Discordance between thallium-201 scintigraphy and coronary angiography in patients with kawasaki disease: Myocardial ischemia with normal coronary angiogram

Abstract

To assess the usefulness of radionuclide tests in detecting coronary occlusive lesions in children with Kawasaki disease, we compared the results of stress thallium-201 myocardial single photon emission computed tomography with dipyridamole infusion and coronary angiography in 34 patients (19 males and 15 females). Perfusion defects on the stress image only were categorized as transient and were attributed to coronary vascular disease in the presence of redistribution on the delayed image. Others were classified as persistent, due to myocardial damage. Five of the seven children (71%) with severe stenosis on coronary angiography showed persistent and/or transient perfusion defects. However, six of the 11 children (55%) with aneurysms but no obvious stenosis, and four of the 16 children (25%) with normal angiography, showed persistent and/or transient defects. After analyzing 20 individual segments of perfusion defects in the 15 children, six segments (30%) were attributed to the stenosis of supplying coronary arteries, six segments (30%) were related to the coronary aneurysms, and eight segments (40%) were unrelated to any abnormalities on angiography. Thus, significant discordance between the radionuclide and angiographic studies was demonstrated. These results suggest that coronary lesions, as conventionally defined by angiography and supplemented by echocardiography, may not completely identify all Kawasaki patients who may develop myocardial ischemia in the future or who had ischemia in the past.

Long-term outcome of coronary abnormalities in patients after Kawasaki disease

“…After KD the patients should also benefit from other tests, such as the exercise stress test and thallium myocardial scintigraphy [5,12,18]. Exercise testing of young subjects, however, has usually not been possible or practical.…”

“…The introduction of two-dimensional echocardiography for evaluating coronary artery lesions and high-dose intravenous ␥-globulin (IVGG) therapy in combination with oral salicylate have contributed considerably to the improvement of the therapeutic outcomes of KD [3,4,15,16]. Cardiovascular sequelae of KD may, however, lead to ischemic myocardial disease or even fatal myocardial infarction [5,6,8,9]. Thus follow-up plans for those children and young adults with coronary artery lesions after KD remain a considerable task not only for pediatricians but for physicians in general [1].…”

Impaired Cardiac Sympathetic Nerve Function in Patients with Kawasaki Disease: Comparison with Myocardial Perfusion

“…Compared with CAG, perfusion studies could detect perfusion defects even in the absence of coronary abnormalities (1,16,17) and seemed to be useful for making decisions on coronary artery bypass surgery and for predicting the prognosis in KD patients as well (15,18).…”

I Diretriz da Sociedade Brasileira de Cardiologia Sobre Cardiologia Nuclear

“…Padrão perfusional sugestivo de origem anômala da coronária esquerda na artéria pulmonar tem sido descrito quando há dé-ficit de perfusão em territórios da artéria coronária descendente anterior e circunflexa, enquanto se verifica perfusão preservada em território da artéria coronária direita (parede inferior e ínfero-septal) e disfunção de VE. Igualmente, podese empregar a cintilografia miocárdica de perfusão para determinar o grau de repercussão funcional e isquêmica de verdadeiras arterites como a arterite de Takayassu ou Kawasaki 128 . Estratificação de risco e prognóstico -O uso da cardiologia nuclear para estratificação de risco em cardiopatia congênita, incluindo o uso da ventriculografia radioisotó-pica de repouso e esforço, não tem sido demonstrado com suficiente embasamento científico na literatura.…”