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Published on: April 13, 2015
Estimation of myocardial hemodynamics before and after intervention in children with Kawasaki disease
Shunichi Ogawa1, Takashi Ohkubo, Ryuji Fukazawa
1Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan. boston@nms.ac.jp
Insights
Coronary flow reserve (CFR) and fractional flow reserve (FFR(myo)) effectively assess coronary artery stenosis and ischemia in children with Kawasaki disease. These measurements reliably evaluate treatment outcomes after angioplasty and bypass surgery.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Coronary flow reserve (CFR) and fractional flow reserve (FFR(myo)) are established tools for assessing coronary artery stenosis and myocardial ischemia in adults.
- Limited data exists on the application of CFR and FFR(myo) in pediatric populations, particularly in children with Kawasaki disease (KD).
Purpose of the Study:
- To establish cut-off values for CFR and FFR(myo) in assessing functional severity of coronary stenosis and myocardial ischemia in children with KD.
- To evaluate the utility of these hemodynamic measurements before and after interventions like plain old balloon angioplasty (POBA) and coronary artery bypass graft surgery (CABG).
Main Methods:
- The study included 128 pediatric patients with 314 coronary branches, categorized into normal, abnormal without ischemia, and ischemia groups.
- Coronary flow reserve (CFR) and myocardial fractional flow reserve (FFR(myo)) were measured in each coronary branch.
Main Results:
- CFR and FFR(myo) were significantly lower in the ischemia group compared to other groups.
- Established adult cut-off values (CFR <2.0, FFR(myo) <0.75) were found effective in this pediatric cohort.
- High sensitivity and specificity were achieved for detecting myocardial ischemia using CFR (94.0%, 98.5%) and FFR(myo) (95.7%, 99.1%).
- Both CFR and FFR(myo) demonstrated reliability in assessing coronary hemodynamics pre- and post-POBA and CABG.
Conclusions:
- CFR and FFR(myo) serve as valuable indices for assessing coronary artery stenosis and myocardial ischemia in children with KD.
- These hemodynamic parameters effectively estimate the functional outcomes of POBA and CABG in pediatric KD patients, mirroring adult findings.
Objectives:
We used myocardial fractional flow reserve (FFR(myo)) and coronary flow reserve (CFR) to estimate cut-off values for assessment of the functional severity of coronary stenosis and myocardial ischemia, and we tested the usefulness of coronary blood hemodynamic measurements before and after plain old balloon angioplasty (POBA) and coronary artery bypass graft surgery (CABG).
Background:
Fractional flow reserve and CFR are useful for assessing the functional severity of coronary artery stenosis, coronary microvascular dysfunction, and myocardial ischemia during cardiac catheterization in adults. However, there have been no reports on the use of these measurements in children with Kawasaki disease (KD).
Methods:
The study group included 128 patients with 314 coronary branches. The subjects were classified into three groups: normal coronary group, with 206 branches; abnormal coronary artery without ischemia group, with 58 branches; and ischemia group, with 50 branches.
Results:
In each branch, CFR and FFR(myo) were significantly lower in the ischemia group than in the other groups. Cut-off values for assessing the functional severity of coronary stenosis and CFR were approximately equal to those obtained for adults (CFR: <2.0; FFR(myo): <0.75). We obtained very high sensitivity and specificity for estimating myocardial ischemia using CFR and FFR(myo) (CFR: 94.0% and 98.5%, respectively; FFR(myo): 95.7% and 99.1%, respectively). Both CFR and FFR(myo) were reliable indicators of coronary hemodynamics before and after POBA and CABG.
Conclusions:
Together, CFR and FFR(myo) provide a useful index for assessing the functional severity of coronary artery stenosis and myocardial ischemia and estimating the effectiveness of POBA and CABG in children with KD, the same as they do for adults.
