bluuebunny/crossref_metadata_2025 huggingface dataset:
Abdominal obesity is associated with increased risk of acute coronary events in men
Authors: Lakka Hanna-Maaria , Salonen Jukka T , Lakka Timo A
Published: March 2022

P68

Obesity is an important risk factor for coronary heart disease (CHD), but the relative importance of overall and abdominal obesity is unclear. Abdominal obesity has been linked to several atherogenic disorders through which it could increase coronary risk. We investigated the associations of overall and abdominal obesity with the risk of acute coronary events and possible biological mechanisms underlying the relationships in a prospective population-based study among 1346 men aged 42-60 years in Finland. Body mass index (BMI) was used as a measure of overall obesity and waist-to-hip ratio (WHR) and waist circumference (WC) were used as measures of abdominal obesity. Data on acute coronary events were obtained by computer linkage to national hospital discharge and death certificate registers. There were 111 acute coronary events during an average follow up of 10 years. Men with the WHR of 0.91-0.94, 0.95-0.98 and >0.98 (three highest quartiles) had a 3.34-fold (95% CI 1.57-7.10, p=0.002), 2.97-fold (1.39-6.34, 0.005) and 3.40-fold (1.61-7.18, 0.001) risk of acute coronary events, respectively, compared with men with the WHR of <0.91 (lowest quartile) adjusting for confounders. Men with the WC of 83.5-89.5 cm, 90.0-95.5 cm and >95.5 cm (three highest quartiles) had a 1.29-fold (0.71-2.37), 1.70-fold (0.96-3.02) and 1.94-fold (1.10-3.40, 0.021) risk of acute coronary events compared with men with the WC of <83.5 cm (lowest quartile). These associations were partly explained by serum HDL cholesterol, triglycerides and apolipoprotein B, systolic and diastolic blood pressure, diabetes, fasting serum insulin, plasma fibrinogen and serum uric acid. BMI had a markedly weaker association with coronary risk than WHR or WC. Men with both overall and abdominal obesity (BMI ≥25.0 kg/m

2

and WHR ≥0.91) had a 4.56-fold risk of acute coronary events compared with men without obesity. This study indicates that even mild abdominal obesity is independently associated with increased risk of CHD, and that the association is partly explained by other coronary risk factors. This study also suggests that abdominal obesity has a stronger association with coronary risk than overall obesity.
Workplace and Leisure Time Physical Activity: Opposing Relations with Progression of Early Atherosclerosis. The Los Angeles Atherosclerosis Study.
Authors: Nordstrom Cheryl K , Dwyer Kathleen M , Merz C N Bairey , Shircore Anne M , Dwyer James H
Published: March 2022

P74

Background. While exercise during leisure is a consistent protective factor for CVD, there is inconsistency across studies concerning the impact of physical activity during work. The current study investigated the relationship between progression of sub-clinical atherosclerosis and physical activity during work and during leisure time. Methods. Participants were from a cohort of 573 randomly sampled utility workers asymptomatic for CVD who were aged 40-60 years at entry. Physical activity during leisure was determined from the number of times per week the subject reported working up a sweat; physical activity during work was ascertained from an NHLBI Physical Activity Index. Sub-clinical atherosclerosis was measured as intima-media thickness (IMT) of the common carotid arteries by high resolution B-mode ultrasound. 36 month change in IMT was measured in microns per year. Results. The mean (±SD) IMT in the sample with complete follow-up (n=447) was 678±106 μm. Those scoring in the highest quintile of workplace activity had significantly more IMT progression compared with those in the lowest quintile (mean±SE = 13.0±1.8 vs 6.9±1.8 μm/yr, respectively; p for trend=0.02 in a model adjusted for age, sex, age-sex interaction, smoking status, alcohol use, use of blood pressure and/or cholesterol lowering medications, BMI, HDL-c, total serum cholesterol, heart rate, systolic blood pressure, and intake of supplemental vitamin C and E). For leisure activity, significantly less IMT progression was found with more activity, but only among those in the highest quintile of activity relative to those in the other 4 quintiles (6.5±1.8 vs 10.9±0.9 μm/yr; p=0.03 in a model adjusted for the same covariates listed above). No significant interaction with sex was detected. Workplace activity was strongly correlated with workplace psychological stress (ρ=0.56), which was previously shown to be a risk factor for IMT in this cohort. Conclusions. These findings suggest that protective effects of physical activity may be blocked or counteracted when activity is performed in a psychologically stressful context.
The association of chromium with the risk of a first myocardial infaction in men. The EURAMIC Study.
Authors: Guallar Eliseo , Jimenez F. Javier , Veer Pieter van ’t , Bode Peter , Martin-Moreno Jose M , Kok Frans J.
Published: March 2022

P82

Background: Chromium, an essential heavy metal, is a cofactor of insulin that increases insulin sensitivity at the receptor level. Chromium has been shown to help control blood glucose and insulin in patients with type 2 diabetes mellitus and glucose intolerance, and it may also improve lipid variables. Although an inverse association between chromium and cardiovascular endpoints has long been hypothesized, no epidemiologic studies have been reported on this association. Objective: To evaluate the association between toenail chromium concentrations and the risk of a first myocardial infarction in men. Setting: The EURAMIC study, a large case-control study conducted in 10 European countries and Israel. Cases (n = 684) were men with a first diagnosis of myocardial infarction recruited within 24 hours of admission to the coronary units of participating hospitals. Controls (n = 724) were men selected to be representative of the populations that originated the cases. Toenail chromium was assessed by instrumental neutron activation analysis. Results: Average concentrations of toenail chromium were 1.10 mg/kg in cases (95% confidence interval [CI] 1.02 - 1.18) and 1.30 mg/kg in controls (1.21 - 1.40). Age and center-adjusted odds ratios (95% CI) of myocardial infarction for quintiles 2-5 of toenail chromium with respect to the first quintile were 0.74 (0.54-1.03), 0.77 (0.56-1.06), 0.53 (0.38-0.75), and 0.65 (0.46-0.91). The p for trend was 0.005. This inverse association was essentially unchanged after further adjustment for smoking, body mass index, HDL cholesterol, diabetes, and history of hypertension. Multivariate adjusted odds ratios for quintiles 2-5 were 0.84 (0.56-1.26), 0.70 (0.46-1.05), 0.56 (0.37-0.87), and 0.65 (0.42-0.99), with a p for trend of 0.049. Conclusions: Toenail chromium was inversely associated to the risk of a first myocardial infarction in men. Further studies are needed to replicate these findings and to elucidate the potential protective mechanisms of chromium on cardiovascular risk.
Coronary artery calcium in older adults aged 67-99
Authors: Newman Anne B , Naydeck Barbara L , Sutton-Tyrrell Kim , Edmondowicz Daniel , Kuller Lewis H
Published: March 2022

0001

Coronary artery calcification (CAC) appears to increase with age to at least age 75, but has not been studied in adults well beyond this age. Between 1998-2000, 614 of 767 participants from the Pittsburgh cohort of the Cardiovascular Health Study, mean age 80 years (range 67-99), had CAC measured by electron beam tomography (total Agatson score). All had prior clinical exams, non-invasive exams of carotid wall thickness, ankle-arm index, and ECG to detect subclinical CVD (’94- 95), and baseline risk factor assessment (’89- 90). Of the 614, 367 (60%) were women and 247(40%) were men; 23% were African American. The prevalence of clinical CVD at scan was 33%, and another 33% had at least one marker of subclinical CVD. CAC scores were skewed towards low scores, with a median of 625 for men and 202 for women. Median CAC score increased with age, were usually higher in men than women regardless of the presence or absence of clinical or subclinical CVD (

Table). No detectable CAC was found in 6% of men and 11% of women but the proportion with a zero score decreased with age (from 15% under age 80 to 5% of those 80+). Those with higher scores were also more likely to be Caucasian, but did not differ in prevalence of baseline hypertension, diabetes, or lipid levels. Smoking history was of borderline significance. These data suggest that CAC continues to increase in these survivors into advanced old age and is more strongly related to age than to baseline risk factors. Also of note, a small proportion remained free of detectable CAC past age 80.

Table 1.
A Prospective Study of Vitamin E and Coronary Heart Disease Among Men:
Authors: Rimm Eric B
Published: March 2022

0016

A growing body of evidence suggests that oxidative modification of LDL-cholesterol is important in the early development of atherosclerotic lesions. Although past observational epidemiologic evidence suggests CHD benefit for long term vitamin E supplement use, two recent large secondary prevention trials have not found a lower risk of CVD among patients randomized to vitamin E. Data comparing the benefits of vitmain E between populations with and without prior CVD have not been adequately explored. We examined prospectively the association between vitamin E supplements (>100 IU/day for 2 or more years) and risk of coronary heart disease among 38,884 U.S. male health professionals, 40 to 75 years of age at baseline (1986) and who were free of diagnosed CVD, diabetes, and cancer. During ten years of follow-up, we documented 1145 incident cases of fatal and non-fatal myocardial infarction (MI). After controlling for several known coronary risk factors, we observed a lower risk of coronary disease among men with use of vitamin E supplements. As compared with men who did not take vitamin E supplements, men who took at least 100 IU per day for at least two years had a multivariate relative risk of MI of 0.78 (95 percent confidence interval, 0.65 to 0.95). The benefits of vitamin E were substantially greater among populations free of CVD-related conditions. Among men without self-reported physician-diagnosed hypercholesterolmia, the RR of MI for vitamin E was 0.74 (95% CI 0.60,0.93). Men with hypercholesterolemia did not show appreciable benefit from vitamin E (RR=0.93;95% CI 0.63, 1.37). Men without hypertension had a lower risk of MI associated with vitamin E use (RR=0.74;95% CI 0.58, 0.94) than men with hypertension (RR=0.88;95% CI0.63, 1.22). Men free of either condition showed a significantly greater benefit from taking vitamin E (RR=0.71; 95% CI 0.54, 0.92) than men with either of these two conditions (RR=0.88; 0.67, 1.17). These data suggest a reduced risk of CHD for long term vitamin E supplement use among an otherwise healthy population and are consistent with the recent null findings from secondary prevention trials.
Insulin resistance and five-year progression of carotid intimal-medial wall thickness:
Authors: Saad
Published: March 2022

0026

Insulin resistance (IR) is thought to be an important risk factor for atherosclerosis. It is unclear, however, whether the effect is independent of other cardiovascular (CV) risk factors that cluster with IR, e.g., obesity, hypertension (HTN), and hyperlipidemia. IRAS is a multi-ethnic epidemiologic cohort study investigating the association between IR and CV disease. IR was measured by the frequently sampled intravenous glucose tolerance test with minimal model analysis in 773 non-diabetic persons aged 60 years (range 44 - 75) who participated in the baseline IRAS examination (1992-4). Intimal-medial thickness (IMT) of the carotid arteries was measured by B-mode ultrasonography as an index of atherosclerosis at baseline and at the 5-year follow-up exam (1998-9). Both scans were read at the follow-up time point to eliminate possible reader drift. We modeled change in IMT on IR, adjusting for baseline IMT using a general linear models approach. The models adjusted progressively for demographic variables and CV risk factors. Overall, common carotid (CCA) IMT increased 30 μm (s.e. = 8 μm). Average IR at baseline was 2.2 units (range 0 - 14.2). Adjusting for age, sex, ethnicity, clinic and baseline measurement, CCA IMT increased 20 μm (p=0.007) for a 2 unit increase in IR (change from 25th to 75th percentile). Further adjustment for baseline HDL, LDL, smoking, HTN and glycemia attenuated the effect (17 μm, p=0.05). Adjustment for BMI and waist-hip ratio explained some of the effect (13 μm, p=0.13). No significant association was observed between IR and progression in the internal carotid artery. Analyses incorporating hierarchical measurement error models for IMT were performed to confirm these results. As expected in these analyses, the IR effect was somewhat attenuated, but not eliminated. In summary, IR is associated with progression of carotid atherosclerosis, but this effect may be mediated through the associated cluster of CV risk factors.
Effect of Soy Protein Supplementation on Serum Lipids:
Authors: He Jiang , Gu Dongfeng , Wu Xigui , Duan Xiufang , Whelton Paul K.
Published: March 2022

0029

Clinical trials have indicated that soy protein supplementation reduces blood cholesterol in patients with hypercholesterolemia and in postmenopausal women. We examined the effect of soy protein supplementation on serum lipids in a randomized, double-blinded, placebo-controlled trial. A total of 60 male and 90 female study participants aged 35 to 65 years were recruited from the community in Beijing, China. They were randomly assigned to receive 40 g isolated soy protein per day (n=76) or complex carbohydrate placebo (n=74) for 12 weeks. Fasting serum total cholesterol, HDL-cholesterol, and triglyceride were measured at baseline, and at interim (6 wks) and termination (12 wks) follow-up visits using standard methods. Overall, 92.0% (138/150) of the study participants completed the trial. The results were determined using an intention-to-treat analysis. At baseline, the supplementation and control groups were similar in age (55.8 vs. 55.9 yrs), blood pressure (135.9/82.6 vs. 134.5/82.2 mm Hg), weight (70.1 vs. 67.7 kg), total cholesterol (201.2 vs. 205.5 mg/dl), HDL-cholesterol (44.3 vs. 45.6 mg/dl), LDL-cholesterol (129.7 vs. 129.7 mg/dl), and triglyceride (135.7 vs. 151.1 mg/dl) levels. Compared to the carbohydrate control group, the soy protein supplementation group had a net increase in serum lipid of 3.3% (p=0.047) for total cholesterol, 4.7% (p=0.038) for HDL-cholesterol, 3.0% (p=0.21) for LDL-cholesterol, and 2.6% (p=0.67) for triglyceride levels. Our study suggests that soy protein intake may increase HDL-cholesterol but not affect LDL-cholesterol significantly in populations with a normal blood cholesterol level and consumption of a relatively low animal protein diet.
Abstract 107: Urinary β2 Microglobulin To Creatinine Ratio As A Predictive Factor Of Intravenous Immunoglobulin Resistance
Authors: Yoshikawa Takahisa , Waki Kenji , Ogino Kayo , Sawada Mariko , Hayashi Tomohiro , Arakaki Yoshio
Published: March 2022

Introduction:
The standard dose of intravenous immunoglobulin (IVIG) as initial therapy for patients with Kawasaki disease (KD) is generally 2 g/kg. In our hospital, the initial IVIG dose for patients with KD is 1 g/kg, which is augmented according to treatment response, and therapy is changed to plasma exchange (PE) if IVIG therapy over 6 g/kg is ineffective. To date, various factors and scoring systems for predicting IVIG resistance have been reported. We evaluated consecutive urinary β2 microglobulin to creatinine ratio (β2MG/Cr) data as a possible predictive factor of IVIG therapy resistance.

Objectives:
To clarify whether urinary β2MG/Cr is an effective predictive factor for IVIG therapy resistance.

Methods:
We retrospectively reviewed the data of all patients with KD who underwent IVIG therapy at a dose of over 6g/kg in our hospital from January 1997 to January 2014. Patients with recurrent KD were excluded from the study. Patients were divided into two groups for analysis, those who did and did not require PE. Factors including urinary β2MG/Cr were compared across the two groups. We used the peak urinary β2MG/Cr of each patient in the course of the disease.

Results:
There were 713 patients with KD who were treated in our hospital from January 1997 to January 2014. There were 28 patients without recurrent KD who underwent IVIG therapy over 6g/kg. IVIG was successful in 24 patients (non-PE group), and 4 patients required PE (PE group). Urinary β2MG/Cr was not measured in only one patient of the non-PE group. Urinary β2MG/Cr significantly higher in the PE group (median 119,228 μg/gCr, 69,286-234,290 μg/gCr) compared to the non-PE group (median 12,270 μg/gCr, 1,981-210,647 μg/gCr) (p=0.001, t-test). Urinary β2MG/Cr exceeded 100,000 μg/gCr in 4 % (1 of 23) of the PE group and 75 % (3 of 4) of non-PE group. There were temporarily coronary artery lesions (dilation or aneurysm) in 57 % (13 of 23) of the non-PE group and 75 % (3 of 4) of the PE group. Coronary artery lesions regressed in all patients.

Conclusion:
Our study suggests that urinary β2MG/Cr measurement is a useful non-invasive test for predicting IVIG resistance.
Abstract 133: Assessment of Therapeutic Effect of Medium-Dose Intravenous Immunoglobulin as An Initial Treatment for Kawasaki Disease in Korean Children
Authors: Kim Hye-Jin , Lee Jae Young , Shim Sun Hee , Lee Eun-Jung , Oh Jin Hee , Han Ji Whan , Lee Kyung Yil , Lee Soon Ju
Published: March 2022

Objectives:
A high-dose (2g/kg) intravenous immunoglobulin (IVIG) has been generally incorporated into the acute treatment protocols for Kawasaki disease (KD), with ongoing debates on this issue. The aim of this study was to assess the effectiveness of medium-dose (1g/kg) IVIG as an initial treatment of KD in Korean children.

Methods:
A retrospective study was done in a total of 255 children with KD, in whom 91 patients (group 1, mean age; 2.8 ± 2.5 years) had 2g/kg of IVIG and 164 patients (group 2, mean age; 2.7 ± 1.7 years) had 1g/kg of IVIG as an initial treatment of KD, along with 30-50 mg/kg of aspirin. Echocardiography (Echo) was done during admission, around 2 weeks, 2 months, and 1 year after the onset of fever according to our protocol. Patients who completed one-year Echo study were included in this study. Patients’ demographic, laboratory, and Echo findings were recorded, and compared between groups. Coronary artery lesions (CAL) were defined as a coronary artery diameter > 2 SD of normal mean for age or coronary artery stenosis. The primary end point was the incidence of CAL at 1 year after treatment. The secondary end points were the incidence of CAL at 2 weeks and 2 months study, and clinical outcomes. Comparisons between groups were done using an unpaired t-test or Fisher’s exact test.

Results:
There was no significant difference in age, gender, and laboratory findings before treatment between the two groups. Group 1 had higher incidence of CAL at 2 weeks (32/91, 35.2 % vs. 33/164, 20.2 %, p = 0.011), but similar incidence of CAL at 2 months (18/91, 19.8% vs. 24/164, 14.6%, p > 0.05) and 1 year (6/91, 6.6% vs. 10/164, 6.1%, p > 0.05) compared with group 2. Group 1 had a higher proportion of patients needed additional dose of IVIG (23/91, 25.3% vs. 15/164, 9.1%, p = 0.001), but received significantly lower total dose of IVIG (1.3 ± 0.7 g/kg vs. 2.1 ± 0.5 g/kg, p < 0.001) compared with group 2. There was no difference in duration of fever after IVIG and duration of hospital stay between the two groups.

Conclusion:
This study demonstrated that medium-dose IVIG is as effective as high-dose IVIG for the treatment of KD in terms of CAL prevention, defervescence, and duration of hospital stay. Further prospective and randomized study is needed to verify this.
Abstract 140: A study on 15 patients with Kawasaki disease who underwent coronary bypass surgery at our hospital
Authors: Ohtaka Masao , Akimoto Katsumi , Nakamura Asuka , Harada Mana , Furukawa Takeshi , Fukunaga Hideo , Ohtsuki Masahiro , Takahashi Ken , Kishiro Masahiko , Shimizu Toshiaki
Published: March 2022

Background:
Kawasaki Disease (KD)-related coronary artery aneurysm results in stenotic lesions due to thrombus formation and intimal thickening. In its acute phase, KD may follow an acute course due to thrombotic occlusion leading to myocardial infarction. On the other hand, in the convalescent phase, it does not follow a rapid course due to the development of collateral circulation and often occurs with chest pain. In this study, we retrospectively analyzed the following variables in patients who underwent bypass surgery: clinical course until initiation of surgical treatment, indication of surgical treatment.

Subjects and Methods:
The subjects were 15 patients who underwent coronary artery bypass graft (CABG) surgery at our hospital (male:female ratio, 8:7; age, 24-58 years; mean age, 38.3 years). In these subjects, we examined the age at onset, period until initiation of surgical treatment, presence or absence of symptoms, radiographic findings, indications for surgical treatment, and operative methods.

Results:
The age at onset of KD was between 6 months and 12 years. For 3 patients, KD was not diagnosed in childhood and the diagnosis was based on calcification and chest radiography findings. The period from onset to surgical treatment ranged 7-42 years (mean, 25.6 years). Most of the subjects underwent surgical treatment during adulthood. Radiography showed bilateral lesions in 14 patients, complete occlusion of the right coronary artery in 5 patients, and calcification in 4 patients. Collateral circulation developed in all subjects who underwent surgical treatment during adulthood. Although exertional chest pain was observed in 9 patients, no patient required emergency CABG. Surgical treatment involving the bilateral inferior mesenteric arteries was performed in 14 patients. In 2 patients, a bulky mass was resected from the right coronary artery.

Conclusion:
The mean age at surgery was approximately 40 years. There were many subjects in whom the time elapsed since disease onset was long, which was presumably attributed to the development of collateral circulation. Therefore, it is necessary to examine such patients using diagnostic imaging or stress myocardial scintigraphy even if they are asymptomatic.
Abstract 143: Clinical Consideration of Kawasaki Disease Development in Younger and Older Children
Authors: Sakurai Kenzo
Published: March 2022

Background:
Kawasaki disease (KD) is an acute febrile illness of childhood. Most KD patients are children aged from 6 months to 4 years, although a small number of cases occur in children less than 6 months or over 5 years of age. KD symptoms are not easily observed in younger and older children, and so it is necessary to understand how the features of KD change with age.

Objective:
This study aimed to evaluate the clinical features of KD in children less than 6 months and greater than 5 years of age in our hospital.

Methods:
Patients diagnosed between October 2006 and September 2013 were divided into 2 groups: group A included 19 infants less than 6 months old and group B included 222 children who were more than 6 months old (1). On the other hand, patients were divided into another 2 groups: group C which included 219 children less than 5 years old and group D which included 29 children who were more than 5 years old (2). The features and symptoms of KD were compared between the groups; in particular, white blood cell counts, neutrophil ratios, platelet counts, total bilirubin, aspartate transaminase, alanine transaminase, sodium, C-reactive protein, fibrinogen, D-dimer, and intravenous immunoglobulin unresponsive scores were compared.

Results:
(1) Few infants less than 6 months old had changes in their extremities or cervical lymph node swelling; most of the infants less than 6 months old had incomplete KD. The neutrophil ratio before treatment tended to be significantly lower in infants less than 6 months old. (2) Most of the children over 5 years old had erythema, but few had significant cervical lymph node swelling. The neutrophil ratio before treatment tended to be significantly higher in infants over 5 years old.

Discussion:
The symptoms of KD are not easily observed in infants less than 6 months old, and so KD diagnosis can be difficult. KD in children over 5 years old is sometimes diagnosed as pyogenic cervical lymphadenitis, and these patients sometimes have to wait a long time to be diagnosed with KD. It is important to carefully observe the clinical progress of young infants with a continuing high fever and children diagnosed with pyogenic cervical lymphadenitis.
Abstract 16: A Clinical Study Of Older Children With Kawasaki Disease
Authors: Nagamori Yukako , Ogihara Yoshihito , Sato Kayoko , Ebato Takasuke , Otani Kiyotaka , Nakamura Shinya , Minoura Kastunori , Ogata Shohei , Ishii Masahiro
Published: March 2022

Background:
Kawasaki disease(KD) patients exhibiting a disease onset past infancy are likely to receive a delayed diagnosis, as it takes time for all major symptoms to manifest and the disease also includes many non-typical features. Most general pediatricians and infectious disease specialists may not consider KD in the differential diagnosis among schoolchildren.

Objective:
To examine the clinical features of KD in patients with school-age onset.

Methods:
Among a total of 650 patients who received a diagnosis of KD in groups Department of pediatrics, Kitasato University School of Medicine , Sagamihara Cooperation Hospital and Ebina General Hospital over the seven-year period from April 2007 to March 2014, we investigated schoolchildren 7 years of age or older. Using the patients’ medical records, we retrospectively assessed data for sex, age, duration of illness, symptoms, treatment effectiveness and coronary artery lesions.

Results:
Fourteen (2.2%) schoolchildren were identified (male: n=7, 50%). The median age was 8 years (oldest age: 12 years). The incomplete type was diagnosed in 4 cases (29%), and the typical type was diagnosed in 10 cases (71%). The median duration of illness was 5 days (range: 3-12 days). Five patients (36%) were diagnosed with lymphadenitis at the initial diagnosis. Two patients with Mycoplasma pneumonia and acute appendicitis received a delayed diagnosis of KD. Their symptoms included gastrointestinal symptoms, joint pain with headaches and muscle pain. Nine patients (64%) exhibited membranous desquamation. Two of these patients displayed swelling of the hands and feet at diagnosis. All 14 patients were first treated with intravenous immunoglobulin therapy (IVIG: 2 g/kg); only one patient was resistant. Two patients (14%) were diagnosed with transient coronary artery dilatation; however, no patients had coronary aneurysms.

Conclusions:
KD with a school-age onset is rare; however, the incidence of cardiovascular complications in such cases has been reported to be high. Therefore, providing an early diagnosis and appropriate therapy is necessary. Physicians should consider the possibility of KD in school-age children who present with a persistent fever.
Abstract 189: Natural History of Coronary Artery Aneurysms in Kawasaki Disease in US population and Risk Factors for Persistent Aneurysms
Authors: Friedman Kevin G , Hamaoko-Okamoto Akiko , Gauvreau Kimberly , de Ferranti Sarah , Baker Annette , Fulton David , Tremoulet Adriana , Tang Alexander , Berry Erika , Mahavadi Vidya S , Burns Jane , Newburger Jane
Published: March 2022

Background:
The late natural history of coronary artery aneurysms (CAA) after IVIG treatment in the US is not well described.

Methods:
We evaluated all KD patients (pts) at 2 centers from 1984-2014. Entry criteria were: 1) IVIG treatment; 2) CAA, defined as LAD or RCA z-score ≥ 3 or Japanese Ministry of Health criteria; and 3) ≥1 follow-up (f/u) echo. Kaplan Meier curves evaluated time to CAA regression (z < 2.5) and Cox regression examined factors associated with persistent CAA and major adverse cardiac events (MACE= death, MI, CABG, PCI, occluded CA).

Results:
Of 2592 KD pts, 408 (15%) met entry criteria and were 72% male; 54% white, 21% Asian, 7% black, 18% other race. Median age at fever onset was 1.8 y [IQR: 0.7-4.4y], 74% had complete KD, and fever days before 1
st
IVIG were 7d [IQR 6-10d]. IVIG retreatment occurred in 35% and adjunctive anti-inflammatory therapy in 37%, both increased over time (p<.001). LAD and RCA CAA occurred in 31%, LAD alone in 47% and RCA alone in 22%. Median z-scores at CAA diagnosis were: LAD 3.61 (IQR 3.1-5.1) and RCA 3.1 (1.7-4.1) with 93 (23%) pts having giant CAA (z ≥10).

Over median f/u of 2.6 y (0.01-29.0y), 313 (77%) had CAA regression at median of 1.1 mo (IQR =0.3-16.9mo). Univariate risk factors for CAA persistence were z ≥ 8 at diagnosis (HR 0.22, p <.001), earlier era (2010-2014 HR =1.0 , 2000-2009 HR = 0.60, 1990-1999 HR =0.38, 1984-1989=0.15, all p<.001), multi-vessel CAA (LCA alone HR =1, RCA alone HR =0.99 p=.99, LCA+RCA HR=0.35, p<.001) IVIG retreatment (HR 0.68, p=.003), IVIG treatment >Day 10 (HR 0.46, p<0.001), adjunctive anti-inflammatory therapy (HR 0.65, p=.03), and non-Asian race (HR 0.64, p=.001). Multivariable model for persistent CAA included earlier era (p<.001), z-score >8 at diagnosis (p<.001), multi-vessel CAA (<.001) and treatment after Day 10 (p=.01). MACE occurred in 25 (1%) pts, including 3 deaths, with univariate risk factors of CAA z-score ≥ 8 (p<.001), earlier era (p<.001), treatment after 10 d (p=.03), and non-Asian race (p=.03)

Conclusion:
Most CAA regress within the first year after treatment. Persistent CAA are more likely in pts with larger CAA, multi-vessel CAA and late IVIG treatment. In pts with large CAA, time to regression has gotten shorter in more recent eras, possibly related to greater use of adjunctive therapies.
Abstract 202: Emergence and Characterization of Premature Acute Coronary Syndrome in Young Adults with a Confirmed History of Kawasaki Disease in Japan: Clinical and Mechanistic Insight.
Authors: Mitani Yoshihide , Tsuda Etsuko , Kato Hitoshi , Ogawa Shunichi , Higaki Takashi , Sawai Toshiki , Murase Yoshiaki , Fujiwara Masako , Nakamura Yosikazu , Takahashi Kei , Ayusawa Mamoru , Kobayashi Tohru , Ichida Fukiko , Matsushima Masaki , Kamada Masahiro , Suda Kenji , Ohashi Hiroyuki , Sawada Hirofumi , Yokoi Hiroyoshi , Hamaoka Kenji
Published: March 2022

Background:
Sporadic cases of acute coronary syndrome (ACS) have been reported in adults with coronary sequelae presumably due to Kawasaki disease (KD). However, ACS in adults with a confirmed (whether followed-up or lost to follow-up) as well as unconfirmed history of KD is poorly characterized. Methods: To investigate ACS in such adults after KD during 2000-10, a nationwide survey was conducted in Japan. Results: A total of 67 patients (median age 35 yo, male 76%) were recruited. A diagnosis of KD was made in 32 during acute illness (Group A), in which 17 were lost to follow up. A KD diagnosis was made retrospectively in the other 35 patients from coronary imaging at ACS (Group B). Overall, 67 patients were characterized by demonstrable thrombosis (74%) as well as the presence of giant aneurysms (GAN) (≥8mm) (38%), severe stenosis (>75%) (38%) and IVUS-derived calcification (92%) in culprit lesions. Group A represented younger age at ACS (26.5 yo vs. 40 yo in group B, p<.001), lower conventional coronary risks (87% vs 65%, p=.043), low percentage of severe stenosis (25% vs. 50%, p=.302) and high proportion of IVUS-derived calcification (86% vs. 100%, p=.335). In group A, patients who were followed up before ACS represented a higher proportion of GAN in culprit lesions (69% vs. 29% in KD patients lost to follow up, p=.030) as well as a shorter interval from acute KD (20 y vs. 27 y, p=.008) and higher percentage of medication before ACS (87% vs. 0%, p<.001). In the convalescence of acute KD in group A, the vessel size of prospective culprit lesion was 6.0-7.9mm in 36% and ≥8mm in 64%. Coronary angio, IVUS and MDCT of cases in 3 categories are presented. Conclusions: Premature ACS in young adults with a confirmed history of KD, significant coronary sequelae just after acute KD and low coronary risks is emerging in Japan. ACS in this population comprises two subtypes: ACS with GAN in culprit lesions in adults followed up for KD, as in childhood myocardial infarction in KD, and ACS in adults lost to follow up, characterized by the absence of GAN or severe stenosis and the presence of IVUS-derived calcification in culprit lesions, which was unmasked in this population. The present findings may give an insight into mechanisms in ACS, screening and medication, as well as recognition of KD in adulthood.
Abstract 214: Outcomes of KD by the KD type: Linking Inpatient and Outpatient Follow-up Data
Authors: Texter Karen , Kovalchin John , Ramilo Octavio , Jaggi Preeti
Published: March 2022

Background:
The relationship between KD type and outcomes is not well described. We sought to describe the incidence of KD outcomes based on type of KD presentation.

Methods:
Using an electronic medical record, we prospectively recorded clinical data for each KD encounter (initial treatment, 2 and 6 week follow up visits) for all pts treated with IVIG at our hospital and followed in our KD clinic from 11/2012-9/2014. Pts were grouped by KD type as determined on the day of treatment - Complete, Incomplete, or questionable KD (qKD), defined as incomplete KD and < 3 supplemental lab criteria. Late treatment was defined as IVIG given at > 10 days of fever. The correlation of KD type with outcomes of persistent fever requiring repeat IVIG, development of periungual peeling (PP), and coronary abnormalities (CAA) was assessed using chi-square.

Results:
We studied 109 pts treated with IVIG; 95 were treated within 10 days of fever onset (14 late). Late treatment was most common in qKD (9/19=47%) compared to Incomplete (4/22=18%) and Complete (1/68=1.5%), p<0.01. PP was least common in qKD (4/19=21%), compared to Incomplete (12/22=54%) and Complete (49/68=72%), p<0.05. No pts with qKD developed CAA, compared to 5/67 (7%) of Complete and 3/18 (16%) of Incomplete pts treated within 10 days of fever, (p=0.16, NS). Late treatment more commonly had CAA (5/14=36%, v. 8/95=8%), relative risk = 4.2 (p=0.003). In pts with CAA, 10 /13 (77%) had CAA on the first echocardiogram. The remaining 3 pts (2 Complete, 1 Incomplete) had a pericardial effusion initially and developed CAA by the second echocardiogram. Need for repeat IVIG was not different between groups (Complete 16/68 = 24%, Incomplete 3/22=14%, qKD 2/19=11%, p=0.33). Of the 2 qKD pts who required a second dose of IVIG, one was subsequently diagnosed with juvenile idiopathic arthritis and the other with Bartonella henselae; neither developed PP or CAA.

Conclusions:
The incidence of CAA was not statistically different between KD types, though no qKD pts developed CAA despite a higher incidence of late treatment with IVIG. In most pts who developed CAA, the initial echocardiogram showed either CAA or a pericardial effusion. PP was least common in qKD. In qKD, failure of initial IVIG should prompt re-evaluation of the diagnosis of KD.
Abstract 215: Fatal Arrhythmia In The Adult Patient Of Kawasaki Disease
Authors: Watanabe Hirofumi , Ayusawa Mamoru , Kamiyama Hiroshi , Karasawa Kensuke , Takahashi Syouri
Published: March 2022

We herein report the two adult patients hardly predictable sudden cardiac arrest caused by presumed Kawasaki disease (KD). Case 1: A 29- year-old man who had a history of KD at 10 months of his age complicated with bilateral giant coronary aneurysms, and was received a surgery of coronary artery bypass grafting (CABG) when he was 17 years old. He was transferred to emergency center because of sudden cardiac arrest during live concert and revived by automated external defibrillator (AED). Case 2: A 26-year-old man with a history of KD at 1year old of his age, complicated with bilateral giant coronary aneurysms, and was received a catheter intervention of rotational atherectomy (ROTA) to left anterior descending (LAD) artery at 16 years old of his age. He suddenly fell with ventricular fibrillation (VF) on playing futsal, and was hospitalized after revival by AED. Both of them had past history of myocardial infarction (MI) in their youths, however, did not have left ventricular dysfunction, symptomatic arrhythmia, and evidence of acute MI at admission. Therefore, it was difficult to strongly predict possibility of fatal arrhythmia in these cases. Finally, they received the second CABG’s for each after stabilizing and returned to their daily lives. It had been rarely reported a fatal arrhythmia in asymptomatic KD patients with normal left ventricular function with revival with recent spread of life support with public access of defibrillator. Our experiences may suggest one style with a paradigm shift in management of patients with coronary artery complications at the remote period of KD.
Abstract 224: Repeat Coronary Artery Bypass Grafting in an Adult Case of Kawasaki Disease
Authors: Sakurai Yuka , Chikada Masahide , Suzuki Hirotoshi , Sagane Masanori , Ro Daijyun , Chiba Kiyoshi , Ono Hirokuni , Oono Makoto , Kitanaka Yousuke , Nishimaki Hiroshi , Miyairi Takeshi
Published: March 2022

Background:
The incidence of giant coronary artery aneurysm as a complication of Kawasaki disease is approximately 0.35%. Kawasaki disease was first described in 1967. However, only a few studies have reported on adult cases of cardiovascular sequelae in Kawasaki disease. Adult cases of coronary stenosis due to Kawasaki disease shows a predilection for the age range of late teens to the twenties; elderly onset, such as around the age of 60 years, is rare.

Case report:
A 62-year-old woman with a history of coronary artery bypass grafting (two-vessel bypass) was diagnosed with a coronary artery aneurysm and concomitant Kawasaki disease at another hospital at the age of 48 years. A reoperation was recommended owing to re-strangulation, but the patient opted for progress observation. At the age of 53 years, the patient experienced respiratory pain during laborious work, and coronary angiography was indicated. We therefore performed coronary artery bypass grafting (four-vessel bypass) for there to base Kawasaki disease, calcification of advanced, restenosis, coronary flow was observed. The postoperative course was good, and the patient has remained without restenosis for 9 years after the surgery.

Conclusion:
The progress of patients with a history of Kawasaki disease in adulthood has not been established; these patients therefore require periodical follow-up examinations. Moreover, because coronary artery involvement in Kawasaki disease is a risk factor for myocardial infarction, careful attention should be paid to lifestyle-related diseases.
Abstract 27: Elevated Soluble Interleukin 2 Is A Risk Of Treatment Resistance And Coronary Artery Abnormalities In Kawasaki Disease
Authors: Takatsuki Shinichi , Takebe Junko , Naoi Kazuyuki , Ikahara Satoshi , Nakayama Tomotaka , Matsuura Hiroyuki , Morita Toshisuke , Saji Tsutomu
Published: March 2022

Background and objective:
Soluble ST2 (sST2), an interleukin (IL)-1 receptor family member, has been identified as a novel biomarker for cardiac stress. Although sST2 were reported to be elevated in acute Kawasaki disease (KD) and correlated with cardiac diastolic dysfunction, relation between sST2 levels and treatment resistance and risk of coronary artery abnormalities (CAAs) is not studied. The aim of this study is to evaluate clinical utility of sST2 in acute KD.

Methods:
We measured serum sST2 from 54 children (median age; 22 months, 29 boys and 26 girls) with acute KD before and after initial treatment, 10 febrile controls (FC) (median age; 14 months) and 2 healthy controls (HC). Using Kobayashi score from RAISE study, patients were divided into high (>score 5)and low risk group (≤score 4) for IVIG resistance.

Results:
Serum sST2 in KD significantly elevated compared with FC and HC (median; KD vs FC 0.81 vs 0.25 ng/ml, p<0.05, KD vs HC 0.81 vs 0.12 ng/ml, respectively, p<0.05). Compared with sST2 levels before treatment, sST2 decreased at 4 days after initial therapy, but it was not significant (median 0.81 vs 0.67 ng/ml). Statistically significant differences were observed in sST2 between high risk group and low risk group (median; 1.80 vs 0.54 ng/ml, respectively, p<0.05). Additionally, sST2 levels in non-responders to initial treatment were significantly higher than those in responders (median; 1.65 vs 0.64 ng/ml, respectively, p<0.05). There were no significant correlations between sST2 level at diagnosis and plasma brain natriuretic peptide (r = -0.05), C-reactive protein (r = 0.04), and AST (r = 0.07). Overall, 4 children (7%) had CAAs at 4 weeks of illness. sST2 levels at diagnosis were not significantly different between children with and without CAAs, median sST2 levels in children without CAAs (1.68 vs 0.79 ng/ml, respectively, p=0.07). At 4 days after initial therapy, median sST2 levels decreased in children without CAAs, (0.79 vs 0.65, p=0.1), whereas median sST2 levels increased in children with CAAs (1.68 vs 1.70, p=0.9).

Conclusions:
Elevated sST2 may be a potential risk factor of initial treatment resistance and developing CAAs in acute KD.
Abstract 63: Evaluation Of The Immune Dynamics Of Kawasaki Disease :For Opting Timing for Vaccination
Authors: Kobayashi kayoko , Ogata Shohei , Takanashi Manabu , Honda Takashi , Ogihara Yoshihito , Minoura Katunori , Ishii Masahiro
Published: March 2022

Background:
We investigated immune function in Kawasaki diseas(KD)patints during the acute phase , 1 month aftr onset , 6 months after onset and 9 months after onset.

Methods:
All patients treated with 2g/kg of Intravenous immunoglobulin (single IVIG) or 4g/kg of IVIG(additional IVIG). We enrolled 18 KD patients(age,4 to 90 months).IgG,IgM,IgA,IgD,B-cell surface immunoglobulin(Sm-Ig),CD3,CD4,CD8,CD20,CD56 were measured using flow cytometry;the lymphocyte transformation test(LTT)was also performed.In addition,migration of IVIG antibodies was assessed,and measles,rubella,mumps,and chickenpox antibodies were investigated using enzyme immunoassay(EIA).

Results:
IgG at 1 month after KD onset was significantly higher than before IVIG treatment. In addition, the number of the lymphocytes at 1 month after KD onset was higher than before IVIG treatment.. The valus for Sm-Ig IgM,Sm-Ig IgD,Sm-Ig κ,and Sm-Ig λ before IVIG treatment was higher than those at 1 month after KD onset. In addition, The valus for CD8 before IVIG treatment was higher than those at 1 month after KD onset. The values for CD3,CD4 before IVIG treatment was lower then those at 1 month after KD onset. The values for CD8 was higher at 1 month after KD onset. The levels of measles,rubella,mumps,and chickenpox antibodies were positive at 1 month after single IVIG treatment and these antibodies were negative at 6 months after single IVIG treatment. The levels of measles,rubella,mumps,and chickenpox antibodies were positive at 1 month after additional IVIG treatment. These antibodies were still positive in some of patient at 6 month after additional IVIG treatment,but negative at 9 months after additional IVIG treatment.

Conclusions:
Abnormal immune function at KD onset may improve at 1month after KD. onset.We can vaccinate children at least 2 month after KD onset. However it is recommended that live vaccines be deferred for at least 6 months following treatment with single IVIG ,and 9 months following treatment with additional IVIG.
Abstract 72: Chest X-ray as an Additional Diagnostic Tool in Kawasaki Disease
Authors: Advani Najib , Alim Santoso Lucyana
Published: March 2022

Background:
Diagnosis of Kawasaki disease (KD) is sometimes doubtful. Chest x-ray examination is easily available and relatively not expensive. However, its role in the diagnosis of Kawasaki disease according to some studies, is not significant.So far we have no data from Indonesia.

Objective:
To know the chest x-ray patterns in acute KD patients.

Methods:
We studied chest x-ray films of KD children at acute stage from January 2003 till July 2013 which were taken consecutively in 5 hospitals. All cases were treated by the author. All films were seen and confirmed by radiologists.

Results:
We analyzed chest x-ray films (antero-posterior view) of 503 KD patients at acute stage, age ranging from 33 days to 16 years. The results were that 335 (67%) of them showed abnormalities, of which almost all showed infiltrates in bilateral lung fields especially in perihillar and paracardial regions. Only one case showed lobar pneumonia pattern and another with pleural effusion. Only 31 (10.8%) patients with chest x-ray abnormalities clinically showed respiratory signs and symptoms such as cough and running nose.

Conclusion:
It is concluded that the presence of pulmonary infiltrates in chest x-ray may be of value in supporting the diagnosis of KD, especially in doubtful or incomplete cases.
Abstract 83: Usefulness of Serum Immunoglobulin G Levels Calculated in the Acute Phase of Kawasaki disease
Authors: Iida Chiaki , Iwanaga Akira , Tashiro Katsuya
Published: March 2022

Background:
Intravenous gamma-globulin treatment (IVGG) is an established therapy for acute phase Kawasaki disease (KD). Since a lot of studies have already testified that the efficacy of IVGG is dose-dependent, a single large dose of IVGG has been accepted as a standard treatment of KD. Some reports described the increasing rate of serum Immunoglobulin G (IgG) after IVGG would have a relationship with efficacy of IVGG. It should, therefore, be very important to compass trends of serum IgG levels in each in KD patient. However, it is unable to frequently measure values of serum IgG in KD patients from the standpoint of medical expenses. If we can estimate IgG levels in KD patients from routine biochemical data without additional costs, that is very helpful to assess inflammatory status in acute phase of KD.

Aim to this study:
We hypothesized that serum levels of IgG in acute phase of KD patients could be extrapolated by serum values of total protein (TP) and albumin (Alb), and, we tried to establish a simple formula to estimate serum levels of IgG.

Materials and methods:
We enrolled 42 KD cases (27 ± 21 month, Male 24/Female 18) that were treated in Saga University Hospital, Japan from April of 2010 to August of 2014. All cases met the diagnostic criteria of KD. They were initially treated with IVGG and aspirin or flurbiprofen. 12 patients (28.6%) needed additional treatments such as steroid and cyclosporine A. In this study, we examined relations before and after treatments of serum TP and Alb and IgG in serum of them and tried to establish a simple formula to estimate serum levels of IgG in acute phase of KD. For statistical analysis, we used paired t-test.

Results:
We found that values obtained by subtracting serum values of IgG and Alb from TP were almost constant through acute phase in each KD patient, regardless of differences in clinical course and therapies. Therefore, we could estimate serum IgG values, once we checked levels of TP, Alb and IgG before treatment. Calculated IgG values were lineally correlated with values of directly measured IgG (P<0.0001, r=0.90). From this finding, we would assess the course of IgG levels during acute phase of KD patients correctly.

Conclusion:
By estimation of IgG levels, we can grasp inflammatory status of KD and make appropriate therapeutic plans.