Coronary artery changes occurring with the acute vasculitis of Kawasaki disease can cause death. Treatment with intravenous gamma globulin and aspirin significantly reduces coronary vascular changes. The American Heart Association (AHA) recommends echocardiography to evaluate the coronary arteries six to eight weeks after initial presentation and again six to 12 months later. Tuohy and colleagues studied the value of the second follow-up echocardiogram.
The study was a retrospective review of all patients diagnosed with Kawasaki disease over a 16-year period at several large hospitals in the United States. Patients were included only if there was documentation of echocardiography at presentation, at one to two months after diagnosis and again after at least five months. Of the 536 patients in the study, 134 (25 percent) had abnormal initial echocardiograms demonstrating aneurysms, ectasia, increased perivascular echogenicity or pericardial effusions. Of the 402 patients with normal initial echocardiograms, 277 had follow-up data and 267 had normal echocardiograms at one to two months. Ten patients developed abnormalities, including ectasia and aneurysm, within this eight-week period. None of the patients with a normal echocardiogram at one to two months who underwent another study demonstrated an abnormality more than five months after the initial presentation.
The authors conclude that, because abnormalities can develop early in the course of disease, echocardiography at one to two months remains appropriate in patients with normal initial echocardiography. Patients with a normal echocardiogram at presentation and at follow-up in one to two months did not develop coronary artery abnormalities at a later date. This was also true of patients with initially abnormal echocardiograms whose test results were normal after one to two months. The authors acknowledge that this system is contrary to the current AHA recommendation for additional follow-up echocardiography after six to 12 months in all patients with Kawasaki disease. They recommend eliminating follow-up echocardiograms beyond eight weeks in patients with previously normal test results, a step that will improve patient care and contain costs.