(Circulation. 1996;94:2103-2106.)
© 1996 American Heart Association, Inc.
Articles |
Endothelial Dysfunction Late After Kawasaki Disease
the Cardiothoracic Unit, Special Pediatric Unit (M.N., M.J.D.), and Infectious Diseases Unit (V.N.), Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Correspondence to Dr John E. Deanfield, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Background Kawasaki disease (KD) is a systemic vasculitis of childhood with widespread vascular endothelial damage in the acute stage. Long-term complications, such as myocardial infarction and death, are recognized, but the extent and nature of late vascular abnormalities that might predispose to these events have not been studied.
Methods and Results We used high-resolution ultrasound to study endothelial function in the brachial artery of 20 patients 5 to 17 years after acute KD (median, 11 years) and compared findings with those in 20 age- and sex-matched control subjects. Vascular responses to reactive hyperemia (with flow increase leading to endothelium-dependent dilation) and to sublingual glyceryl trinitrate (GTN; endothelium-independent dilation) were recorded. The relationship between endothelium-dependent vascular responses and features of the acute illness was examined. There was no difference in baseline vessel diameter, degree of reactive hyperemia, or response to GTN between patients and control subjects. In contrast, flow-mediated dilation was markedly reduced in KD patients compared with control subjects (3.1% versus 9.4%; P<.001). Late endothelium-dependent responses were not related to features of the acute illness.
Conclusions Abnormalities of systemic endothelial function are present many years after resolution of acute KD, even in patients without detectable early coronary artery involvement. Because this may be an important factor in the genesis of late vascular complications, long-term follow-up of all patients with KD is indicated.
Key Words: Kawasaki disease • ultrasonics • endothelium
This article has been cited by other articles:
 |
|
 |
|
  J. B. Gordon, A. M. Kahn, and J. C. Burns When children with kawasaki disease grow up myocardial and vascular complications in adulthood. J. Am. Coll. Cardiol., November 17, 2009; 54(21): 1911 - 1920. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kitamura, E. Tsuda, J. Kobayashi, H. Nakajima, Y. Yoshikawa, T. Yagihara, and A. Kada Twenty-Five-Year Outcome of Pediatric Coronary Artery Bypass Surgery for Kawasaki Disease Circulation, July 7, 2009; 120(1): 60 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Senzaki Long-Term Outcome of Kawasaki Disease Circulation, December 16, 2008; 118(25): 2763 - 2772. [Full Text] [PDF]
|
|
|
|
 |
|
 M.-T. Lin, S.-J. Chen, Y.-L. Ho, K.-C. Huang, C.-A. Chen, S.-N. Chiu, L.-C. Sun, W.-J. Lee, H.-C. Chen, J.-K. Wang, et al. Abnormal Matrix Remodeling in Adolescents and Young Adults with Kawasaki Disease Late after Onset Clin. Chem., November 1, 2008; 54(11): 1815 - 1822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-f. Cheung, G.-y. Huang, S.-b. Chen, X.-q. Liu, L. Xi, X.-c. Liang, M.-r. Huang, S. Chen, L.-s. Huang, X.-q. Liu, et al. Inflammatory Gene Polymorphisms and Susceptibility to Kawasaki Disease and Its Arterial Sequelae Pediatrics, September 1, 2008; 122(3): e608 - e614. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Tousoulis, M Charakida, and C Stefanadis Endothelial function and inflammation in coronary artery disease Postgrad. Med. J., July 1, 2008; 84(993): 368 - 371. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.-E. W. Kavey, V. Allada, S. R. Daniels, L. L. Hayman, B. W. McCrindle, J. W. Newburger, R. S. Parekh, and J. Steinberger Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics Circulation, December 12, 2006; 114(24): 2710 - 2738. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Tousoulis, M Charakida, and C Stefanadis Endothelial function and inflammation in coronary artery disease Heart, April 1, 2006; 92(4): 441 - 444. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Simonini, C. D. Rose, A. Vierucci, F. Falcini, and B. H. Athreya Diagnosing Kawasaki syndrome: the need for a new clinical tool Rheumatology, August 1, 2005; 44(8): 959 - 961. [Full Text] [PDF]
|
|
|
|
|
|
H. Senzaki, C.-H. Chen, H. Ishido, S. Masutani, T. Matsunaga, M. Taketazu, T. Kobayashi, N. Sasaki, S. Kyo, and Y. Yokote Arterial Hemodynamics in Patients After Kawasaki Disease Circulation, April 26, 2005; 111(16): 2119 - 2125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Vallbracht, P. L. Schwimmbeck, U. Kuhl, U. Rauch, B. Seeberg, and H.-P. Schultheiss Differential Aspects of Endothelial Function of the Coronary Microcirculation Considering Myocardial Virus Persistence, Endothelial Activation, and Myocardial Leukocyte Infiltrates Circulation, April 12, 2005; 111(14): 1784 - 1791. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Charakida, A. E. Donald, M. Terese, S. Leary, J. P. Halcox, A. Ness, G. D. Smith, J. Golding, P. Friberg, N. J. Klein, et al. Endothelial Dysfunction in Childhood Infection Circulation, April 5, 2005; 111(13): 1660 - 1665. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Bots, J. Westerink, T. J. Rabelink, and E. J.P. de Koning Assessment of flow-mediated vasodilatation (FMD) of the brachial artery: effects of technical aspects of the FMD measurement on the FMD response Eur. Heart J., February 2, 2005; 26(4): 363 - 368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Mitani, H. Sawada, H. Hayakawa, K. Aoki, H. Ohashi, M. Matsumura, K. Kuroe, H. Shimpo, M. Nakano, and Y. Komada Elevated Levels of High-Sensitivity C-Reactive Protein and Serum Amyloid-A Late After Kawasaki Disease: Association Between Inflammation and Late Coronary Sequelae in Kawasaki Disease Circulation, January 4, 2005; 111(1): 38 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Newburger, M. Takahashi, M. A. Gerber, M. H. Gewitz, L. Y. Tani, J. C. Burns, S. T. Shulman, A. F. Bolger, P. Ferrieri, R. S. Baltimore, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association Pediatrics, December 1, 2004; 114(6): 1708 - 1733. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Vallbracht, P. L. Schwimmbeck, U. Kuhl, B. Seeberg, and H.-P. Schultheiss Endothelium-Dependent Flow-Mediated Vasodilation of Systemic Arteries Is Impaired in Patients With Myocardial Virus Persistence Circulation, November 2, 2004; 110(18): 2938 - 2945. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y F Cheung, M H K Ho, S C F Tam, and T C Yung Increased high sensitivity C reactive protein concentrations and increased arterial stiffness in children with a history of Kawasaki disease Heart, November 1, 2004; 90(11): 1281 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Newburger, M. Takahashi, M. A. Gerber, M. H. Gewitz, L. Y. Tani, J. C. Burns, S. T. Shulman, A. F. Bolger, P. Ferrieri, R. S. Baltimore, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association Circulation, October 26, 2004; 110(17): 2747 - 2771. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. K Maconochie KAWASAKI DISEASE Arch. Dis. Child. Ed. Pract., June 1, 2004; 89(1): ep3 - ep8. [Full Text] [PDF]
|
|
|
|
|
|
Y.-f. Cheung, T.-c. Yung, S. C. F. Tam, M. H. K. Ho, and A. K. T. Chau Novel and traditional cardiovascular risk factors in children after Kawasaki disease: Implications for premature atherosclerosis J. Am. Coll. Cardiol., January 7, 2004; 43(1): 120 - 124. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Vaudo, S Marchesi, R Gerli, R Allegrucci, A Giordano, D Siepi, M Pirro, Y Shoenfeld, G Schillaci, and E Mannarino Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity Ann Rheum Dis, January 1, 2004; 63(1): 31 - 35. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J U Kim, H K Chang, S S Lee, J W Kim, K T Kim, S W Lee, and W T Chung Endothelial nitric oxide synthase gene polymorphisms in Behcet's disease and rheumatic diseases with vasculitis Ann Rheum Dis, November 1, 2003; 62(11): 1083 - 1087. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Meissner and D. Y. M. Leung Kawasaki Syndrome: Where Are the Answers? Pediatrics, September 1, 2003; 112(3): 672 - 676. [Full Text] [PDF]
|
|
|
|
|
|
A D Filer, J M Gardner-Medwin, J Thambyrajah, K Raza, D M Carruthers, R J Stevens, L Liu, S E Lowe, J N Townend, and P A Bacon Diffuse endothelial dysfunction is common to ANCA associated systemic vasculitis and polyarteritis nodosa Ann Rheum Dis, February 1, 2003; 62(2): 162 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Bergholm, M. Leirisalo-Repo, S. Vehkavaara, S. Makimattila, M.-R. Taskinen, and H. Yki-Jarvinen Impaired Responsiveness to NO in Newly Diagnosed Patients With Rheumatoid Arthritis Arterioscler Thromb Vasc Biol, October 1, 2002; 22(10): 1637 - 1641. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Vallbracht, P. L. Schwimmbeck, B. Seeberg, U. Kuhl, and H.-P. Schultheiss Endothelial dysfunction of peripheral arteries in patients with immunohistologically confirmed myocardial inflammation correlates with endothelial expression of human leukocyte antigens and adhesion molecules in myocardial biopsies J. Am. Coll. Cardiol., August 7, 2002; 40(3): 515 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Raza, J. Thambyrajah, J. N. Townend, A. R. Exley, C. Hortas, A. Filer, D. M. Carruthers, and P. A. Bacon Suppression of Inflammation in Primary Systemic Vasculitis Restores Vascular Endothelial Function: Lessons for Atherosclerotic Disease? Circulation, September 26, 2000; 102(13): 1470 - 1472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Burns, H. I. Kushner, J. F. Bastian, H. Shike, C. Shimizu, T. Matsubara, and C. L. Turner Kawasaki Disease: A Brief History Pediatrics, August 1, 2000; 106(2): 27e - 27. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. K. Han, B. Sinclair, A. Newman, E. D. Silverman, G. W. Taylor, P. Walsh, and B. W. McCrindle Recognition and management of Kawasaki disease Can. Med. Assoc. J., March 1, 2000; 162(6): 807 - 812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Iemura, M Ishii, T Sugimura, T Akagi, and H Kato Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function Heart, March 1, 2000; 83(3): 307 - 311. [Abstract] [Full Text]
|
|
|
|
 |
|
 H. Huang, T. M. Calderon, J. W. Berman, V. L. Braunstein, L. M. Weiss, M. Wittner, and H. B. Tanowitz Infection of Endothelial Cells with Trypanosoma cruzi Activates NF-kappa B and Induces Vascular Adhesion Molecule Expression Infect. Immun., October 1, 1999; 67(10): 5434 - 5440. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W Newburger and J. C Burns Kawasaki disease Vascular Medicine, August 1, 1999; 4(3): 187 - 202. [Abstract] [PDF]
|
|
|
|
 |
|
 A. H. Rowley and S. T. Shulman Kawasaki Syndrome Clin. Microbiol. Rev., July 1, 1998; 11(3): 405 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M J Dillon Childhood vasculitis Lupus, May 1, 1998; 7(4): 259 - 265. [Abstract] [PDF]
|
|