Frequency of heart involvement in Kawasaki disease during a decade in Iran

Document Type : Original Article


Assistant Professor of Pediatrician, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Kawasaki disease (KD) is an acute febrile illness of unknown etiology that is also associated with cardiovascular complications, making it the most common manifestation. It primarily occurs in children under the age of 5.
Objectives: This study aimed to investigate the clinical and preclinical findings of Kawasaki disease and determine heart involvement in Iranian child patients with Kawasaki disease.
Methods: In this retrospective study, medical records of all hospitalized child patients with Kawasaki disease in four hospitals in TEHRAN during the years 2011 to 2021 were examined. Patients with cardiac involvement were identified according to specific criteria. Demographic data, clinical and pre-clinical symptoms, the type and severity of cardiovascular disease, the type of complications, and mortality were recorded.
Results: Out of 108 child patients with Kawasaki disease, 36 patients (33.3%) had heart involvement. Among these patients with heart involvement, 63.2% were male, and 72.2% were aged less than 5 years old. Echocardiography results showed that 66.7% of patients had pericardial effusion as evidence of cardiac involvement. No mortality was recorded.
Conclusions: Heart involvement in Iranian children with Kawasaki disease was found to be 33.3% and was more common in boys. The most common type of heart involvement was pericardial effusion.


  1. Chen DT, Chang JP, Cheng SW, Chang HC, Hsu JH, Chang HH, et al. Kawasaki disease in childhood and psychiatric disorders: A population-based case-control prospective study in Taiwan. Brain Behav Immun. 2022;100:105-11. doi:1016/j.bbi.2021.11.017 PMid:34848339
  2. Gellis L, Castellanos DA, Oduor R, Gauvreau K, Dionne A, Newburger J, et al. Comparison of coronary artery measurements between echocardiograms and cardiac CT in Kawasaki disease patients with aneurysms. J Cardiovasc Comput Tomogr. 2022;16(1):43-50. doi:10.1016/j.jcct.2021.09.002. PMid:34548269
  3. Lin CH, Lai JN, Lee IC, Chou IC, Lin WD, Lin MC, Hong SY. Kawasaki Disease May Increase the Risk of Subsequent Cerebrovascular Stroke. 2021. doi:10.1161/STROKEAHA.120.032953 PMid:34844424
  4. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, 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. 2004;110(17):2747-71 doi:10.1161/01.CIR.0000145143.19711.78 PMid:15505111
  5. Xie Z, Huang Y, Li X, Lun Y, Li X, He Y, et al. Atlas of circulating immune cells in Kawasaki disease. Int Immunopharmacol. 2022; 102:108396. doi:10.1016/j.intimp.2021.108396 PMid:34890998
  6. Tizard EJ, Suzuki A, Levin M, Dillon MJ. Clinical aspects of 100 patients with kawazaki disease. Arch Dis Child. 1991; 66: 185-8. doi:10.1136/adc.66.2.185 PMid:1900405 PMCid:PMC1792829
  7. Chuang C, Hsiao M, Chiu C, Huang Y, Lin T. Kawasaki disease in infants three months of age or younger. J Microbiol, Immunol, infect. 2006;39(5):387-91.
  8. Weng K-P, Hsieh K-S, Huang S-H, Ou S-F, Ma C-Y, Ho T-Y, et al. Clinical relevance of the risk factors for coronary artery lesions in Kawasaki disease. Kaohsiung J Med Sci. 2012;28(1):23-9. doi:10.1016/j.kjms.2011.09.002 PMid:22226058
  9. Asadi-Pooya AA, Borzoee M, Amoozgar H. The Experince with 113 Patients with Kawasaki Disease in Fars Province, Iran. Turk J Pediatr. 2006;48(2):109.
  10. Nakamura Y, Yashiro M, Uehara R, Oki I, Watanabe M, Yanagawa H. Epidemiologic features of Kawasaki disease in Japan: results from the nationwide survey in 2005-2006. J Epidemiol/Japan Epidemiol Assoc. 2007;18(4):167-72. doi:10.2188/jea.JE2008001 PMid:18635901 PMCid:PMC4771586
  11. Baer AZ, Rubin LG, Shapiro CA, Sood SK, Rajan S, Shapir Y, et al. Prevalence of coronary artery lesions on the initial echocardiogram in Kawasaki syndrome. Arch Pediatr Adolesce Med. 2006;160(7):686-90. doi:10.1001/archpedi.160.7.686 PMid:16818833
  12. Lin YT, Manlhiot C, Ching JC, Han RK, Nield LE, Dillenburg R, et al. Repeated systematic surveillance of Kawasaki disease in Ontario from 1995 to 2006. Pediatr Int. 2010; 52(5):699-706. doi:10.1111/j.1442-200X.2010.03092.x PMid:20113416
  13. AL-Ammouri I, Al-Wahsh S, Khuri-Bulos N. Kawasaki disease in Jordan: demographics, presentation, and outcome. Cardiol Young. 2012;22(04):390-5. doi:10.1017/S1047951111001818 PMid:22067065
  14. Park YW, Han JW, Hong YM, Ma JS, Cha SH, Kwon TC, et al. Epidemiological features of Kawasaki disease in Korea, 2006-2008. Pediatr Int. 2011;53(1):36-9.
    doi:10.1111/j.1442-200X.2010.03178.x PMid:20534021
  15. Singh S, Kawasaki T. Kawasaki Disease-An Indian Perspective. Indian Pediatr. 2009;46(7).
  16. Kordi D, Kazemi A, Nik Y, Torfeh N. Assessing Kawasaki Disease In Children At Alzahra Hospital (1995-1999). J Qazvin Univ Med Sci. 2008; 14 (4): 42-7.
  17. Tashakkor M, Chavoshzadeh Z, Droodgar A. Report of 12 cases of Kawazaki patients in shahid Beheshti university of medical science of Kashan during 1997-1999. Feyz Med Sci J. 2000;11(3): 61-7.
  18. Martinez RM, Delcastillo MF, Borque AC, Garcia MMJ, De Jose Gomez MI, Martinez F. Incidence and clinical characteristics of Kawasaki's disease. An Pediatr Borc. 2003; 59(4): 323-7.
  19. Sharrif MR, Iranfar M. Surveying the related factors in Kawasaki disease in children hospitalized in Shaheed Beheshti Hospital (Kashan) and Tehran Children's Center, 1995-2000. Feyz Med Sci J. 2002; 6(2): 44-39.
  20. Royle J, Burgner D, Curtis N. The diagnosis and management of Kawasaki disease. J Pediatr Child Health. 2005;41(3):87-93. doi:10.1111/j.1440-1754.2005.00555.x PMid:15790316
  21. Gheini S, Hemati M, Arghavanifard P. Characteristics of Kawasaki patients in Kermanshah hospitals during 1997-2002. J Kermanshah Univ Med Sci. 2004;8(3)
  22. Schroh AM, Domínguez P, Laghezza LB, Melonari PA, Olguín M, Miatello R. Kawasaki disease: heart disease during childhood. Rev Esp Cardiol (English Edition). 2006; 59 (4):387-90 doi:10.1016/S1885-5857(06)60777-9
  23. Kowalczyk M, Kawalec W, Daszkowska-York J, Turska-Kmieć A, Brzezińska-Rajszys G, Sobielarska D, et al. Kawasaki disease in children--9 years experience. Med Wieku Rozwoj. 2004;9(2): 179-93.
  24. Sadeghi E, Amin R, Ajamee G. Kawasaki syndrome: the Iranian experience. East Mediterr Health J. 2000;7(1-2):16-25 doi:10.26719/2001.7.1-2.16 PMid:12596947