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Long-term vascular dysfunction in Kawasaki disease: systematic review and meta-analyses
Cardiology in the Young ( IF 1 ) Pub Date : 2022-09-14 , DOI: 10.1017/s1047951122002906
Pratap Kumar Patra 1 , Aaqib Zaffar Banday 2 , Rashmi Ranjan Das 3 , Sumita Manohari 2 , Ankur Kumar Jindal 2 , Surjit Singh 2
Affiliation  

Background:

Long-term physiological dysfunction in coronary/systemic vasculature may persist in individuals with Kawasaki disease even in the absence of coronary artery abnormalities. We perform a systematic review and meta-analyses of studies assessing long-term vascular function in Kawasaki disease.

Methods:

PubMed, Embase, and Web of Science databases were searched for relevant literature published till May 2021. Patients with Kawasaki disease were included as cases and healthy age/sex-matched individuals as controls. Newcastle Ottawa Scale was used to assess the study quality. Outcome measures were differences in markers of vascular function 1 year after diagnosis of Kawasaki disease. Data were analysed using Review Manager software. Comprehensive meta-analysis software was used for meta-regression. To assess the certainty of evidence, GRADE Profiler software was utilised.

Results:

Of 2280 citations, 49 case-control studies (comprising 2714 cases and 2118 controls) were included for data synthesis. Decreased flow-mediated dilatation [3.83, 95%CI 0.94–6.72] and increased pulse-wave velocity [39.34 cm/sec, 95%CI 20.86–57.83], arterial stiffness [0.35, 95%CI 0.11–0.59], and common carotid artery intima-media thickness were noted in patients with Kawasaki disease. No significant difference was observed for nitroglycerine-mediated dilatation and endothelial peripheral artery tonometry (endo-PAT). Significant inter-study heterogeneity was observed for flow-mediated dilatation, arterial stiffness, carotid artery intima-media thickness, and endo-PAT. The GRADE evidence was of ‘very low quality’ for all outcome measures except ‘moderate quality’ for pulse-wave velocity.

Conclusions:

Evidence suggests the presence of long-term endothelial dysfunction in patients with Kawasaki disease even in the absence of coronary artery abnormalities. Avoidance of development of other cardiovascular risk factors seems prudent in patients with Kawasaki disease.



中文翻译:

川崎病的长期血管功能障碍:系统评价和荟萃分析

背景:

即使没有冠状动脉异常,川崎病患者的冠状动脉/全身脉管系统的长期生理功能障碍也可能持续存在。我们对评估川崎病长期血管功能的研究进行了系统回顾和荟萃分析。

方法:

检索了 PubMed、Embase 和 Web of Science 数据库,查找截至 2021 年 5 月发表的相关文献。川崎病患者作为病例,年龄/性别匹配的健康个体作为对照。纽卡斯尔渥太华量表用于评估研究质量。结果测量是诊断川崎病一年后血管功能标志物的差异。使用Review Manager 软件分析数据。使用综合荟萃分析软件进行荟萃回归。为了评估证据的确定性,使用了 GRADE Profiler 软件。

结果:

在 2280 条引用中,纳入了 49 项病例对照研究(包括 2714 例病例和 2118 例对照)进行数据合成。血流介导的扩张减少[3.83,95%CI 0.94–6.72],脉搏波速度增加[39.34 cm/sec,95%CI 20.86–57.83],动脉僵硬度[0.35,95%CI 0.11–0.59],并且常见在川崎病患者中观察到颈动脉内膜中层厚度。硝酸甘油介导的扩张和内皮外周动脉张力测定(endo-PAT)没有观察到显着差异。在血流介导的扩张、动脉僵硬度、颈动脉内膜中层厚度和内源性 PAT 方面观察到显着的研究间异质性。除了脉搏波速度的“中等质量”之外,所有结果指标的 GRADE 证据均为“非常低质量”。

结论:

有证据表明,即使没有冠状动脉异常,川崎病患者也存在长期内皮功能障碍。对于川崎病患者来说,避免出现其他心血管危险因素似乎是谨慎的做法。

更新日期:2022-09-14
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