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Impaired endothelial function in epicardial coronary arteries after Kawasaki disease
1Department of Pediatrics, Mie University School of Medicine, Tsu, Japan.
Insights
Kawasaki disease (KD) patients show persistent endothelial dysfunction in epicardial coronary arteries, raising concerns for early arteriosclerosis. Long-term surveillance of KD patients is recommended to monitor for cardiovascular complications.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Biology
Background:
- Kawasaki disease (KD) can lead to intimal lesions in coronary arteries (CAs), suggesting premature arteriosclerosis.
- Long-term effects of KD on endothelial function require investigation.
Purpose of the Study:
- To investigate endothelial function in epicardial and resistance CAs after Kawasaki disease.
- To assess CA responses to vasodilators in KD patients with and without aneurysms.
Main Methods:
- Quantitative angiography and Doppler flow wire system used to assess CA responses.
- Serial intracoronary infusions of acetylcholine and nitroglycerin administered.
- Three groups studied: controls, KD patients with normal CAs, and KD patients with CA aneurysms.
Main Results:
- Acetylcholine caused significant vasoconstriction in KD patients compared to controls, indicating endothelial dysfunction.
- Nitroglycerin induced vasodilation in all groups, but less pronounced in KD patients with aneurysms.
- Persistent endothelial dysfunction observed in epicardial CAs, but not resistance CAs, post-KD.
Conclusions:
- Kawasaki disease leads to persistent endothelial dysfunction in epicardial CAs.
- Enhanced arterial stiffness noted in persistent or regressed aneurysms.
- Ongoing surveillance of KD patients is crucial for early detection of arteriosclerosis.
Background:
Intimal lesions observed in the coronary arteries (CAs) of patients who have suffered episodes of Kawasaki disease (KD) raise concern about the premature development of arteriosclerosis. Accordingly, we investigated endothelial function in the epicardial and resistance CAs after KD during long-term observation.
Methods And Results:
We assessed the responses of left epicardial and resistance CAs to serial intracoronary infusions of acetylcholine (final concentrations, 0.1 and 1 micromol/L) and nitroglycerin in subjects by using quantitative angiography and a Doppler flow wire system. Three age-matched groups were evaluated: 8 control subjects (group 1), 10 KD patients with normal left CA from the onset (group 2), and 8 KD patients with a persistent or regressed aneurysm in the left anterior descending CA (LAD) (group 3). Acetylcholine (1 micromol/L) changed the LAD area to 114.0+/-2.6%, 72.7+/-3.9% (P<.05 versus group 1), and 88.9+/-4.3% (P<.05 versus groups 1 and 2) of baseline in groups 1, 2, and 3, respectively, with a similar degree of increased coronary blood flow in each group. Nitroglycerin increased the LAD area to 143.5+/-7.7%, 132.3+/-1.9%, and 120.8+/-5.6% (P<.05 versus group 1), respectively.
Conclusions:
Results demonstrate a persistent endothelial dysfunction in the epicardial but not resistance CAs in patients after KD and enhanced stiffness of persistent or regressed aneurysms. The concern over early arteriosclerosis warrants the surveillance of KD patients from childhood to adulthood.