Author + information
- Welton M. Gersony, MD* ()
- ↵*Columbia University Medical Center, 3959 Broadway, 2-North, New York, New York 10032-1537
I thank Dr. Dahdah for his interest in my paper (1). In his letter to the editor, Dr. Dahdah raises concerns about the long-term effects of myocarditis on adults who had Kawasaki disease (KD) as a child, and that my commentary, which pertained to the risk of late coronary artery events, did not address this potential issue. As he indicates, a myocardial inflammatory process in the acute phase of KD has been well documented, even when coronary involvement may have been minimal or even absent. However, Dr. Dahdah's assertion that late manifestations of acute myocarditis are likely to be a serious threat to the adult who had KD is not evidence based. The references accompanying his letter do not describe a single case of an adult with late myocarditis or nonischemic cardiomyopathy, and there have been hundreds of thousands of patients who have had KD. Furthermore, the biopsy studies carried out in 1978 and 1981 were obtained from patients in the acute and subacute phases of the disease. By no means can they be interpreted as sufficient evidence for physicians to raise realistic concerns about myocarditis as a significant potential problem in adults who had KD in childhood. I believe that Dr. Dahdah is in a tiny minority when he suggests that the review by Gordon et al. and, particularly, my commentary are “completely distracted from the central realities associated with KD.”
Similar to the discussion concerning early transient coronary artery involvement, in >40 years of observation, the early myocardial inflammation occurring in some cases of KD has not been shown to progress to chronic myocardial disease. Of course, future clinical observations will be considered, but at this time there is no evidence to suggest that former KD patients should be instilled with the fear of late myocarditis. As in all of medicine, physician-patient communication is essential. As stated in the commentary: “The [KD] guidelines should be reviewed individually, and interpreted on a 1-to-1 basis, so that each post-KD individual will have a clear perspective as to what is actually known about late risk in his/her circumstances.” Equating this statement with physicians' refraining to discuss the effects of obesity when counseling patients is not credible.
- American College of Cardiology Foundation