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Kawasaki disease evaluated by two-dimensional echocardiogram and dipyridamole 201Tl-chloride myocardial SPET
Insights
Kawasaki disease (mucocutaneous lymph node syndrome) can cause myocardial involvement in over 50% of children. Combined dipyridamole 201Tl-chloride SPET and 2D-Echo improve detection of cardiac issues, revealing myocardial ischemia and coronary aneurysms.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Nuclear Cardiology
Background:
- Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is a significant cause of acquired heart disease in children.
- Myocardial involvement is common in KD, but its full extent and detection methods require further investigation.
Purpose of the Study:
- To assess the incidence and nature of myocardial involvement in children with Kawasaki disease.
- To compare the diagnostic capabilities of dipyridamole 201Tl-chloride myocardial single-photon emission tomography (SPET) and two-dimensional echocardiography (2D-Echo).
Main Methods:
- Thirty pediatric patients diagnosed with Kawasaki disease underwent both SPET and 2D-Echo within a 7-day interval.
- SPET assessed myocardial perfusion abnormalities, including redistribution and reverse redistribution.
- 2D-Echo identified coronary aneurysms.
Main Results:
- SPET revealed myocardial perfusion abnormalities in 50% of patients, with 53.3% of these abnormalities showing reverse redistribution, indicating myocardial ischemia or viable but damaged myocardium.
- 2D-Echo detected coronary aneurysms in 53.3% of patients.
- The combined use of SPET and 2D-Echo increased the detection rate of myocardial involvement to 66.6%.
Conclusions:
- Over 50% of Kawasaki disease patients exhibit myocardial involvement detectable by SPET or 2D-Echo.
- Combined SPET and 2D-Echo offer additive benefits for detecting myocardial involvement in Kawasaki disease.
- SPET findings suggest myocardial ischemia and/or damaged but viable myocardium in affected patients.
Abstract:
Kawasaki disease (mucocutaneous lymph node syndrome) is a disease of unknown aetiology that affects infants and children, with most patients having myocardial involvement. To evaluate the incidence and nature of myocardial involvement, 30 patients with Kawasaki disease underwent both dipyridamole 201Tl-chloride myocardial single photon emission tomography (SPET) and two-dimensional echocardiography (2D-Echo), which were performed within 7 days of each other. The SPET image of 15 of 30 (50%) patients showed 27 segments with myocardial perfusion abnormalities: 6 patients had one or more segments showing redistribution; 6 patients had both one or more segments of reverse redistribution and redistribution; 2 patients had reverse redistribution; and one patient had one redistribution and one fixed defect. Eight of 15 (53.3%) SPET abnormalities included reverse redistribution. Of 15 patients with positive SPET, 13 were male (age 0.3-12 years, mean = 3.55) and 2 were female (age 3-4 years, mean = 3.5). The interval between the onset of disease and SPET ranged from 1 to 594 weeks. Of the 15 patients with a negative SPET, 10 were male (age 0.4-6 years, mean = 2.08) and 5 were female (age 0.2-5 years, mean = 1.8). The interval between the onset of the disease and SPET ranged from 2 to 54 weeks. There were no significant differences in age (P = 0.10), sex (P = 0.41) or interval between the onset of disease and SPET in the patients with positive SPET and those with negative SPET (P = 0.60). With 2D-Echo, 16 (11/15 patients with positive SPET and 5/15 patients with negative SPET) of 30 (53.3%) patients had demonstrable coronary aneurysms. There was no statistical difference (P = 0.4) in the ability to detect myocardial abnormalities between SPET and 2D-Echo. Combining SPET and 2D-Echo, detectability of myocardial involvement was 66.6% (20/30). We conclude (1) that more than 50% of the patients' myocardial involvement was expressed by the myocardial perfusion status on SPET or by coronary aneurysm on 2D-Echo. Combined SPET and 2D-Echo may be of additive benefit for the detection of myocardial involvement. All 15 patients with SPET abnormalities had one or more segments of redistribution and/or reverse redistribution, indicating myocardial ischaemia and/or damaged but viable myocardium.