Pre-IVIG echocardiography enables targeted treatment in infants younger than 6 months with Kawasaki Disease
摘要
The 2024 American Heart Association scientific statement suggests intensification therapy in infants younger than 6 months (< 6 months) with Kawasaki disease (KD) may be beneficial, but indications remain undefined. We hypothesized that pre-IVIG echocardiographic findings could identify infants < 6 months who do not require intensification beyond standard intravenous immunoglobulin (IVIG). This multicenter cohort study in Taiwan (2019–2023) included children with KD who underwent echocardiography before IVIG and received IVIG within 10 days of illness onset. Children receiving early intensification therapy were excluded. Participants were stratified as < 6 months or ≥ 6 months. Echocardiography was performed at four time points: pre-IVIG, days 11–42, weeks 7–8, and 3 months after KD onset. Among 398 children with KD, 44 (11.1%) were younger than 6 months. Infants < 6 months had higher coronary artery aneurysm (CAA) prevalence at diagnosis than older children (52.3% vs 28.5%; OR, 2.74 [95% CI, 1.45–5.18]; P = .001). IVIG within 7 days was associated with lower CAA risk in both groups. Among children with initially normal coronary dimensions, new CAA risk did not differ significantly between younger and older groups (4.8% vs 2.4%; P = .42). Among 21 infants < 6 months without initial CAA, none developed new CAA except one with KD shock syndrome.
Conclusions: Pre-IVIG echocardiography may help identify infants < 6 months at low risk for subsequent CAA development with standard IVIG treatment. Given the observational nature of this study, larger prospective studies are warranted to confirm these findings.