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CLINICAL RESEARCH

Estimation of myocardial hemodynamics before and after intervention in children with kawasaki disease

^* Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan

Manuscript received May 23, 2003; revised manuscript received September 12, 2003, accepted October 11, 2003.

^* Reprint requests and correspondence: Dr. Shunichi Ogawa, Department of Pediatrics, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 Japan.
boston{at}nms.ac.jp

OBJECTIVES: We used myocardial fractional flow reserve (FFR_myo) and coronary flow reserve (CFR) to estimate cut-off values for assessment of the functional severity of coronary stenosis and myocardial ischemia, and we tested the usefulness of coronary blood hemodynamic measurements before and after plain old balloon angioplasty (POBA) and coronary artery bypass graft surgery (CABG).

BACKGROUND: Fractional flow reserve and CFR are useful for assessing the functional severity of coronary artery stenosis, coronary microvascular dysfunction, and myocardial ischemia during cardiac catheterization in adults. However, there have been no reports on the use of these measurements in children with Kawasaki disease (KD).

METHODS: The study group included 128 patients with 314 coronary branches. The subjects were classified into three groups: normal coronary group, with 206 branches; abnormal coronary artery without ischemia group, with 58 branches; and ischemia group, with 50 branches.

RESULTS: In each branch, CFR and FFR_myo were significantly lower in the ischemia group than in the other groups. Cut-off values for assessing the functional severity of coronary stenosis and CFR were approximately equal to those obtained for adults (CFR: <2.0; FFR_myo: <0.75). We obtained very high sensitivity and specificity for estimating myocardial ischemia using CFR and FFR_myo (CFR: 94.0% and 98.5%, respectively; FFR_myo: 95.7% and 99.1%, respectively). Both CFR and FFR_myo were reliable indicators of coronary hemodynamics before and after POBA and CABG.

CONCLUSIONS: Together, CFR and FFR_myo provide a useful index for assessing the functional severity of coronary artery stenosis and myocardial ischemia and estimating the effectiveness of POBA and CABG in children with KD, the same as they do for adults.

Abbreviations and Acronyms   APV = averaged peak velocity   CABG = coronary artery bypass graft   CAG = coronary angiography   CFR = coronary flow reserve   D = abnormal coronary artery without ischemia group   FFRmyo = myocardial fractional flow reserve   IS = ischemia group   IVUS = intravascular ultrasonography   KD = Kawasaki disease   LAD = left anterior descending artery   LCx = left circumflex artery   N = normal coronary group   POBA = plain old balloon angioplasty   RCA = right coronary artery