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Long-term vascular dysfunction in Kawasaki disease: systematic review and meta-analyses

Published online by Cambridge University Press:  14 September 2022

Pratap Kumar Patra Open the ORCID record for Pratap Kumar Patra [Opens in a new window] ,
Aaqib Zaffar Banday Open the ORCID record for Aaqib Zaffar Banday [Opens in a new window] ,
Rashmi Ranjan Das ,
Sumita Manohari ,
Ankur Kumar Jindal  and
Surjit Singh
Pratap Kumar Patra*
Affiliation:
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India
Aaqib Zaffar Banday
Affiliation:
Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Rashmi Ranjan Das
Affiliation:
Department of Pediatrics, AIIMS, Bhubaneswar, Odisha, India
Sumita Manohari
Affiliation:
Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Ankur Kumar Jindal
Affiliation:
Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Surjit Singh
Affiliation:
Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
*
Author for correspondence: Dr. Pratap Kumar Patra, Associate Professor, Department of Pediatrics, AIIMS, Patna, Bihar, India. Tel: +91 77669 32165. E-mail: patrapratap41@gmail.com
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Abstract

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.

Keywords

Kawasaki diseasearterial stiffnesscarotid intima-media thicknessendothelial dysfunctionflow-mediated dilatationnitroglycerine-mediated dilatationperipheral artery tonometrypositron emission tomographypulse-wave velocity
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 9 , September 2023 , pp. 1614 - 1626
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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