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Long-Term Coronary Artery Evaluation Using Noncontrast-Enhanced Magnetic Resonance Angiography in Patients with
Haruki Nonaka1, Masahiro Tahara2, Takayuki Yoshiura3
1Department of Radiological Technology, Tsuchiya General Hospital, 3-30 Nakajima-Cho, Naka-Ku, Hiroshima, 730-8655, Japan. swing_by_byp@yahoo.co.jp.
Insights
Noncontrast-enhanced coronary magnetic resonance angiography (NC-CMRA) effectively monitors coronary artery stenosis in Kawasaki disease (KD) patients long-term. This imaging technique shows good agreement with coronary angiography, making it a valuable follow-up tool.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Health
Background:
- Kawasaki disease (KD) can lead to coronary artery aneurysms and stenosis.
- Long-term monitoring of coronary artery complications in KD is crucial.
- Noncontrast-enhanced coronary magnetic resonance angiography (NC-CMRA) is a potential imaging modality for this follow-up.
Purpose of the Study:
- To evaluate the efficacy of NC-CMRA for the long-term follow-up of coronary artery stenosis in patients with Kawasaki disease.
- To assess the prevalence of coronary artery stenotic lesions over time in KD patients with varying aneurysm sizes.
- To compare the diagnostic accuracy of NC-CMRA with conventional coronary angiography (CAG) for detecting stenosis.
Main Methods:
- Retrospective analysis of 40 Kawasaki disease patients who underwent NC-CMRA.
- Classification of coronary artery aneurysms into small, medium, large, and giant based on American Heart Association criteria.
- Evaluation of stenotic lesion prevalence using Kaplan-Meier analysis and comparison with CAG via Bland-Altman analysis and ICC.
Main Results:
- Significant prevalence of coronary artery stenosis observed in patients with large/giant aneurysms (71.9% at 20 years) and medium aneurysms (23.7% at 20 years).
- No stenotic lesions were detected in patients with small aneurysms.
- NC-CMRA demonstrated moderate consistency (ICC 0.65) with CAG in detecting stenotic lesions, with all 16 detected lesions being concordant.
Conclusions:
- NC-CMRA is a reliable imaging technique for detecting coronary artery stenosis in long-term follow-up of Kawasaki disease patients.
- The prevalence of stenosis increases over time, particularly in patients with larger aneurysms.
- NC-CMRA serves as a viable alternative to conventional angiography for monitoring coronary artery health in KD patients post-echocardiography.
Abstract:
To evaluate the use of noncontrast-enhanced coronary magnetic resonance angiography (NC-CMRA) for long-term follow-up in patients with Kawasaki disease (KD). In total, 40 (77 aneurysms) patients with KD who underwent NC-CMRA were retrospectively analyzed. Coronary artery aneurysms and dilations observed during the acute phase were classified into three groups according to their diameter based on the American Heart Association criteria. The prevalence of coronary artery stenotic lesions was evaluated using the Kaplan-Meier method (log-rank test). The agreement in the coronary artery stenosis rates between NC-CMRA and coronary angiography (CAG) was examined via Brand-Altman analysis and intraclass correlation coefficients (ICC). In patients with large or giant aneurysms, the prevalence of coronary artery stenotic lesions was 26.3% at 10 years, 53.2% at 15 years, and 71.9% at 20 years. In patients with medium aneurysms, the prevalence of coronary artery stenotic lesions was 8.4% at 10 and 15 years and 23.7% at 20 years. Patients with small aneurysms did not exhibit stenotic lesions. Patients with large or giant aneurysms had significantly higher rate of coronary stenotic lesions than those with medium and small aneurysms (p < 0.05). All 16 stenotic lesions detected on NC-CMRA were consistent with those observed on CAG, and the coronary artery stenotic rate had moderate consistency (ICC 0.65). In KD, the detection of coronary artery stenosis using NC-CMRA was consistent with that using CAG. Therefore, NC-CMRA can be a better alternative following echocardiography for long-term coronary artery evaluation in patients with KD.
