Follow-Up Assessment of the Collateral Circulation in Patients with Kawasaki Disease Who Underwent Dipyridamole Stress Technetium-99m Tetrofosmin Scintigraphy

Abstract

To assess the alteration of myocardial ischemic findings and the role of collateral vessels in patients with Kawasaki disease (KD), we used dipyridamole stress technetium-99m tetrofosmin (Tf) single photon emission computed tomography (SPECT). A comparison study of coronary angiography and dipyridamole stress (0.70 mg/kg) Tf-SPECT was repeated at least twice in 20 patients. The subjects included 7 patients with coronary stenosis, 1 with pre- and post-coronary artery bypass grafting (CABG) due to coronary stenosis, 1 with progression to coronary stenosis, and 11 with persistent coronary aneurysms. In the stenosis group, Tf-SPECT revealed that 6 of the 7 patients had some degree of ischemic findings, and 5 of these 6 did not show any change in their ischemic findings during follow-up. In 1 patient, the ischemic findings changed according to the collateral circulation changes. The patient who underwent CABG had pre-CABG ischemic changes that disappeared after CABG. In the patient whose coronary arteries progressed to stenosis, the ischemic findings progressed as the coronary stenosis progressed. In the persistent aneurysm group, there were no ischemic findings. In the future Tf-SPECT may become one of the most useful methods for monitoring the progressive changes of myocardial ischemia in KD.

Do Kawasaki disease patients without coronary artery abnormalities need a long‐term follow‐up? A myocardial single‐photon emission computed tomography pilot study

“…By applying the 20‐segment perfusion score, 9 significant myocardial SPECT abnormalities (score ≥4) were found in five patients: two patients in group 1, and three patients in group 2 (Fig. 1, Table 1).…”

Changes in Coronary Perfusion after Occlusion of Coronary Arteries in Kawasaki Disease

“…However, severely stenotic or occlusive coronary arteries as a sequelae of KD develop collaterals in the chronic phase of KD, most of which develop sufficiently to prevent myocardial infarction 7. Therein, recanalization or collateral formation improves the perfusion to the distal myocardium of the occluded native coronary artery 8,12. Contrary to this, Tatara, et al13 reported that the development of collateral vessels cannot protect against myocardial ischemia and the degree of collaterals have no effect on myocardial imaging.…”

“…A regular myocardial stress test and CAG should be done in patients with coronary arterial complications associated with KD. Fukuda, et al12 proposed that unnecessary CAG could be postponed until the time at which ischemic findings change in the dipyridamole stress SPECT. With myocardial ischemia, there are no evidence-based guidelines for follow-up and evaluation of patients with coronary abnormalities after KD.…”

“…Nevertheless, there could be personal bias when the grade was analyzed. Coronary arterial remodeling in KD has not yet been clearly described,16 and to the best of our knowledge, very few reports on the assessment of the changes in collaterals that develop after occlusion of coronary arteries in KD have been published 12. The development of collateral vessels associated with total occlusion of coronary artery in infants and young children may contribute to a better prognosis,8 Some investigators have reported that myocardial viability is highly associated with the distribution of collateral blood flow within the occluded infarct bed 17.…”

Demonstration of Extensive Ischemia in a Patient With Kawasaki Disease

“…3 Myocardial scintigraphy has shown improved sensitivity for the detection of myocardial ischemia and tissue damage and has become the noninvasive method of choice for the assessment of ischemia and prognosis in these patients. 3,4 However, obstructive coronary lesions secondary to giant aneurysms in Kawasaki disease are often proximal, and the presence of diffuse and balanced ischemia may lead to a false-negative scintigraphy. In our patient, dipyridamole first-pass perfusion CMR showed diffuse myocardial ische- …”