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Pathological Alterations of Coronary Arteries Late After Kawasaki Disease: An Optical Coherence Tomography Study

Yasutsugu Shiono1, Masahiro Takahata1, Yasushi Ino1

  • 1Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

JACC. Advances
|June 28, 2024
PubMed

Insights

Kawasaki disease can cause long-term coronary artery changes, including intimal thickening and medial disruption. Arteries with persistent aneurysms show more advanced atherosclerosis years later.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Vascular Biology

Background:

  • The long-term effects of Kawasaki disease on coronary arteries remain incompletely understood.
  • Kawasaki disease is a leading cause of acquired heart disease in children.

Purpose of the Study:

  • To investigate the in vivo state of coronary arteries in the late convalescent phase after Kawasaki disease.
  • To assess coronary artery changes in patients with persistent, regressed, and absent coronary artery aneurysms (CAAs).

Main Methods:

  • Followed 24 patients with a history of Kawasaki disease and CAAs.
  • Utilized optical coherence tomography (OCT) at a median of 16.6 years post-disease onset.
  • Analyzed 61 coronary arteries (17 persistent CAA, 29 regressed CAA, 15 no CAA) for pathological changes.

Main Results:

  • Intimal thickening and medial disruption were prevalent in all investigated arteries.
  • Advanced atherosclerotic features, including calcification, microvessels, cholesterol crystals, macrophage accumulation, and layered plaque, were significantly more frequent in persistent CAAs compared to regressed or absent CAAs.
  • Specifically, calcification (71% vs 17% vs 7%), microvessels (71% vs 35% vs 27%), and macrophage accumulation (65% vs 14% vs 27%) were notably higher in persistent CAAs.

Conclusions:

  • Coronary arteries in patients with a history of Kawasaki disease exhibit long-term pathological changes.
  • Persistent CAAs are associated with a significantly higher burden of advanced atherosclerotic features compared to regressed or absent CAAs, indicating a heightened risk profile.
Abstract

Keywords:
Kawasaki diseaseatherosclerosiscoronary artery aneurysm

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