Transthoracic echo-Doppler assessment of coronary microvascular function late after Kawasaki disease

Area of Science:

• Pediatric Cardiology
• Cardiovascular Imaging
• Vascular Physiology

Background:

• Kawasaki disease (KD) can lead to coronary artery abnormalities and potential microvascular dysfunction.
• Noninvasive assessment of coronary microvascular function is crucial for managing children with a history of KD.
• Coronary flow reserve (CFR) is a key indicator of microvascular health.

Purpose of the Study:

• To evaluate the utility of Doppler transthoracic echocardiography (TTE) for assessing coronary microvascular dysfunction in children with previous KD.
• To measure CFR using TTE during a cold pressor test (CPT) in children with and without coronary artery lesions (CALs) post-KD.
• To compare CFR in KD patients with healthy controls.

Main Methods:

• Twenty-five children with prior KD (16 CALs(-), 9 CALs(+)) and 17 healthy controls underwent Doppler TTE.
• Diastolic peak velocity (DPV) was measured in the anterior descending artery at rest (DPV(Rest)) and during CPT (DPV(CPT)).
• Coronary flow reserve (CFR) was calculated as DPV(CPT)/DPV(Rest).

Main Results:

• KD patients exhibited significantly higher DPV at rest and during CPT compared to controls.
• CFR was significantly reduced in KD patients (1.5 +/- 0.4) compared to controls (2.1 +/- 0.2).
• Reduced CFR was observed similarly in KD patients with (1.4 +/- 0.4) and without (1.6 +/- 0.4) coronary artery lesions.

Conclusions:

• Doppler TTE with CPT is a valuable noninvasive tool for evaluating CFR in children with a history of KD.
• Coronary microvascular dysfunction, indicated by reduced CFR, is prevalent in KD patients irrespective of coronary artery lesion presence.
• This method aids in identifying subclinical cardiovascular risks in pediatric KD survivors.