intervention and constitutes a reliable indicator of clinical outcome in adult subjects, even in a pediatric cohort (O’Leary et al 1999; Jarvisalo et al 2001)
We speculated that there are significant differences between the values of absolute CIMT and those of standard deviation scores (SDS) transformed by least mean squares (LMS) methods (CIMT-SDS) in children and adolescents after Kawasaki disease (KD) and controls
The following criteria were accepted for inclusion in this study: (1) subjects with a diagnosis of KD, (2) an interval from initial onset of illness of ≥1 year, (3) KD patients and control subjects who underwent carotid ultrasound according to the Mannheim CIMT consensus, (4) mean CIMT measurements at least in triplicate by the far wall of either right or left common carotid artery (CCA), and (5) the use of either manual tracing with electronic calipers or a semiautomated border detection program for the assessment of CIMT
Summary
Several studies showed that carotid intima-media thickness (CIMT), a surrogate of atherosclerotic vessel wall changes, is sensitive to risk intervention and constitutes a reliable indicator of clinical outcome in adult subjects, even in a pediatric cohort (O’Leary et al 1999; Jarvisalo et al 2001). We speculated that there are significant differences between the values of absolute CIMT and those of SDS transformed by LMS methods (CIMT-SDS) in children and adolescents after KD and controls. We reviewed previously published articles regarding CIMT in KD patients and controls
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