The Importance of Echocardiogram during the Second Week of Illness in Children with Kawasaki Disease

Abstract

To determine the timing of peak coronary artery dilation and the characteristics of patients who present with new-onset coronary artery dilation during the acute phase of Kawasaki disease with an initial normal echocardiogram. This retrospective study analyzed 231 children hospitalized for Kawasaki disease in Hawai'i over a period of 7years. Clinical and echocardiographic data were collected to calculate the timing of peak z score, and study subjects were compared based on the timing of coronary dilation. Peak coronary artery dilation was observed on average at 11.5days from the onset of fever (median 8, IQR 7-13days). Among study subjects with normal z scores in both coronary arteries during the initial encounter and echocardiogram (n=164), 16 (10%) developed coronary artery dilation or aneurysm at the second echocardiogram, and 5 (3%) continued to have coronary artery dilation or aneurysm at the convalescent phase. A repeat echocardiogram during the second week of illness (day 7-14 from fever onset) in patients with normal initial echocardiogram could identify new-onset coronary artery dilation or aneurysm and could be useful in the timely adjustment of antithrombotic or anti-inflammatory therapies.