The morbidity of coronary artery lesions caused by Kawasaki disease in Guangzhou Children's Hospital and the four years follow-up

Objective To explore the onset characteristics of coronary artery lesions caused by Kawasaki disease and their changes in 2 years after onset.Methods A colour Doppler echocardiography was performed on 356 patients with Kawasaki disease in Guangzhou Children's Hospital from January 2001 to December 2004.The ages of patients(242 boys,114 girls) in acute stage were 1-123 months[(26.3±21.0)months)].The patients were divided into three groups according to changes in coronary arteries:coronary arterial dilatation(n=72),small or medium coronary aneurysm(n=36) and giant coronary aneurysm group(n=11).The patients with coronary artery lesions were followed-up by echocardiography in 119 cases and ATP stress echocardiographyin in 48cases.The differences of febrile days before diagnosis and the changes in coronary artery were compared respectively among three groups.Results The coronary artery lesions were found in 147 patients(41.3%,147/356) by echocardiography,including 48 cases with coronary aneurysms(13.5%,48/356) and 99 cases with coronary arterial dilatation(27.8%,99/356).The incidences of coronary artery lesions were 38.1%(40/105) in patients aged1 y,40.4%(67/166) in patients aged 1-3 y;40.7%(22/54) in patients aged 3-5 y;58.1%(18/31) in patients aged5 y.The incidence of coronary artery lesions in patients aged5 y was significantly higher than that in patients aged 1 y(P0.05).The febrile days before diagnosis in the giant coronary aneurysm group were more than that in medium or small coronary aneurysm group and the coronary arterial dilatation group[(18.4±12.0)days,(12.9±8.2)days,(7.4±3.6)days,P0.01)].By echocardiography,69 of cases(69.7%,69/99) with coronary atery lesions were found in acute stage,27 of cases(27.3%) in subacute stage(11-21 d from onset),3 of cases(3.0%) in convalescence(21-60 d from onset).27 of cases(56.2%,27/48) with coronary arterial aneurysms lesions were found in acute stage,15 of cases(31.2%) in subacute stage and 6 of cases(12.5%) in convalescence.119 patients(81.0%,119/147) were followed-up.During two years follow-up,the coronary artery lesions were recovered in all patients in coronary arterial dilatation group and in 77.8%(28/36) patients of medium or small coronary aneurysm group.In giant coronary aneurysm group,the mild or moderate regressions were found in 8 of 11 patients;the aneurysms turned to dilatation in 3 cases;the right coronary artery stinosis was observed in 1 case,which was conformed by coronary angiography.48 of 119 cases were given ATP stress echocardiography.The results revealed that in coronary arterial dilatation,small or medium coronary aneurysm and giant coronary aneurysm group,the incidences of wall motion abnormalities were 14.8%(4/27),58.8%(10/17)and 75.0%(3/4),respectively,and the rates of decreased coronary flow reserve were 22.2%(6/27)in patients with coronary arterial dilatation,38.1%(8/21) in patients with coronary aneurysm.the rate of decreased coronary flow reserve in coronary aneurysm group was significantly higher than that in the group of coronary artery dilatation(P 0.05).Conclusions Most of coronary artery lesions caused by Kawasaki disease were transient.The giant coronary aneurysms may exist for longer time.Echocardiography is helpful for finding the coronary artery lesions and monitoring their changes.Stress echocardiography is useful for the follow-up of Kawasaki disease.