Pediatric Rheumatology Online Journal

Pediatric Rheumatology Online Journal → July 2003 → Vasculitides → Kawasaki Disease → Abstract #128

INCIDENCE OF EARLY CARDIAC ABNORMALITIES IN CHILDREN WITH KAWASAKI DISEASE TREATED WITH LOW DOSE ASPIRIN AND INTRAVENOUS IMMUNOGLOBULIN IN THE ACUTE PHASE

R. Scuccimarri,^1,2 C. Rohlicek,^1,2 M. J. Beland,^1,2 K. N. Watanabe Duffy,^1,2 L. Jutras,^1,2 A. Dancea,^1,2 M. Gordon,¹ M. Gibbon,¹ I. Morin,¹ R. Platt,^1,2 C. M. Duffy.^1,2

Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada; ²McGill University, Canada

Background: Kawasaki disease (KD) is a systemic vasculitis characterised by the development of coronary artery lesions (CAL). Other cardiac abnormalities can occur. The treatment of KD includes IVIG and ASA. While there has been no consensus on the appropriate dose of ASA for the acute phase, most North American centers use high dose ASA. Here we describe the early cardiac outcome in our patients treated in the acute phase of KD with low dose ASA and IVIG.
Methods: A retrospective chart review was conducted of all patients admitted at our center with a diagnosis of KD between January 1985 and December 1999. Patients who either fulfilled KD diagnostic criteria or were deemed to have atypical or incomplete KD, and were treated in the acute phase with low dose ASA and IVIG, were included.
Results: Study entry criteria were met by 221 patients. There were 81 girls and 140 boys (1:1.7) with a mean age at diagnosis of 2.97 years (range 0.1-13). At presentation, 180 (81.45%) fulfilled KD diagnostic criteria, 38 (17.19%) had incomplete KD, and 3 (1.36%) had atypical KD. Twenty (9.05%) patients developed CAL. Thirty-nine patients (17.65%) had other early cardiac abnormalities including myocardial dysfunction, pericarditis, and valvular abnormalities. Total fever duration was longer in those with CAL (p=0.0006) and in those with other early cardiac abnormalities (p=0.012). Of the 196 patients who had ECGs, 27 (13.78%) were abnormal. There was 1 death (0.45%) unlikely related to KD.
Conclusion: Treatment with low dose ASA and IVIG in the acute phase of KD is associated with a similar incidence of CAL to high dose ASA and IVIG. Other early cardiac abnormalities and ECG changes occur commonly. All cardiac events are associated with longer duration of total fever. The significance of these findings and the long-term outcome of this cohort are currently under study.