FOLLOWUP ECHOCARDIOGRAM RATE AFTER DIAGNOSIS OF KAWASAKI DISEASE: A RETROSPECTIVE REVIEW

1
FOLLOW-UP ECHOCARDIOGRAM RATE AFTER DIAGNOSIS OF
KAWASAKI DISEASE A RETROSPECTIVE REVIEW Lowry
AW, Liou A, Myones BL, Han YS Baylor College of
Medicine, Texas Childrens Hospital, Houston, TX
BACKGROUND
RESULTS

• 452 patients were identified, and 43 were
  excluded based on comorbid or preexisting
  conditions that would warrant echocardiogram
  follow-up irrespective of Kawasaki Disease.
• All 409 patients received an echocardiogram
  shortly after diagnosis.
• Overall, 59 of 409 (14) patients received only
  one echocardiogram, 175 (43) received only two
  echocardiograms, and 175 (43) received three or
  more echocardiograms.
• Among the 302 patients with a normal
  echocardiogram at diagnosis, 52 received no
  further follow-up imaging, and 11 had an abnormal
  or indeterminate second study.
• Only 11 (4) patients with normal echocardiograms
  received follow-up consistent with published
  guidelines.

• Despite therapy, some Kawasaki Disease (KD)
  patients develop coronary artery aneurysms.
  Appropriate follow-up is essential to detect
  life-threatening complications.

1994 AHA Guidelines repeat cardiac ultrasound
examination may be performed 6 to 8 weeks after
the onset of illness. Subsequent cardiac
ultrasound studies are performed 6 to 12 months
after the onset of acute illness.
2004 AHA guidelines For uncomplicated cases,
echocardiographic evaluation should be performed
at the time of diagnosis, at 2 weeks, and at 6 to
8 weeks after onset of the disease.
52 No further imaging
143 No further imaging
11 AHA-COMPLIANT FOLLOW-UP (4)
mean time to 1st echo 2.3 days
239 Normal 2nd echo
452 KD diagnosis
409 Included
302 Normal 1st echo
TABLE 1 Summary of AHA Recommendations for
Cardiac Imaging of Low-Risk Patients with
Kawasaki Disease

• To date, we know of no study that has evaluated
  echocardiogram follow-up practices for KD
  patients.

85 Received 3rd echo, but timing was
non-compliant (for either 2nd or 3rd
echo)
107 1st echo abnormal (59) or indeterminate (48)
43 Excluded for pre-existing conditions
11 2nd echo abnormal (3) or indeterminate (8)
METHODS

• Echocardiogram reports were obtained of all
  patients diagnosed with KD from January 1999 to
  July 2007.
• Patients were categorized into 3 groups based on
  initial echocardiogram results Normal,
  Indeterminate (subjective mild ectasia/aneurysm,
  z-score 2.0-2.9), or Abnormal (subjective
  ectasia/aneurysm or z-score gt2.9)
• Follow-up was considered to be compliant with AHA
  guidelines if the following criteria were met
• 1) First and second echocardiograms were normal,
  and
• 2) For patients diagnosed prior to publication of
  Oct 2004 guidelines, follow-up studies were
  obtained at 6-8 weeks (42-63 days) 6-12 months
  for those diagnosed after Oct 2004, follow-up
  studies were required at 1-3 weeks (7-28 days)
  and 1-3 months from initial study.

FIGURE 1 Flow Representation of Echocardiogram
Follow-Up Patterns
CONCLUSIONS

• Inconsistent echocardiogram follow-up after
  diagnosis of Kawasaki Disease could result in
  under-diagnosis of early and late cardiac
  sequelae of Kawasaki Disease.
• Echocardiogram follow-up practices at our
  institution do not adhere to published
  guidelines.
• These findings warrant investigation into
  institutional practices and policies to ensure
  these patients receive appropriate follow-up.

REFERENCES

• Dajani AS, Taubert KA, Takahashi M, et al.
  Guidelines for long-term management of patients
  with Kawasaki disease. Circulation. 89(2)916-22,
  1994 Feb.
• Newburger JW, Takahashi M, Gerber MA, 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. 110(17)2747-71,
  2004 Oct 26.