Hu Lei, Wang Chuan, Zhou Zhongqin, Azhe Shiganmo, Peng Shengkun, Zhang Nanjun, Zhou Kaiyu, Guo Yingkun, Yu Li, Wen Lingyi
Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):8348-8358. doi: 10.21037/qims-2024-2772. Epub 2025 Aug 13.
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.
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.
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: 14.1×10/L 13.9×10/L, P=0.57; median CRP: 87.4 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% 68.1%±10.3%; P=0.13) or fractional shortening (37.6%±5.3% 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% 39.9%±20.5%; P=0.20), global circumferential strain (-18.7%±6.8% -18.3%±7.2%; P=0.38), and global longitudinal strain (-13.2%±3.7% -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 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.
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.
在当前指南中，无冠状动脉（CA）瘤的川崎病（KD）患者的管理算法主要依赖于儿科医生的临床经验。有必要对这些患者进行全面评估，为其管理提供更高水平的证据。因此，我们的研究旨在使用多维数据评估KD患者并调查其预后。
共回顾性招募了455例KD患者，分为非CA受累组（n = 313）和仅CA扩张组（n = 142），分别有16.1%（50/311）和15.5%（22/142）的患者在恢复期间接受了心脏磁共振（CMR）检查。比较了两组在急性期和恢复期的炎症标志物、心电图和超声心动图数据。进行Kaplan-Meier分析以估计包括冠状动脉事件、心源性死亡、心力衰竭和新发恶性心律失常在内的终点事件的累积概率。
KD非CA受累患者与仅CA扩张患者的基线炎症标志物，包括白细胞计数（WBC）和C反应蛋白（CRP），无显著差异（WBC中位数：14.1×10⁹/L对13.9×10⁹/L，P = 0.57；CRP中位数：87.4对85.6 mg/L，P = 0.73）。在基线超声心动图评估方面，非CA受累组与仅CA扩张组在左心室射血分数（分别为67.8%±13.6%和68.1%±10.3%；P = 0.13）或缩短分数（分别为37.6%±5.
