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This narrative review, appraised against SANRA after drafting, examines echocardiography across the disease\u2010management lifecycle, from pre\u2010treatment risk enrichment to long\u2010term surveillance. PubMed\/MEDLINE searches were supplemented by cross\u2010source discovery and metadata verification. Standardized serial coronary measurement with consistent use of one Z\u2010score system remains the management core. Initial composite echocardiographic abnormalities, myocardial deformation, and tissue\u2010Doppler indices may enrich risk assessment, but current discrimination is moderate and thresholds lack external validation. IVIG non\u2010response and coronary aneurysm are related but non\u2010interchangeable; defervescence does not establish coronary safety, whereas definite baseline coronary artery aneurysm is a treatment\u2010relevant high\u2010risk phenotype. Deformation, myocardial work, right\u2010heart indices, coronary flow reserve, and complementary imaging can refine selected clinical questions but should not trigger treatment in isolation. Echocardiography can therefore structure coronary and myocardial surveillance, but cannot yet independently determine treatment resistance or support a universal multimodal treatment score. Prospective multicenter standardization, external validation, and clinical\u2010utility testing are required before multimodal imaging\u2010guided treatment decisions are adopted.<\/jats:p>","DOI":"10.1111\/echo.70589","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:55:54Z","timestamp":1787151354000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal Echocardiographic Assessment in Intravenous Immunoglobulin\u2010Resistant Kawasaki Disease: From Prediction to Long\u2010Term Surveillance"],"prefix":"10.1111","volume":"43","author":[{"given":"Xin","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Pediatric Functional Examination Lanzhou University Second Hospital  Lanzhou Gansu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pediatric 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