Non-invasive measurement of coronary flow reserve in children with Kawasaki disease.
OBJECTIVE
To investigate whether transthoracic Doppler echocardiography (TTE) can reliably measure the coronary flow reserve in the left anterior descending coronary artery in children with Kawasaki disease.


METHODS
Coronary flow velocity in the distal left anterior descending coronary artery was measured by TTE and was compared with that obtained by intracoronary Doppler guide wire. The ratio of maximum hyperaemia (intravenous administration of adenosine triphosphate, 160 microg/kg/min) to baseline peak (mean) diastolic coronary flow velocity in the distal artery was used as an estimate of coronary flow reserve.


METHODS
University hospital.


METHODS
10 patients with significant left anterior descending coronary stenosis (> 70% diameter stenosis) (group A) in the proximal or middle portion of the artery and 14 patients (group B) without significant stenosis, all with Kawasaki disease documented by previous coronary angiography.


RESULTS
The reduced hyperaemic coronary flow velocity in group A compared with group B resulted in a markedly lower coronary flow reserve, derived from both peak diastolic velocity and mean diastolic velocity by either technique of investigation. Multivariate analysis identified the best predictor of left anterior descending coronary artery stenosis to be a coronary flow reserve of < or = 2.2, derived from mean diastolic flow velocity measured using TTE (sensitivity 90%, specificity 100%, accuracy 96%). A good correlation was found between diastolic velocity derived values for coronary flow reserve measured using both TTE and Doppler guide wire (r = 0.92, p = 0.0001).


CONCLUSIONS
Coronary flow reserve in the distal left anterior descending coronary artery can be accurately measured using TTE without any intravascular instrumentation in children with Kawasaki disease.
Noto
N
N
Department of Paediatrics and Cardiology, Nihon University School of Medicine, Tokyo, Japan. nnoto@med.email.ne.jp
Karasawa
K
K
Kanamaru
H
H
Ayusawa
M
M
Sumitomo
N
N
Okada
T
T
Harada
K
K
D000293:Adolescent; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000502:physiology*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015588:Observer Variation; D012212:Rheology / Q000379:methods