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Altered myocardial flow reserve and endothelial function late after Kawasaki disease
Hideto Furuyama1, Yasuhisa Odagawa, Chietsugu Katoh
1Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Insights
Kawasaki disease (KD) can impair myocardial flow reserve (MFR) and endothelial function, even without coronary artery lesions. Positron emission tomography revealed reduced blood flow in patients years after KD.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Nuclear Cardiology
Background:
- Kawasaki disease (KD) can lead to coronary arterial lesions and intimal hypertrophy.
- These vascular changes may result in impaired coronary endothelial function.
- Assessing myocardial function post-KD is crucial for long-term patient management.
Purpose of the Study:
- To evaluate myocardial flow reserve (MFR) in patients after Kawasaki disease.
- To assess endothelial function in various myocardial regions following KD.
- To utilize positron emission tomography (PET) for detailed regional analysis.
Main Methods:
- PET imaging with (15)O-water was used to measure myocardial blood flow (MBF).
- MFR was determined by changes in MBF during adenosine triphosphate infusion.
- Endothelial function was assessed by MBF changes during cold pressor testing in 27 KD patients and 12 controls.
Main Results:
- Resting MBF was comparable across all myocardial regions.
- Hyperemic MBF and MFR were significantly lower in KD patients compared to controls.
- Reduced MBF during cold pressor testing indicated impaired endothelial function in KD patients.
Conclusions:
- Patients with a history of Kawasaki disease exhibit impaired MFR.
- Endothelial dysfunction is present in KD survivors, irrespective of coronary artery status.
- PET imaging effectively demonstrates persistent myocardial dysfunction after KD.
Objectives:
Coronary arterial lesions after Kawasaki disease (KD) may cause coronary endothelial dysfunction as the result of intimal hypertrophy. Our purpose was to assess myocardial flow reserve (MFR) and endothelial function in various myocardial regions after KD by using positron emission tomography.
Study Design:
Twenty-seven patients, 17.2 +/- 3.2 years of age, who had KD at 1.9 +/- 1.4 years, and 12 normal healthy subjects, 26.5 +/- 3.4 years of age, were evaluated by means of myocardial blood flow (MBF) with (15)O-water positron emission tomography. MFR was estimated by MBF changes under adenosine triphosphate infusion and endothelial function by MBF changes under cold pressor testing. The left ventricle was divided into three coronary territories. Ten stenotic regions, 20 aneurysmal regions, 30 regressed aneurysmal regions, and 21 regions without coronary arterial lesions were compared with 36 control regions of the normal volunteers.
Results:
MBF at rest was similar in each region. Hyperemic blood flow and MFR in each region after KD was significantly lower than those in the regions of normal volunteers. MBF during cold pressor testing was significantly reduced in each region after KD, as compared with no change in the control regions.
Conclusions:
Our study indicates impaired MFR and endothelial function regardless of coronary artery status after KD.