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CLINICAL STUDY: CARIOVASCULAR ULTRASOUND STUDIES

Transthoracic Doppler assessment of coronary flow velocity reserve in children with Kawasaki disease

Comparison with coronary angiography and thallium-201 imaging

^* Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

Manuscript received March 13, 2002; revised manuscript received June 6, 2002, accepted August 1, 2002.

^* Reprint requests and correspondence: Dr. Satoshi Hiraishi, Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228, Japan.
satoshih{at}med.kitasato-u.ac.jp

OBJECTIVES: The purpose of this study was to determine the feasibility of coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) in children with Kawasaki disease (KD).

BACKGROUND: Doppler-derived CFVR is a reliable marker predicting the presence of myocardial ischemia.

METHODS: We studied 49 patients (median age 11 years) with KD. The CFVR was calculated as the ratio of hyperemic to basal peak (peak CFVR) and mean (mean CFVR) diastolic flow velocities in the posterior descending coronary artery (PD) and left anterior descending coronary artery (LAD). The CFVR measurements by TTDE were compared with the results of coronary angiography, thallium-201 (Tl-201) single-photon emission computed tomography (SPECT), and intracoronary Doppler study.

RESULTS: The CFVR measurements by TTDE were obtained in 92 (94%) of 98 vessels of the PD and LAD in 49 study patients. Both peak and mean CFVRs for 21 stenotic vessels were significantly smaller than those for 35 normal vessels and for 20 vessels with aneurysmal lesions (p < 0.0001). Peak and mean CFVR <2.0 predicted significant coronary stenosis, as determined by coronary angiography, with sensitivities and specificities of 89% and 96% and 89% and 97%, respectively. Also, both peak and mean CFVRs were correlated with reversible perfusion defects on Tl-201 SPECT (agreement 80%; kappa 0.4). The correlation between peak and mean CFVRs determined by the TTDE and intracoronary Doppler studies in 36 vessels of 23 patients were 0.76 and 0.80, respectively.

CONCLUSIONS: The CFVR measured by TTDE predicts the presence of significant coronary stenosis of either the right coronary artery or LAD, as well as myocardial ischemia of these territories in children with KD.

Abbreviations and Acronyms   CABG   coronary artery bypass graft surgery   CFVR   coronary flow velocity reserve   KD   Kawasaki disease   LAD   left anterior descending coronary artery   PD   posterior descending artery   RCA   right coronary artery   SPECT   single-photon emission computed tomography   Tl-201   thallium-201   TTDE   transthoracic Doppler echocardiography

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