Comprehensive assessment of patients with Kawasaki disease without coronary artery aneurysm.
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BACKGROUND: In the current guidelines, the management algorithm for patients with Kawasaki disease (KD) without coronary artery (CA) aneurysms primarily depends on the clinical experience of pediatricians. It is necessary to conduct a comprehensive evaluation of these patients to provide a higher level of evidence for their management. Therefore, our study aimed to assess patients with KD using multidimensional data and investigate their prognosis. METHODS: A total of 455 patients with KD were retrospectively recruited and divided into a non-CA involvement group (n=313) and a CA dilation-only group (n=142), with 16.1% (50/311) and 15.5% (22/142), respectively, undergoing cardiac magnetic resonance (CMR) examinations during recovery. Data regarding inflammatory markers, electrocardiography, and echocardiography were compared between the two groups both in the acute phase and during the recovery period. Kaplan-Meier analysis was performed to estimate the cumulative probability of the endpoints including coronary events, cardiac death, heart failure, and new-onset malignant arrhythmias. RESULTS: Baseline inflammatory markers, including white blood cell count (WBC) and C-reactive protein (CRP), were not significantly different between patients with KD and non-CA involvement and those with dilation only (median WBC: 14.1×109/L vs. 13.9×109/L, P=0.57; median CRP: 87.4 vs. 85.6 mg/L, P=0.73). In terms of echocardiography assessment at baseline, there were no significant differences between the non-CA involvement group and the dilation-only group in terms of left ventricular ejection fraction (67.8%±13.6% vs. 68.1%±10.3%; P=0.13) or fractional shortening (37.6%±5.3% vs. 35.4%±6.6%; P=0.25). For CMR assessment at recovery, the myocardial systolic function of patients with KD but non-CA involvement was not significantly different from that of patients with CA dilation only in terms of global radial strain (38.3%±18.7% vs. 39.9%±20.5%; P=0.20), global circumferential strain (-18.7%±6.8% vs. -18.3%±7.2%; P=0.38), and global longitudinal strain (-13.2%±3.7% vs. -13.4%±4.1%; P=0.17). The global native T1 value of patients with non-CA involvement was 1,296.5±74.1 msec, while that of patients with CA dilation only was 1,313.3±80.5 msec (P=0.21); there was also no significant difference in global T2 values between the two groups of patients (38.2±4.1 vs. 38.1±3.5 msec; P=0.53). Finally, at a median follow-up of 4.2 years, there was a favorable prognosis in both two groups of patients, with no patients reaching the endpoints. CONCLUSIONS: Comprehensive assessment revealed no significant differences between patients with KD and CA dilation only and those with non-CA involvement, and thus these patients should be treated according to the same medium-long-term management algorithm.