Echo - Coronary artery dimensions in Non-Kawasaki febrile children

CIRCULATION CARDIOVASCULAR IMAGING.112.000159


Published online before print January 28, 2013,

doi: 10.1161/​CIRCIMAGING.112.000159


Coronary Artery Dimensions in Febrile Children without Kawasaki Disease

Juan-Carlos G. Muniz1, Kirsten Dummer1, Kimberlee Gauvreau1, Steven D. Colan1, David R. Fulton1 and Jane W. Newburger1*

Background—Coronary artery (CA) dilatation on echocardiography is a criterion for treatment with intravenous immunoglobulin for incomplete Kawasaki disease (KD). However, CA dimensions for febrile children are unknown. We compared CA dimensions in children with febrile illnesses other than KD to those of normal afebrile children and to KD patients.

Methods and Results—We performed echocardiograms in 43 patients who met the following inclusion criteria: (1) age 3 months to 18 years, (2) daily fever >38 °C for ≥96 hours, and (3) a diagnosis other than KD.
These subjects had mean CA z-scores greater than normative values (LMCA=0.66±0.75, P<0 .001="" ca="" lad="0.35±1.0," maximum="" p="0.03)." rca="0.28±0.81," z-score="" zmax="">2 was found in 2 subjects (osteomyelitis, Mycoplasma pneumonia).
Among demographic and laboratory measures, only higher platelet count was associated with greater LAD z-scores (P=0.004) and zMax (P=0.03).
Non-KD febrile subjects, compared to 144 KD patients, had smaller CA z-scores (P=0.04, P<0 .001="" 2.0="" 20="" 25="" 32="" 84="" 95="" 98="" a="" all="" and="" blood="" cell="" count="" cut-off="" distinguishing="" erythrocyte="" febrile="" for="" from="" had="" in="" kd="" lad="" lmca="" lower="" non-kd="" of="" p="" patients="" platelet="" rate="" rca="" respectively="" sedimentation="" sensitivity="" specificity="" was="" white="" zmax="2.5,">
Conclusions—This pilot study found that mean CA dimensions in children with non-KD febrile illnesses are larger than those in normative afebrile subjects but smaller than dimensions in patients with KD. Future studies should augment the available data on CA dimensions in children with more severe febrile illnesses.