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Coronary Computed Tomographic Angiographic Findings in Patients With Kawasaki Disease

Published:September 14, 2014DOI:https://doi.org/10.1016/j.amjcard.2014.09.004
      Kawasaki disease (KD) is the leading cause of acquired coronary disease in children and may lead to subsequent myocardial ischemia and infarction. Because coronary computed tomographic angiography (CTA) is the most sensitive noninvasive test in patients with atherosclerosis, the aim of this study was to retrospectively evaluate coronary CTA performed in patients with KD for aneurysm, stenosis, and calcified and noncalcified coronary artery disease (CAD). Clinical histories and prior stress and imaging test results were reviewed. Thirty-two patients underwent coronary CTA for KD, and 385 coronary segments were evaluated. Twenty-three of 32 patients had ≥1 diseased coronary segment. There were 20 aneurysms, 7 lesions, and 75 segments (20%) with nonobstructive CAD (16% noncalcified, 2% calcified, and 2% mixed). All nonobstructive and obstructive CAD was in patients with histories of acute-phase coronary artery dilatation or aneurysm (echocardiographic z score 4 to 44), and were almost always associated with normal stress imaging test results on follow-up. No lesion or CAD was found in coronary computed tomographic angiographic studies performed in a control group referred for other indications (n = 32, 422 segments evaluated). The median coronary computed tomographic angiographic dose-length product was 59 mGy cm (interquartile range 32 to 131), the median unadjusted radiation dose was 0.8 mSv (interquartile range 0.4 to 1.8), and the median age- and size-adjusted radiation dose was 1.3 mSv (interquartile range 0.7 to 2.3). In conclusion, high-risk patients with histories of KD had nonobstructive and obstructive CAD not visualized by other noninvasive imaging tests. In properly selected high-risk patients with KD, coronary CTA may identify a subset at increased risk for future coronary pathology who may benefit from medical therapy.
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      References

        • Taubert K.A.
        • Rowley A.H.
        • Shulman S.T.
        Nationwide survey of Kawasaki disease and acute rheumatic fever.
        J Pediatr. 1991; 119: 279-282
        • Suda K.
        • Iemura M.
        • Nishiono H.
        • Teramachi Y.
        • Koteda Y.
        • Kishimoto S.
        • Kudo Y.
        • Itoh S.
        • Ishii H.
        • Ueno T.
        • Tashiro T.
        • Nobuyoshi M.
        • Kato H.
        • Matsuishi T.
        Long-term prognosis of patients with Kawasaki disease complicated by giant coronary aneurysms: a single-institution experience.
        Circulation. 2011; 123: 1836-1842
        • Newburger J.W.
        • Takahashi M.
        • Gerber M.A.
        • Gewitz M.H.
        • Tani L.Y.
        • Burns J.C.
        • Shulman S.T.
        • Bolger A.F.
        • Ferrieri P.
        • Baltimore R.S.
        • Wilson W.R.
        • Baddour L.M.
        • Levison M.E.
        • Pallasch T.J.
        • Falace D.A.
        • Taubert K.A.
        Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.
        Pediatrics. 2004; 114: 1708-1733
        • Min J.K.
        • Dunning A.
        • Lin F.Y.
        • Achenbach S.
        • Al-Mallah M.
        • Budoff M.J.
        • Cademartiri F.
        • Callister T.Q.
        • Chang H.J.
        • Cheng V.
        • Chinnaiyan K.
        • Chow B.J.
        • Delago A.
        • Hadamitzky M.
        • Hausleiter J.
        • Kaufmann P.
        • Maffei E.
        • Raff G.
        • Shaw L.J.
        • Villines T.
        • Berman D.S.
        Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease.
        J Am Coll Cardiol. 2011; 58: 849-860
        • Detrano R.
        • Guerci A.D.
        • Carr J.J.
        • Bild D.E.
        • Burke G.
        • Folsom A.R.
        • Liu K.
        • Shea S.
        • Szklo M.
        • Bluemke D.A.
        • O’Leary D.H.
        • Tracy R.
        • Watson K.
        • Wong N.D.
        • Kronmal R.A.
        Coronary calcium as a predictor of coronary events in four racial or ethnic groups.
        N Engl J Med. 2008; 358: 1336-1345
        • Dajani A.S.
        • Taubert K.A.
        • Takahashi M.
        • Bierman F.Z.
        • Freed M.D.
        • Ferrieri P.
        • Gerber M.
        • Shulman S.T.
        • Karchmer A.W.
        • Wilson W.
        Guidelines for long-term management of patients with kawasaki disease. Report from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.
        Circulation. 1994; 89: 916-922
        • Han B.K.
        • Lindberg J.
        • Overman D.
        • Schwartz R.S.
        • Grant K.
        • Lesser J.R.
        Safety and accuracy of dual-source coronary computed tomography angiography in the pediatric population.
        J Cardiovasc Comput Tomogr. 2012; 6: 252-259
        • Raff G.L.
        • Abidov A.
        • Achenbach S.
        • Berman D.S.
        • Boxt L.M.
        • Budoff M.J.
        • Cheng V.
        • DeFrance T.
        • Hellinger J.C.
        • Karlsberg R.P.
        SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography.
        J Cardiovasc Comput Tomogr. 2009; 3: 122-136
        • Rinehart S.
        • Vazquez G.
        • Qian Z.
        • Murrieta L.
        • Christian K.
        • Voros S.
        Quantitative measurements of coronary arterial stenosis, plaque geometry, and composition are highly reproducible with a standardized coronary arterial computed tomographic approach in high-quality CT datasets.
        J Cardiovasc Comput Tomogr. 2011; 5: 35-43
        • Naoe S.
        • Takahashi K.
        • Masuda H.
        • Tanaka N.
        Coronary findings post Kawasaki disease in children who died of other causes.
        Prog Clin Biol Res. 1987; 250: 341-346
        • Dadlani G.H.
        • Gingell R.L.
        • Orie J.D.
        • Roland J.M.
        • Najdzionek J.
        • Lipsitz S.R.
        • Pieroni D.R.
        • Lipshultz S.E.
        Coronary artery calcifications in the long-term follow-up of Kawasaki disease.
        Am Heart J. 2005; 150: 1016
        • Kahn A.M.
        • Budoff M.J.
        • Daniels L.B.
        • Jimenez-Fernandez S.
        • Cox A.S.
        • Gordon J.B.
        • Burns J.C.
        Calcium scoring in patients with a history of Kawasaki disease.
        JACC Cardiovasc Imaging. 2012; 5: 264-272
        • Suzuki A.
        • Miyagawa-Tomita S.
        • Nakazawa M.
        • Yutani C.
        Remodeling of coronary artery lesions due to Kawasaki disease: comparison of arteriographic and immunohistochemical findings.
        Jpn Heart J. 2000; 41: 245-256
        • Suzuki A.
        • Miyagawa-Tomita S.
        • Komatsu K.
        • Nishikawa T.
        • Sakomura Y.
        • Horie T.
        • Nakazawa M.
        Active remodeling of the coronary arterial lesions in the late phase of Kawasaki disease: immunohistochemical study.
        Circulation. 2000; 101: 2935-2941
        • Wenke K.
        • Meiser B.
        • Thiery J.
        • Nagel D.
        • von Scheidt W.
        • Krobot K.
        • Steinbeck G.
        • Seidel D.
        • Reichart B.
        Simvastatin initiated early after heart transplantation: 8-year prospective experience.
        Circulation. 2003; 107: 93-97
        • Schmauss D.
        • Weis M.
        Cardiac allograft vasculopathy: recent developments.
        Circulation. 2008; 117: 2131-2141
        • Shiraishi I.
        • Onouchi Z.
        • Hayano T.
        • Hamaoka K.
        • Kiyosawa N.
        Asymptomatic myocardial infarction in Kawasaki disease: long-term prognosis.
        Pediatr Cardiol. 1991; 12: 78-82
        • Fu Y.C.
        • Shiau Y.C.
        • Tsai S.C.
        • Kao A.
        • Hwang B.
        • Chi C.S.
        Discordance between dipyridamole stress technetium-99m tetrofosmin single photon emission computed tomography and coronary angiography in patients with Kawasaki disease.
        Int J Cardiovasc Imaging. 2002; 18: 357-362
        • Lee P.C.
        • Shiau Y.C.
        • Fu Y.C.
        • Kao A.
        • Lin C.C.
        • Lee C.C.
        Discordance between dipyridamole technetium-99m-sestamibi myocardial perfusion single photon emission computed tomography and two-dimensional echocardiography in Kawasaki disease—a preliminary report.
        Int J Cardiovasc Imaging. 2002; 18: 343-348
        • Hadamitzky M.
        • Taubert S.
        • Deseive S.
        • Byrne R.A.
        • Martinoff S.
        • Schomig A.
        • Hausleiter J.
        Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease.
        Eur Heart J. 2013; 34: 3277-3285
        • Motoyama S.
        • Sarai M.
        • Harigaya H.
        • Anno H.
        • Inoue K.
        • Hara T.
        • Naruse H.
        • Ishii J.
        • Hishida H.
        • Wong N.D.
        • Virmani R.
        • Kondo T.
        • Ozaki Y.
        • Narula J.
        Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome.
        J Am Coll Cardiol. 2009; 54: 49-57