Coronary Endothelial Dysfunction After Kawasaki Disease: Evaluation by Intracoronary Injection of Acetylcholine
- 1 April 1998
- journal article
- Published by Elsevier BV in Journal of the American College of Cardiology
- Vol. 31 (5), 1074-1080
- https://doi.org/10.1016/s0735-1097(98)00033-3
Abstract
Objectives. This study sought to assess the endothelial function of long-term coronary artery lesions in patients with Kawasaki disease (KD). Background. The vascular function of the coronary arteries in children with long-term KD remains uncertain. We report our findings of the vascular response of the coronary arteries to intracoronary injection of acetylcholine (ACh) in patients with KD. Methods. A total of 35 patients (25 patients with KD and 10 control subjects) were examined using coronary angiography. Individual arteries were divided into four groups according to the type of the coronary artery lesion: group 1 consisted of 25 sites with regressed aneurysms. These aneurysms had developed in the acute stage but had subsequently regressed and demonstrated normal findings on the follow-up coronary angiogram. Group 2 consisted of 24 sites with persistent aneurysms. Group 3 involved 60 angiographically normal sites in the same patients as those in group 1 or 2. Group 4 consisted of 30 sites in control subjects who had congenital heart disease with normal coronary arteries. During coronary angiography we infused 15 μg of ACh chloride into the coronary artery. The lumen diameters were measured using a cine videodensitometric analyzer to study the distensibility of the coronary artery wall. Results. The mean (±SD) change in diameter was an increase of 11.71 ± 12.34% in group 3 (coronary arteries without lesions in patients with KD) and 12.21 ± 9.71% in the control group, demonstrating marked vasodilation in both groups. In contrast, the changes in the regressed aneurysms of group 1 and in the persistent aneurysms of group 2 were −2.65 ± 12.12% and −0.08 ± 6.51%, respectively, demonstrating no change or mild vasoconstriction. The change in groups 1 and 2 was significantly less than that in group 3 or in the control group. Group 3 showed no significant difference from the control group. Conclusions. These findings suggest that long-term coronary artery lesions, even after aneurysm regression, may have impaired endothelial function. A long-term follow-up study for those patients is essential.Keywords
This publication has 14 references indexed in Scilit:
- Long-term Consequences of Kawasaki DiseaseCirculation, 1996
- Evidence of Impaired Endothelium-Dependent Coronary Vasodilatation in Patients with Angina Pectoris and Normal Coronary AngiogramsNew England Journal of Medicine, 1993
- Vasodilatory response of the coronary arteries after Kawasaki disease: Evaluation by intracoronary injection of isosorbide dinitrateThe Journal of Pediatrics, 1992
- Response of angiographically normal and atherosclerotic left anterior descending coronary arteries to acetylcholineThe American Journal of Cardiology, 1990
- Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factorNature, 1987
- Paradoxical Vasoconstriction Induced by Acetylcholine in Atherosclerotic Coronary ArteriesNew England Journal of Medicine, 1986
- HIGH-DOSE INTRAVENOUS GAMMAGLOBULIN FOR KAWASAKI DISEASEThe Lancet, 1984
- Fate of coronary aneurysms in Kawasaki disease: Serial coronary angiography and long-term follow-up studyThe American Journal of Cardiology, 1982
- Regression of aneurysms in Kawasaki disease: A pathological studyThe Journal of Pediatrics, 1982
- Coronary aneurysms in infants and young children with acute febrile mucocutaneous lymph node syndromeThe Journal of Pediatrics, 1975