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Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function
M Iemura1, M Ishii, T Sugimura
1Department of Pediatrics and the Cardiovascular Research Institute, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Insights
Long-term follow-up of Kawasaki disease patients reveals persistent vascular abnormalities and dysfunction at regressed coronary aneurysm sites. These findings highlight the need for lifestyle counseling and ongoing monitoring into adulthood.
Area of Science:
- Pediatric Cardiology
- Vascular Biology
- Rheumatology
Background:
- Kawasaki disease (KD) can lead to coronary artery aneurysms.
- Long-term consequences of regressed aneurysms in KD patients remain incompletely understood.
- Assessing vascular wall morphology and function post-aneurysm regression is crucial.
Purpose of the Study:
- To investigate long-term outcomes of regressed coronary aneurysms in Kawasaki disease patients.
- To evaluate vascular wall morphology using intravascular ultrasound imaging.
- To assess coronary artery function with pharmacological stress tests.
Main Methods:
- Study included 33 patients: 27 with prior KD and 6 with congenital heart disease (controls).
- Patients with regressed aneurysms (large/small) underwent follow-up coronary angiography and intravascular ultrasound.
- Intracoronary acetylcholine and isosorbide dinitrate infusions assessed vascular reactivity.
Main Results:
- Coronary angiography showed no stenosis or irregularity in regressed aneurysm sites.
- Intravascular ultrasound revealed intimal thickening at sites of previous aneurysms.
- Patients with regressed aneurysms exhibited impaired vasodilation and enhanced constriction compared to controls.
Conclusions:
- Regressed coronary aneurysms in KD patients are associated with persistent abnormal vascular morphology and dysfunction.
- These findings suggest an increased risk for atherosclerosis.
- Long-term monitoring and risk factor modification are recommended for affected individuals.
Objectives:
To investigate the long term consequences of regressed aneurysms after Kawasaki disease, using follow up coronary angiography; to assess the vascular wall morphology at the site of the aneurysms by intravascular ultrasound imaging; and to evaluate the function of the affected vessels using intracoronary infusions of acetylcholine and isosorbide dinitrate.
Design:
33 patients were studied, 27 with previous Kawasaki disease and six with congenital heart disease. All Kawasaki disease patients were followed for more than 10 years from disease onset. The 33 patients comprised four groups: group 1 included 13 Kawasaki disease patients with a total of 23 sites of regressed large sized (>/= 4 mm) coronary aneurysms; group 2 included 13 Kawasaki disease patients with 22 sites of regressed small sized (< 4 mm) coronary aneurysms (four patients had sites of both large and small sized aneurysms); group 3 included a further five Kawasaki disease patients with 25 normal coronary angiography sites in the acute stage of Kawasaki disease; and group 4 comprised the six patients with congenital heart disease as controls, with a total of 27 normal coronary angiography sites. During coronary angiography, 15 microg of acetylcholine and 0.5 mg isosorbide dinitrate were infused into the coronary artery. The luminal diameter at the sites was measured using a cine-videodensitometric analyser, to assess the distensibility of the coronary artery wall.
Results:
Coronary angiography in all 22 patients in groups 1 and 2 and in all the patients in group 3 was normal, with no stenoses and no irregularity of the arterial wall. However, the intravascular ultrasound imaging in groups 1 and 2 showed various degrees of the intimal thickening. In groups 1 and 2, there was significantly more vascular constriction with acetylcholine, and poorer dilatation with isosorbide dinitrate than in groups 3 or 4 (each p < 0.05, respectively). There was no difference between group 3 and group 4 in response to either acetylcholine or isosorbide dinitrate,
Conclusions:
There is evidence of persisting abnormal vascular wall morphology and vascular dysfunction at the site of regressed coronary aneurysms in patients with previous Kawasaki disease. These patients should be counselled to avoid potential risk factors for atherosclerosis, and long term follow up is needed into adult life.