Quantification of myocardial blood flow and flow reserve in children with a history of Kawasaki disease and normal coronary arteries using positron emission tomography

Department of Radiology, Children's Hospital of Michigan, Detroit 48201-2196, USA.

OBJECTIVES: The purpose of this investigation was to determine whether myocardial blood flow and flow reserve, based on quantitative measurements derived from positron emission tomographic (PET) imaging, would be globally impaired in children with a previous history of Kawasaki disease and normal epicardial coronary arteries. BACKGROUND: Kawasaki disease is an acute inflammatory process of the arterial walls that results in panvasculitis in early childhood. Children with a history of Kawasaki disease and normal epicardial coronary arteries were previously considered to have normal coronary flow reserve. However, recent studies have reported exercise-induced regional perfusion abnormalities on single-photon positron emission tomographic (SPECT) imaging. METHODS: We assessed myocardial blood flow and flow reserve at rest and during adenosine stress with nitrogen-13 ammonia and PET in 10 children with a history of Kawasaki disease and in 10 healthy young adult volunteers. All children had acute Kawasaki disease 4 to 15 years before the PET study. None of the children had epicardial coronary artery abnormalities at the acute stage of the disease or during follow-up, as assessed by echocardiography. RESULTS: Rest blood flows normalized to the rate-pressure product, an index of cardiac work, were similar in both the patients with Kawasaki disease and healthy adult volunteers (82 +/- 14 vs. 77 +/- 16 ml/100 g per min [mean +/- SD], p = NS). However, hyperemic blood flows were significantly lower in the patients with Kawasaki disease than in the control subjects (263 +/- 64 vs. 340 +/- 57 ml/100 g per min, p = 0.01). As a result, estimates of myocardial flow reserve were lower in the patients with Kawasaki disease than in the healthy young adult volunteers (3.2 +/- 0.7 vs. 4.6 +/- 0.9, p = 0.003). In addition, total coronary resistance was higher in the patients with Kawasaki disease than in the healthy adult volunteers (33 +/- 11 vs. 24 +/- 5 mm Hg/ml per g per min, p = 0.04). Quantitative analysis of perfusion images demonstrated no evidence of regional perfusion abnormalities. CONCLUSIONS: Children with a previous history of Kawasaki disease and normal epicardial coronary arteries exhibit normal rest myocardial blood flows but reduced hyperemic flows and flow reserve. The abnormal hyperemic blood flows and flow reserve suggest an impaired vasodilatory capacity, possibly due to residual damage of the coronary microcirculation.

This article has been cited by other articles:

				M. C. Huisman, T. Higuchi, S. Reder, S. G. Nekolla, T. Poethko, H.-J. Wester, S. I. Ziegler, D. S. Casebier, S. P. Robinson, and M. Schwaiger Initial Characterization of an 18F-Labeled Myocardial Perfusion Tracer J. Nucl. Med., April 1, 2008; 49(4): 630 - 636. [Abstract] [Full Text] [PDF]

				B. W. McCrindle, J. S. Li, L. L. Minich, S. D. Colan, A. M. Atz, M. Takahashi, V. L. Vetter, W. M. Gersony, P. D. Mitchell, J. W. Newburger, et al. Coronary Artery Involvement in Children With Kawasaki Disease: Risk Factors From Analysis of Serial Normalized Measurements Circulation, July 10, 2007; 116(2): 174 - 179. [Abstract] [Full Text] [PDF]

				R.-E. W. Kavey, V. Allada, S. R. Daniels, L. L. Hayman, B. W. McCrindle, J. W. Newburger, R. S. Parekh, and J. Steinberger Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics Circulation, December 12, 2006; 114(24): 2710 - 2738. [Abstract] [Full Text] [PDF]

				S Fratz, M Hauser, F M Bengel, A Hager, H Kaemmerer, M Schwaiger, J Hess, and H C Stern Myocardial scars determined by delayed-enhancement magnetic resonance imaging and positron emission tomography are not common in right ventricles with systemic function in long-term follow up Heart, November 1, 2006; 92(11): 1673 - 1677. [Abstract] [Full Text] [PDF]

				M. Schwaiger, S. Ziegler, and S. G. Nekolla PET/CT: Challenge for Nuclear Cardiology J. Nucl. Med., October 1, 2005; 46(10): 1664 - 1678. [Abstract] [Full Text] [PDF]

				J. W. Newburger, M. Takahashi, M. A. Gerber, M. H. Gewitz, L. Y. Tani, J. C. Burns, S. T. Shulman, A. F. Bolger, P. Ferrieri, R. S. Baltimore, et al. 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, December 1, 2004; 114(6): 1708 - 1733. [Abstract] [Full Text] [PDF]

				J. W. Newburger, M. Takahashi, M. A. Gerber, M. H. Gewitz, L. Y. Tani, J. C. Burns, S. T. Shulman, A. F. Bolger, P. Ferrieri, R. S. Baltimore, et al. 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 Circulation, October 26, 2004; 110(17): 2747 - 2771. [Abstract] [Full Text] [PDF]

				H. Furuyama, Y. Odagawa, C. Katoh, Y. Iwado, K. Yoshinaga, Y. Ito, K. Noriyasu, M. Mabuchi, Y. Kuge, K. Kobayashi, et al. Assessment of Coronary Function in Children With a History of Kawasaki Disease Using 15O-Water Positron Emission Tomography Circulation, June 18, 2002; 105(24): 2878 - 2884. [Abstract] [Full Text] [PDF]

				M. Hauser, F. M. Bengel, A. Kuhn, U. Sauer, S. Zylla, S. L. Braun, S. G. Nekolla, R. Oberhoffer, R. Lange, M. Schwaiger, et al. Myocardial Blood Flow and Flow Reserve After Coronary Reimplantation in Patients After Arterial Switch and Ross Operation Circulation, April 10, 2001; 103(14): 1875 - 1880. [Abstract] [Full Text] [PDF]

				J. C. Burns, H. I. Kushner, J. F. Bastian, H. Shike, C. Shimizu, T. Matsubara, and C. L. Turner Kawasaki Disease: A Brief History Pediatrics, August 1, 2000; 106(2): 27e - 27. [Abstract] [Full Text]

				J. S. Scott, J. A. Ettedgui, and W. H. Neches Cost-Effective Use of Echocardiography in Children With Kawasaki Disease Pediatrics, November 1, 1999; 104(5): 57e - 57. [Abstract] [Full Text]

				J. W Newburger and J. C Burns Kawasaki disease Vascular Medicine, August 1, 1999; 4(3): 187 - 202. [Abstract] [PDF]

				G. Junga, S. Kneifel, A.V. Smekal, H. Steinert, and U. Bauersfeld Myocardial ischaemia in children with isolated ventricular non-compaction Eur. Heart J., June 2, 1999; 20(12): 910 - 916. [Abstract] [PDF]

				C. S. Duvernoy, C. Meyer, V. Seifert-Klauss, F. Dayanikli, I. Matsunari, J. Rattenhuber, C. Hoss, H. Graeff, and M. Schwaiger Gender differences in myocardial blood flow dynamics: Lipid profile and hemodynamic effects J. Am. Coll. Cardiol., February 1, 1999; 33(2): 463 - 470. [Abstract] [Full Text] [PDF]

				F. M. Bengel, M. Hauser, C. S. Duvernoy, A. Kuehn, S. I. Ziegler, J. C. Stollfuss, M. Beckmann, U. Sauer, O. Muzik, M. Schwaiger, et al. Myocardial blood flow and coronary flow reserve late after anatomical correction of transposition of the great arteries J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1955 - 1961. [Abstract] [Full Text] [PDF]

				T. Momenah, S. Sanatani, J. Potts, G. G. S. Sandor, D. G. Human, and M. W. H. Patterson Kawasaki Disease in the Older Child Pediatrics, July 1, 1998; 102(1): 7e - 7. [Abstract] [Full Text]

				A. P. Burke, R. Virmani, L. W. Perry, L. Li, T. M. King, and J. Smialek Fatal Kawasaki Disease With Coronary Arteritis and No Coronary Aneurysms Pediatrics, January 1, 1998; 101(1): 108 - 108. [Full Text] [PDF]