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1.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31732547

RESUMO

BACKGROUND: Coronary artery aneurysms (CAAs) are a well-known complication of Kawasaki disease (KD), but there are no data on incidence or outcomes of systemic artery aneurysms (SAAs) in the current era. METHODS: From April 1, 2016, to March 31, 2019, we screened for SAAs in 162 patients with KD at risk for SAAs with magnetic resonance angiography or peripheral angiography and analyzed incidence and early outcomes of SAAs. RESULTS: Twenty-three patients had SAAs, demonstrating an incidence of 14.2% (23 of 162) in patients who were screened at 1 month after onset. The proportion of patients with SAAs was estimated to be 2% (23 of 1148) of all patients with KD. The median age at onset of KD with SAAs was 5 months. All patients with SAAs had CAAs, with z scores >8. Of patients with giant CAAs, 38.6% (17 of 44) had SAAs. A total of 129 SAAs occurred in 17 different named arteries. The most common sites for SAAs were the axillary (18.6%), common iliac (12.4%), and brachial (11.6%) arteries. During a median follow-up time of 6 months, 92.9% (79 of 85) of SAAs had some degree of regression, with 80% (68 of 85) of SAAs returning to normal. The overall regression rate was higher for medium to large SAAs than for medium to giant CAAs. CONCLUSIONS: Although the incidence of SAAs may not be as dramatically reduced as we expected compared with previous data, SAAs have a high regression rate during short-term follow-up.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/epidemiologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Angiografia por Ressonância Magnética/métodos , Masculino , Estudos Prospectivos
2.
Yonsei Med J ; 60(9): 824-831, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433580

RESUMO

PURPOSE: We evaluated the incidence, predictors, and prognosis of coronary artery aneurysm (CAA) after second-generation drug-eluting stent (DES) implantation. MATERIALS AND METHODS: A total of 976 consecutive patients (1245 lesions) who underwent follow-up angiography after second-generation DES implantation were analyzed. Incidence and predictors of CAA were assessed, and clinical prognosis was compared with 34 cases of CAA after first-generation DES implantation using previous CAA registry data. RESULTS: All 10 cases of CAA (0.80% per lesion) in 10 patients (1.02% per patient) were detected at follow up. Compared to lesions without CAA, those with CAA had greater involvement of the proximal segment (90% vs. 51%, p=0.014), a higher proportion of pre-intervention, a Thrombolysis in Myocardial Infarction score of 0 or 1 flow (80% vs. 16%, p<0.001), more chronic total occlusions (40% vs. 10%, p<0.001), and longer implanted stents (41.9±23.2 mm vs. 28.8±14.8 mm, p=0.006). As for CAA morphology, instances of CAA after second-generation DES were predominantly the single fusiform type (90%), whereas instances of CAA after first-generation DES were multiple saccular (47%) and single saccular (35%) types (p<0.001). Myocardial infarction with stent thrombosis occurred in 5 patients with CAA after first-generation DES (15%), and no adverse events were observed in patients with CAA after second-generation DES over a median follow-up duration of 4.3 years (p=0.047, log-rank). CONCLUSION: Although CAAs after second-generation DES implantation were detected at a similar incidence to that for CAAs after first-generation DES implantation, second-generation DES-related CAAs had different morphologies and more benign clinical outcomes versus first-generation DES-related CAAs.


Assuntos
Aneurisma Coronário/epidemiologia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Idoso , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/terapia , Angiografia Coronária , Reestenose Coronária/terapia , Vasos Coronários , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Prognóstico , Sistema de Registros , Trombose/complicações , Fatores de Tempo , Resultado do Tratamento
3.
Pediatr Rheumatol Online J ; 17(1): 46, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324255

RESUMO

BACKGROUND: The etiology of Kawasaki disease (KD) is still unknown; perinatal factors may have role with few studies. This study was aim to survey the perinatal factors and clinical outcome of KD, including coronary artery lesion (CAL) formation and intravenous immunoglobulin (IVIG) treatment response. METHODS: We enrolled a total of 185 KD patient-caregiver dyads in this study using questionnaires. The questionnaire included two categories: children's characteristics, which consisted of age at disease onset, gender, gestational age at delivery, birth body weight, delivery methods, and breastfeeding status, and caregivers' characteristics, which consisted of parents or not, education levels, maternal age at giving birth, total number of offspring, and family income. We analyzed the association of these factors with CAL formation and IVIG treatment response of KD. RESULTS: KD patients with CAL formation had a higher maternal age than non-CAL patients (32.49 ± 3.42 vs. 31.01 ± 3.92 years, p = 0.016). We also found that maternal age ≥ 32 years group had a higher rate of having KD patients with CAL (39/81 vs. 24/74, odds ratio 1.935, 95% confidence interval [1.007, 3.718], p = 0.047). The maternal age ≥ 35 years group had a higher rate of having KD patients with IVIG resistance (6/31 vs. 6/116, odds ratio 4.400, 95% confidence interval [1.309, 14.786], p = 0.01). There was no significant difference in either CAL formation or IVIG resistance in KD with regard to patient's age at disease onset, gestational age, birth body weight, delivery methods, breastfeeding, caregiver type, caregivers' education level, total number of offspring, or family income (p > 0.05). CONCLUSIONS: This study is the first to report that maternal age is significantly associated with CAL formation and IVIG resistance in KD. We hypothesize that a maternal age less than 32 years would benefit KD offspring.


Assuntos
Aneurisma Coronário/epidemiologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Idade Materna , Síndrome de Linfonodos Mucocutâneos/terapia , Fístula Vascular/epidemiologia , Adulto , Pré-Escolar , Aneurisma Coronário/etiologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Dilatação Patológica , Feminino , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Razão de Chances , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Fístula Vascular/etiologia
4.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31048414

RESUMO

BACKGROUND: Coronary artery aneurysms (CAA) are a serious complication of Kawasaki disease. Treatment with intravenous immunoglobulin (IVIg) within 10 days of fever onset reduces the risk of CAA from 25% to <5%. Corticosteroids and infliximab are often used in high-risk patients or those with CAA at diagnosis, but there are no data on their longer-term impact on CAA. METHODS: Retrospective multicenter study including children who had CAA with a z score ≥2.5 and <10 at time of diagnosis and who received primary therapy with IVIg alone or in combination with either corticosteroids or infliximab within 10 days of onset of fever. RESULTS: Of 121 children, with a median age of 2.8 (range 0.1-15.5) years, 30 (25%) received primary therapy with corticosteroids and IVIg, 58 (48%) received primary therapy with infliximab and IVIg, and 33 (27%) received primary therapy with IVIg only. Median coronary z scores at the time of diagnosis did not differ among treatment groups (P = .39). Primary treatment intensification with either corticosteroids or infliximab were independent protective factors against progression of coronary size on follow-up (coefficient: -1.31 [95% confidence interval: -2.33 to -0.29]; coefficient: -1.07 [95% confidence interval: -1.95 to -0.19], respectively). CONCLUSIONS: Among a high-risk group of patients with Kawasaki disease with CAA on baseline echocardiography, those treated with corticosteroids or infliximab in addition to IVIg had less progression in CAA size compared with those treated with IVIg alone. Prospective randomized trials are needed to determine the best adjunctive treatment of patients who present with CAA.


Assuntos
Aneurisma Coronário/tratamento farmacológico , Aneurisma Coronário/epidemiologia , Imunoglobulinas Intravenosas/administração & dosagem , Infliximab/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Adolescente , Antirreumáticos/administração & dosagem , Criança , Pré-Escolar , Aneurisma Coronário/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
5.
An. pediatr. (2003. Ed. impr.) ; 90(4): 213-218, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186611

RESUMO

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis multisistémica asociada a lesiones en las arterias coronarias. Las infecciones podrían ser un desencadenante de la inflamación. Nuestro objetivo fue describir la presencia de infecciones en los niños con EK y analizar las características clínicas y la presencia de alteraciones coronarias en estos casos. Pacientes y métodos: Análisis retrospectivo de los pacientes incluidos en la red KAWA-RACE entre 2011 y 2016. Se estudió tanto a los pacientes que tuvieron una identificación microbiológica confirmada (IMC) en el periodo agudo como a los que presentaron antecedente de infección previa reciente (IPR) las 4 semanas anteriores. Resultados: Se incluyó a un total de 621 niños, de los cuales 101 (16,3%) tuvieron una IMC y 107 (17,2%) una IPR. Encontramos una significativa menor afectación ecocardiográfica en el grupo de IPR respecto a los niños sin infección previa (23 vs. 35%; p 0,01), con menor proporción no significativa de las alteraciones coronarias globales (16 vs. 25%; p 0,054). Sin embargo, no se detectaron diferencias en la proporción de aneurismas en ninguno de los 2 grupos (IMC o IPR) respecto al resto de los pacientes sin infecciones asociadas. Conclusiones: En nuestro estudio no encontramos diferencias en la incidencia de aneurismas coronarios en niños con y sin IMC o IPR, por lo que ante la sospecha de EK debe iniciarse siempre tratamiento, aunque se tenga infección confirmada microbiológicamente


Introduction: Kawasaki disease (KD) is a multisystem vasculitis associated with coronary artery abnormalities. Infections could be a trigger of the inflammation. The main aim of this study was to describe the presence of infections in children with KD, and to analyse the clinical characteristics and the presence of coronary abnormalities in these cases. Patients and methods: A retrospective study was performed within the Kawasaki Diseases Network (KAWA-RACE (2011-2016). An analysis was performed that included patients with positive microbiological findings (PMF) during the acute phase, as well as those with a previous recent infection (PRI) during the 4 weeks preceding KD diagnosis. Results: The study included total of 621 children with KD, with PMF being found in 101 (16.3%) patients, and a PRI in 107 (17.2%). Significantly less echocardiographic abnormalities were found in the in the group with a PRI, when compared to those without a PRI (23 vs. 35%, P = .01) and also a lower proportion of overall coronary artery lesions (16 vs. 25%, P = .054). No significant differences were found in the proportion of aneurysms in either of these groups (PRI or PMF) when compared to those without infection. Conclusions: In the present study, no differences were found in the incidence of coronary aneurysms in either of the groups, with or without PRI or PMF. Therefore, if KD is suspected, appropriate treatment should be started despite having a confirmed infection


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Aneurisma Coronário/epidemiologia , Infecção/epidemiologia , Síndrome de Linfonodos Mucocutâneos/microbiologia , Estudos Retrospectivos , Aneurisma Coronário/etiologia , Infecção/complicações , Síndrome de Linfonodos Mucocutâneos/fisiopatologia
6.
Clin Exp Med ; 19(2): 167-172, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30725203

RESUMO

Arthritis is a major complication of Kawasaki disease (KD). The aims of this study were to define the frequency and the clinical characteristics of arthritis in KD in China and to analyze the relation between arthritis and coronary outcome in KD. We included 1420 KD patients followed at Jiangxi Children's Hospital from January 2014 to December 2017. Demographic, clinical and laboratory features of KD were analyzed. Among the 1420 patients enrolled, 151 had arthritis. The median age of KD patients with arthritis was 29 months and older than those without arthritis (20 months). Of the 151 patients developed arthritis, 101 patients (66.9%) had oligoarticular involvement and 50 patients (33.1%) had polyarticular involvement. Early-onset and late-onset arthritis were, respectively, observed in 123 (81.45%) and 28 (18.54%) patients. The KD patients with arthritis had significantly increased levels of inflammatory markers, and we observed a higher incidence rate of coronary artery aneurysms among those with arthritis (7.28%) compared to those without arthritis (2.75%) (p = 0.003), but the prevalence of coronary artery lesions (CALs) was similar in the two groups. The arthritis in KD was self-limited, left no sequelae and did not require additional medications. KD patients with arthritis were more likely to get coronary artery aneurysms than the patients without arthritis, so examination of joints in KD was necessary.


Assuntos
Artrite/epidemiologia , Artrite/patologia , Aneurisma Coronário/epidemiologia , Aneurisma Coronário/patologia , Síndrome de Linfonodos Mucocutâneos/complicações , Grupo com Ancestrais do Continente Asiático , Criança , Pré-Escolar , China/epidemiologia , Demografia , Feminino , Humanos , Lactente , Masculino , Prevalência , Estudos Retrospectivos
7.
An Pediatr (Barc) ; 90(4): 213-218, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-30077502

RESUMO

INTRODUCTION: Kawasaki disease (KD) is a multisystem vasculitis associated with coronary artery abnormalities. Infections could be a trigger of the inflammation. The main aim of this study was to describe the presence of infections in children with KD, and to analyse the clinical characteristics and the presence of coronary abnormalities in these cases. PATIENTS AND METHODS: A retrospective study was performed within the Kawasaki Diseases Network (KAWA-RACE (2011-2016). An analysis was performed that included patients with positive microbiological findings (PMF) during the acute phase, as well as those with a previous recent infection (PRI) during the 4 weeks preceding KD diagnosis. RESULTS: The study included total of 621 children with KD, with PMF being found in 101 (16.3%) patients, and a PRI in 107 (17.2%). Significantly less echocardiographic abnormalities were found in the in the group with a PRI, when compared to those without a PRI (23 vs. 35%, P=.01) and also a lower proportion of overall coronary artery lesions (16 vs. 25%, P=.054). No significant differences were found in the proportion of aneurysms in either of these groups (PRI or PMF) when compared to those without infection. CONCLUSIONS: In the present study, no differences were found in the incidence of coronary aneurysms in either of the groups, with or without PRI or PMF. Therefore, if KD is suspected, appropriate treatment should be started despite having a confirmed infection.


Assuntos
Aneurisma Coronário/epidemiologia , Síndrome de Linfonodos Mucocutâneos/microbiologia , Pré-Escolar , Aneurisma Coronário/etiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Estudos Retrospectivos
8.
Am J Cardiol ; 123(2): 249-253, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30477805

RESUMO

The pathophysiology of spontaneous coronary artery dissection (SCAD) is heterogeneous, associated with systemic arteriopathies and inflammatory diseases, and often compounded by environmental precipitants, genetics, or stressors. However, the frequency of these associated conditions with SCAD on a population level remains unknown. Therefore, the objective of this analysis was to evaluate heterogeneous phenotypes of SCAD in the United States using data from the Nationwide Inpatient Sample collected from January 1, 2004, to September 31, 2015. Among 66,360 patients diagnosed with SCAD, the mean age was 63.1 ± 13.2 years and 44.2% were women. A total of 3,415 (5.14%) had depression, 670 (1.0%) had rheumatoid arthritis, 640 (0.96%) had anxiety, 545 (0.82%) had a migraine disorder, 440 (0.66%) used steroids, 385 (0.58%) had malignant hypertension, 280 (0.42%) had systemic lupus erythematosus, 250 (0.38%) had cocaine abuse, 215 (0.32%) had hypertensive heart or renal disease, 130 (0.19%) had coronary spasm, 105 (0.16%) had fibromuscular dysplasia, 85 (0.13%) had Crohn's disease, 75 (0.11%) had celiac disease, 60 (0.09%) had adult autosomal dominant polycystic kidney disease, 60 (0.09%) had hormone replacement therapy, 55 (0.08%) had sarcoidosis, 55 (0.08%) had amphetamine abuse, 15 (0.02%) had granulomatosis polyangiitis, 10 (0.02%) had α1-antitrypsin deficiency, 10 (0.02%) had Marfan syndrome, 10 (0.02%) had Ehlers-Danlos syndrome, 10 (0.02%) had Kawasaki disease, 10 (0.02%) had polyarteritis nodosa, and 5 (0.01%) had multiparity. In conclusion, most cases of SCAD had no apparent concomitant arteriopathy, inflammatory disorder, or evident risk factor.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Coronário/epidemiologia , Vasos Coronários/lesões , Distribuição por Idade , Doenças Autoimunes/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Doenças do Tecido Conjuntivo/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
9.
PLoS One ; 13(9): e0202658, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30180185

RESUMO

BACKGROUND: Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease. OBJECTIVE: To evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions. METHODS: Retrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases. RESULTS: 302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009). CONCLUSIONS: This is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population. CLINICAL TRIAL REGISTRATION: 8/20014/O/OssN.


Assuntos
Aneurisma Coronário/epidemiologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Dor Abdominal , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Dilatação Patológica , Resistência a Medicamentos , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Itália , Masculino , Síndrome de Linfonodos Mucocutâneos/sangue , Contagem de Plaquetas , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Vômito
10.
JACC Cardiovasc Interv ; 11(13): 1211-1223, 2018 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-29976357

RESUMO

Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of largescale outcome data on their various treatment modalities, coronary artery aneurysms and coronary ectasia pose a challenge to the managing clinician. This paper aims to provide a succinct review of aneurysmal coronary disease, with a special emphasis on the challenges associated with its interventional treatment.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fármacos Cardiovasculares/uso terapêutico , Aneurisma Coronário/terapia , Intervenção Coronária Percutânea , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/epidemiologia , Ponte de Artéria Coronária , Humanos , Ligadura , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Fatores de Risco , Stents , Resultado do Tratamento
11.
Postgrad Med ; 130(4): 442-447, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29745742

RESUMO

OBJECTIVE: Kawasaki disease (KD) is a systemic vasculitis with serious complications, especially the development of coronary artery lesions (CALs). The aim of this study was to identify the risk for the development of CALs with IVIG treatment of KD >10 days after illness onset in patients with different KD status, and explore potential moderators of the association between delayed treatment and CALs. METHODS: We performed a retrospective review of the medical records of KD patients. All patients were divided into two groups (conventional therapy group and delayed therapy group, IVIG treatment ≤10 days vs >10 days). We compared the demographic and clinical characteristics, laboratory data, and analyzed risk factors for CALs in patients who received IVIG treatment >10 days, and determined whether different status of KD modified the effects of delayed IVIG treatment on CALs. RESULTS: In the delayed IVIG treatment group, children were more likely to develop CALs and the proportion of incomplete KD was higher, compared with the conventional therapy group. The number of children younger than 12 months or older than 61 months was higher and children had higher BMI and were more likely to receive steroids before diagnosis in the delayed IVIG treatment group compared with the conventional therapy group. Delayed IVIG treatment was an independent risk factor for the development of CALs (adjusted OR = 2.90, 95%CI = 1.42, 5.91). Delayed therapy children with higher levels of C-reactive protein (>79 mg/L) and erythrocyte sedimentation rate (>34 mm/h) had the highest risk for developing CALs (OR = 5.68, 95%CI: 1.17, 27.59; OR = 4.11, 95%CI: 1.62, 10.46, respectively). CONCLUSION: Delayed IVIG treatment was an independent risk factor for the development of CALs. Children in the delayed IVIG treatment group with higher levels of CRP and ESR (CRP >79 mg/L, ESR >34 mm/h) had the greatest likelihood of developing CALs.


Assuntos
Aneurisma Coronário/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Glucocorticoides/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Sedimentação Sanguínea , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Dilatação Patológica/epidemiologia , Feminino , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/metabolismo , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
12.
Cardiovasc Pathol ; 35: 37-47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29772448

RESUMO

Coronary artery ectasia describes a local or diffuse dilatation of the epicardial coronary arteries. This review summarizes the molecular and cellular mechanisms involved in the pathogenesis of coronary artery ectasia. Better identification of the pathophysiologic steps will shed light into the clinical significance and may have direct implications for the management strategies of this disease. Additionally, understanding the underlying etiology may help to improve treatment modalities specific to coronary artery ectasia.


Assuntos
Aneurisma Coronário/metabolismo , Vasos Coronários/metabolismo , Remodelação Vascular , Animais , Anti-Inflamatórios/uso terapêutico , Comorbidade , Aneurisma Coronário/tratamento farmacológico , Aneurisma Coronário/epidemiologia , Aneurisma Coronário/patologia , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/patologia , Dilatação Patológica , Progressão da Doença , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Predisposição Genética para Doença , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Mediadores da Inflamação/metabolismo , Metabolismo dos Lipídeos , Óxido Nítrico/metabolismo , Fatores de Risco , Transdução de Sinais , Remodelação Vascular/efeitos dos fármacos
13.
Arch Cardiol Mex ; 88(5): 441-446, 2018 12.
Artigo em Espanhol | MEDLINE | ID: mdl-29650328

RESUMO

OBJECTIVES: To describe the cardiac manifestations in the acute phase of patients with Kawasaki disease treated in a third level Children's hospital in Mexico City, Mexico. METHODS: A cross-sectional study was conducted in patients with a diagnosis of Kawasaki disease treated in this hospital from August 1995 to December 2016. Information included patient demographics, clinical features, treatment used, electrocardiographic findings, extra-coronary echocardiographic findings, and the development of coronary artery aneurysms in the acute phase of the disease. RESULTS: The study included 508 cases of Kawasaki disease, with a mean age at diagnosis of 37.64±35.56 months (range from 2 to 200 months). Almost two-thirds (65.4%) of the patients were male, with a male/female ratio of 1.88:1. Complete Kawasaki disease was diagnosed in 79.2% of cases. Almost all cases (92.4%) received intravenous immunoglobulin. Twenty-eight patients (5.5%) developed arrhythmias, ST changes developed in 29 patients (5.6%), and 5 patients presented with ischaemic changes. In the initial echocardiographic evaluation, 51 patients (9.9%) were diagnosed with myocarditis, 72 patients (14.0%) with pericarditis and 77 cases (15.0%) developed pericardial effusion. Coronary artery anomalies were detected in 169 cases (32.9%). 32 cases were diagnosed as giant coronary aneurysms. Four patients died from cardiac complications in the acute phase of the disease. CONCLUSIONS: There has been an increase in the diagnosis of Kawasaki disease in Mexico. They presented with more cardiac complications than reported in literature. An increased knowledge of Kawasaki disease is required in Mexico in order to establish the cardiac outcomes of this group of patients.


Assuntos
Aneurisma Coronário/etiologia , Doença da Artéria Coronariana/etiologia , Cardiopatias/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Adolescente , Criança , Pré-Escolar , Aneurisma Coronário/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Ecocardiografia , Feminino , Cardiopatias/epidemiologia , Cardiopatias/fisiopatologia , Hospitais Pediátricos , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Lactente , Masculino , México/epidemiologia , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Estudos Retrospectivos
14.
JAMA Pediatr ; 172(5): e180030, 2018 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-29507955

RESUMO

Importance: Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). Objective: To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. Design, Setting, and Participants: This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. Main Outcomes and Measures: The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score, ≥5 to <10; actual internal diameter, <8 mm), and large (z score, ≥10 or ≥8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. Results: Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52% in men (P < .001) and 100%, 100%, and 75% in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51% in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95% CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95% CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95% CI, 1.4-3.6) were significantly associated with CE. Conclusions and Relevance: Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.


Assuntos
Aneurisma Coronário/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Adolescente , Criança , Pré-Escolar , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/epidemiologia , Aneurisma Coronário/patologia , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Resistência a Medicamentos , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
15.
Arthritis Care Res (Hoboken) ; 70(10): 1536-1540, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29287309

RESUMO

OBJECTIVE: Kawasaki disease (KD) is an acute childhood vasculitis that may result in coronary aneurysms. Treatment of KD with a single infusion of 2 gm/kg intravenous immunoglobulin (IVIG) is well established, but acetylsalicylic acid (ASA) dose remains controversial. Our primary objective was to determine the difference in the incidence of IVIG resistance between 2 ASA doses. Our secondary objective was to compare the duration of hospital stay and the incidence of coronary artery aneurysm. METHODS: We reviewed charts of patients with KD from 2 Canadian centers to assess the impact of ASA dose on IVIG resistance (operationally defined as administration of a second dose of IVIG). Both centers used standard IVIG dosing, but center 1 used low-dose ASA from diagnosis (3-5 mg/kg/day) while center 2 used initial high-dose ASA (80-100 mg/kg/day). RESULTS: There were no significant differences in baseline characteristics between the 2 centers. Retreatment with a second dose of IVIG was required in 28 of 122 patients (23%) treated with low-dose ASA, and in 11 of 127 patients (8.7%) treated with high-dose ASA in center 1 and center 2, respectively (P = 0.003). After adjusting for confounders, low-dose ASA was associated with higher odds of IVIG resistance (OR 3.2 [95% confidence interval 1.1, 9.1]). The mean duration of hospital stay was 4.1 and 4.7 days, respectively (P = 0.37). Coronary artery aneurysms were seen in 2 of 117 and 6 of 125 patients from centers 1 and 2, respectively (P = 0.28). CONCLUSION: Low-dose ASA was associated with 3-times higher odds of IVIG retreatment compared to high-dose ASA, with no significant difference in duration of hospital stay or incidence of coronary artery aneurysms.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Canadá/epidemiologia , Pré-Escolar , Aneurisma Coronário/epidemiologia , Aneurisma Coronário/etiologia , Resistência a Medicamentos , Feminino , Humanos , Incidência , Lactente , Tempo de Internação , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Estudos Retrospectivos
16.
Cardiovasc Revasc Med ; 19(5 Pt B): 589-596, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29276176

RESUMO

BACKGROUND: Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms. METHODS: Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013. Among 51,555 consecutive coronary angiograms, 414 patients with aneurysms were reported, of which 256 were considered acute (82% NSTE-ACS). RESULTS: Predominantly male (80%, mean age 65.5years), cardiovascular risk factors were common (hypertension 65%, dyslipidemia 65%, obesity 25%, diabetes mellitus 28.5%, and smokers 67%). With frequent coronary stenoses (94%), mostly with one aneurysm (80%), it was observed more frequently in the anterior descending artery. After a median follow-up of 52months, 53 died (14 cardiac causes) and 42% presented a cardiovascular event. Complications from the aneurysm were found in 4. The duration of dual antiplatelet therapy, LVEF, age and peripheral vascular disease highlighted in the multivariate analysis of death. CONCLUSION: The presence of coronary aneurysms in patients undergoing coronary angiography with an acute event is low. Patients who present them also have a large burden of atherosclerotic risk factors. In the long-term, the probability of cardiovascular complications is high, but only a small proportion are due to the aneurysm itself. A more intense and prolonged antithrombotic treatment may result in lower mortality rates.


Assuntos
Aneurisma Coronário/epidemiologia , Doença Aguda , Idoso , Comorbidade , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/mortalidade , Aneurisma Coronário/terapia , Angiografia Coronária , Bases de Dados Factuais , Progressão da Doença , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
17.
Catheter Cardiovasc Interv ; 92(3): E235-E245, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29164770

RESUMO

OBJECTIVES: We sought to investigate the long-term clinical outcomes of patients with coronary artery aneurysm (CAA) after drug-eluting stent (DES) implantation, compared with patients without CAA. BACKGROUND: CAA developed after DES implantation is a rare but associated with poor clinical outcome. METHODS: We retrospectively compared 78 patients with CAA after DES implantation with 269 patients without CAA who underwent DES implantation for complex lesions (controls). The primary endpoint was defined as major adverse cardiac events (MACE), the composite of all-cause death, nonfatal myocardial infarction (MI), and target lesion revascularization (TLR). RESULTS: Morphologically, CAAs were saccular (32%), fusiform (13%), or microform (55%). The stent types involved were Cypher (n = 56, 71.8%) and Taxus (n = 22, 28.2%). During a median follow-up period of 1164 days, the incidence of MACE was significantly higher in the CAA group (26.9 vs. 2.2%, P < 0.001); the difference was driven mainly by nonfatal MI (11.5 vs. 0%, P < 0.001) and TLR (20.5 vs. 1.9%, P < 0.001). The incidence of stent thrombosis was higher in the CAA group (12.8 vs. 0.74%, P < 0.001), irrespective of the maintenance of dual antiplatelet therapy. In the CAA group, Cox regression analysis showed significantly higher hazard ratios of CAA for MACE during the follow-up period. Further analyses after propensity-score matching of 65 pairs also showed similar results. CONCLUSIONS: The incidence of MACE was higher in patients with CAA compared with patients without CAA after DES implantation. This difference was driven by TLR and nonfatal MI and widened over time.


Assuntos
Aneurisma Coronário/epidemiologia , Stents Farmacológicos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Idoso , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/mortalidade , Aneurisma Coronário/terapia , Angiografia Coronária , Trombose Coronária/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/mortalidade , Inibidores da Agregação de Plaquetas/administração & dosagem , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Seul/epidemiologia , Fatores de Tempo , Resultado do Tratamento
18.
An. pediatr. (2003. Ed. impr.) ; 87(4): 226-231, oct. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-167300

RESUMO

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda autolimitada relativamente frecuente en la infancia. La etiología de la EK es aún desconocida, aunque los datos clínicos y de laboratorio y las características epidemiológicas sugieren un origen infeccioso. Las diferencias en la incidencia entre los países se han relacionado con factores genéticos, étnicos y otros factores socioculturales y ambientales. Presentamos un estudio poblacional sobre la incidencia de la EK en Cataluña (España), centrándose en las diferencias entre los pacientes en zonas rurales y no rurales de la región. Métodos: Estudio observacional poblacional incluyendo todas las unidades pediátricas en los hospitales catalanes, entre 2004 y 2014. Recogida prospectiva de nuevos casos de EK durante 12 meses (marzo de 2013-marzo de 2014) para determinar la incidencia de la EK. El resto de los datos se recuperaron de forma retrospectiva. Se analizaron los datos de 399 pacientes durante el período de estudio de 10 años. Resultados: Entre el total de pacientes con EK, 353 (88,5%) vivían en zonas no rurales y 46 (11,5%) en zonas rurales. Se encontró una diferencia significativa (p < 0,001) entre el porcentaje de la población rural observada en los pacientes con EK (11,5%), y el esperado 5% para la población catalana. Conclusión: Este es el primer estudio poblacional que muestra diferencias significativas entre las tasas de incidencia de EK entre las zonas rurales y no rurales (AU)


Introduction: Kawasaki disease (KD) is an acute self-limited systemic vasculitis relatively common in childhood. The etiology of KD is still unknown, although clinical, laboratory and epidemiological features suggest an infectious origin or trigger. Differences on incidence between countries have been related to specific genetic factors, ethnicity, country of birth and some other sociocultural and environmental factors. We present a population-based study on incidence of KD in Catalonia (Spain), focusing on differences between patients in rural and non-rural areas of the region. Methods: Observational population-based study including all Pediatric Units in Catalan hospitals, between 2004 and 2014. A 12-month (March 2013-March 2014) prospective collection of new cases of KD was carried out to determine the incidence of KD. The rest of the data was retrieved retrospectively. Results: Data from 399 patients over the 10-year study period was analyzed. Among the total KD patients, 353 (88.5%) lived in non-rural areas and 46 (11.5%) in rural areas. It was found that there is a significant difference (P < .001) between the percentage of rural population observed in patients with KD (11.5%), and the expected 5% of the Catalan population. Conclusion: This is the first population-based study showing significant differences on KD incidence rates between rural and non-rural areas (AU)


Assuntos
Humanos , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Vasculite Sistêmica/epidemiologia , Aneurisma Coronário/epidemiologia , População Rural/estatística & dados numéricos , Estudos Prospectivos , Doenças Autoimunes/epidemiologia
19.
Int J Cardiol ; 248: 308-313, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28818354

RESUMO

BACKGROUND: Coronary artery aneurysms resulting from unrecognised or untreated Kawasaki Disease (KD) have thrombotic and stenotic potential leading to myocardial infarction. We aimed to characterise the prevalence and outcomes of patients presenting to a UK-based adult tertiary cardiology service with angiographic evidence of aneurysm or ectasia. METHODS: Retrospective review was undertaken of reports and original coronary angiograms in all patients under 50years old undergoing coronary angiography between 2011 and 2015. Aneurysm/ectasia were defined by calibre discrepancy >1.5× and the number of segments involved. Aneurysms were categorised as being probable, or unlikely to represent unrecognised KD. RESULTS: Aneurysm or ectasia was observed in 49 of 1578 patients (3.7%). Eleven patients had angiographic findings consistent with probable antecedent KD (0.8%), a further 18 patients had evidence of coronary artery aneurysm (1.4%) and ectasia was observed in 20 patients (1.5%). The commonest mode of presentation was ST elevation myocardial infarction, observed in 71.4% of patients. Review of angiogram written reports demonstrated a spurious application of the terms aneurysm and ectasia, with a sensitivity of 10.3% & 55.0%, and a positive predictive value of reporting of 50.0% & 52.4%, respectively. CONCLUSIONS: As the first UK study to characterise the angiographic prevalence of Kawasaki Disease, both aneurysm and ectasia were observed with a relatively low frequency. However, their presence is associated with high-risk acute ischaemic presentations. Furthermore, we demonstrated a poor level of reporting of coronary abnormalities and advocate an increased awareness of Kawasaki disease and coronary aneurysm/ectasia amongst adult cardiologists.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/epidemiologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Adulto , Angiografia Coronária , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos
20.
An. pediatr. (2003. Ed. impr.) ; 87(2): 65-72, ago. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-165530

RESUMO

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda de causa desconocida, predominante en el sexo masculino. Los efectos de la enfermedad a largo plazo dependen de la existencia de lesiones coronarias -aneurismas-, siendo el pronóstico de los pacientes con aneurismas gigantes sombrío, ya que en su evolución natural pueden presentar trombosis coronaria o lesiones obstructivas severas. Objetivos: Describimos las características de una serie de 8 pacientes lactantes con EK y severa afectación coronaria. Se describen la epidemiología y los métodos diagnósticos, y se revisa el tratamiento de la fase aguda, así como las secuelas cardiovasculares a largo plazo. Métodos: Se realizó un análisis descriptivo de pacientes ingresados en el Servicio de Cardiología Pediátrica del Hospital Universitario La Fe (Valencia) por EK con afectación coronaria. Resultados: En todos los casos se objetivó la afectación de más de una arteria. El diagnóstico se instauró precozmente en solo 2 casos, a pesar de ello, ningún paciente presentó deterioro grave de la función ventricular durante la fase aguda. El tratamiento incluyó gammaglobulina por vía intravenosa y ácido acetilsalicílico en dosis antiinflamatorias durante la fase aguda. En los casos de trombosis coronaria se asociaron doble antiagregación y corticoides. Las lesiones aneurismáticas silentes persisten hasta el momento actual. Conclusiones: La EK es la causa más común de enfermedad cardiaca adquirida en niños. El retraso en el diagnóstico se asocia a mayor frecuencia de lesiones coronarias, que podrían incrementar el riesgo de eventos cardiovasculares en la edad adulta, precisando este subgrupo un seguimiento clínico estrecho con control de los factores de riesgo cardiovascular a largo plazo (AU)


Introduction: Kawasaki disease (KD) is an acute vasculitis of unknown origin and predominant in males. The long-term effects of the disease depend on whether there are coronary lesions, particularly aneurysms. The prognosis of patients with giant aneurysms is very poor due to their natural progression to coronary thrombosis or severe obstructive lesions. Objectives: A series of 8 cases is presented where the epidemiology and diagnostic methods are described. The treatment of the acute and long-term cardiovascular sequelae is also reviewed. Methods: A descriptive analysis was conducted on patients admitted to the Paediatric Cardiology Unit of La Fe University Hospital (Valencia) with KD and a coronary lesion. Results: More than one artery was involved in all patients. Although early diagnosis was established in only two cases, none of the patients had severe impairment of ventricular function during the acute phase. Treatment included intravenous gammaglobulin and acetylsalicylic acid at anti-inflammatory doses during the acute phase. A combination of dual antiplatelet therapy and corticosteroids was given in cases of coronary thrombosis. The silent aneurysms continue to persist. Conclusions: KD is the most common cause of acquired heart disease in children. The delay in diagnosis is associated with a greater likelihood of coronary lesions that could increase the risk of cardiovascular events in adulthood. Thus, this subgroup requires close clinical monitoring for a better control of cardiovascular risk factors over time (AU)


Assuntos
Humanos , Lactente , Aneurisma Coronário/epidemiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Isquemia Miocárdica/prevenção & controle , gama-Globulinas/uso terapêutico , Anticoagulantes/uso terapêutico
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