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Coronary endothelial dysfunction after Kawasaki disease: evaluation by intracoronary injection of acetylcholine
R Yamakawa1, M Ishii, T Sugimura
1Department of Pediatrics and the Cardiovascular Research Institute, Kurume University School of Medicine, Japan.
Insights
Long-term coronary artery lesions in Kawasaki disease (KD) patients show impaired endothelial function, even after aneurysm regression. Further follow-up is essential to understand the long-term vascular health in these individuals.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Vascular Biology
Background:
- Coronary artery (CA) vascular function in children with long-term Kawasaki disease (KD) is not well understood.
- This study investigates the vascular response of CAs to acetylcholine (ACh) in KD patients with varying lesion types.
Purpose of the Study:
- To assess endothelial function in long-term coronary artery lesions in patients with Kawasaki disease (KD).
- To compare vascular response in regressed aneurysms, persistent aneurysms, and normal CAs in KD patients versus controls.
Main Methods:
- Coronary angiography was performed on 35 patients (25 KD, 10 controls).
- Arteries were categorized into: regressed aneurysms (Group 1), persistent aneurysms (Group 2), normal CAs in KD patients (Group 3), and normal CAs in controls (Group 4).
- Intracoronary ACh infusion assessed CA lumen diameter changes using cine videodensitometry.
Main Results:
- KD patients with normal CAs (Group 3) and controls (Group 4) showed significant vasodilation (11.7% and 12.2% diameter increase, respectively).
- Patients with regressed (Group 1) and persistent (Group 2) aneurysms exhibited minimal vasodilation or mild vasoconstriction (-2.6% and -0.08% diameter change, respectively).
- The vascular response in Groups 1 and 2 was significantly impaired compared to Groups 3 and 4.
Conclusions:
- Long-term coronary artery lesions in Kawasaki disease patients, even those with regressed aneurysms, demonstrate impaired endothelial function.
- Further long-term follow-up studies are crucial for understanding the persistent vascular implications in these patients.
Objectives:
This study sought to assess the endothelial function of long-term coronary artery lesions in patients with Kawasaki disease (KD).
Background:
The vascular function of the coronary arteries in children with long-term KD remains uncertain. We report our findings of the vascular response of the coronary arteries to intracoronary injection of acetylcholine (ACh) in patients with KD.
Methods:
A total of 35 patients (25 patients with KD and 10 control subjects) were examined using coronary angiography. Individual arteries were divided into four groups according to the type of the coronary artery lesion: group 1 consisted of 25 sites with regressed aneurysms. These aneurysms had developed in the acute stage but had subsequently regressed and demonstrated normal findings on the follow-up coronary angiogram. Group 2 consisted of 24 sites with persistent aneurysms. Group 3 involved 60 angiographically normal sites in the same patients as those in group 1 or 2. Group 4 consisted of 30 sites in control subjects who had congenital heart disease with normal coronary arteries. During coronary angiography we infused 15 microg of ACh chloride into the coronary artery. The lumen diameters were measured using a cine videodensitometric analyzer to study the distensibility of the coronary artery wall.
Results:
The mean (+/-SD) change in diameter was an increase of 11.71+/-12.34% in group 3 (coronary arteries without lesions in patients with KD) and 12.21+/-9.71% in the control group, demonstrating marked vasodilation in both groups. In contrast, the changes in the regressed aneurysms of group 1 and in the persistent aneurysms of group 2 were -2.65+/-12.12% and -0.08+/-6.51%, respectively, demonstrating no change or mild vasoconstriction. The change in groups 1 and 2 was significantly less than that in group 3 or in the control group. Group 3 showed no significant difference from the control group.
Conclusions:
These findings suggest that long-term coronary artery lesions, even after aneurysm regression, may have impaired endothelial function. A long-term follow-up study for those patients is essential.