In vivo plaque composition and morphology in coronary artery lesions in adolescents and young adults long after Kawasaki disease: a virtual histology-intravascular ultrasound study.
BACKGROUND
Coronary artery lesions (CALs) late after Kawasaki disease were characterized by endothelial dysfunction and low-grade inflammation, surrogate markers for atherosclerosis. We tested the hypothesis that CALs in patients long after Kawasaki disease are accompanied by atheroma-like features, as assessed by virtual histology-intravascular ultrasound, a new method to assess coronary plaque composition and morphology in vivo.


RESULTS
Virtual histology-intravascular ultrasound was performed in 13 Japanese Kawasaki disease patients (median age, 18.3 years; interquartile range, 16.9 to 23.3 years) an interval after Kawasaki disease (median, 15.9 years; interquartile range, 14.3 to 21.9 years). We investigated 6 sites with localized stenosis, 15 sites with an aneurysm, 29 sites with a regressed aneurysm, and 50 sites with a normal coronary segment. Plaque components were categorized into 4 parts: fibrous, fibrofatty, necrotic core, and dense calcium areas. Qualitatively, the normal segment had no or trivial intravascular ultrasound-visible plaque area, whereas the CAL exhibited a heterogeneous plaque area with the 4 components in different amounts and proportions. Quantitatively, a combined group of CALs had a higher absolute value of fibrous, dense calcium, and necrotic core areas than the normal segment. In further analyses of 3 subtypes of CALs, localized stenosis, an advanced lesion, exhibited higher absolute and relative values of dense calcium and necrotic core areas and a lower relative value of the fibrous area than regressed and persistent aneurysms.


CONCLUSIONS
The present limited but initial virtual histology-intravascular ultrasound findings give new insight into the potential role of atherogenesis in the evolution of CALs in adolescents and young adults long after Kawasaki disease and therefore warrant further investigation.
Mitani
Yoshihide
Y
Department of Pediatrics, Mie University Graduate School of Medicine, Tsu City, Japan. ymitani@clin.medic.mie-u.ac.jp
Ohashi
Hiroyuki
H
Sawada
Hirofumi
H
Ikeyama
Yukiko
Y
Hayakawa
Hidetoshi
H
Takabayashi
Shin
S
Maruyama
Kazuo
K
Shimpo
Hideto
H
Komada
Yoshihiro
Y
D000293:Adolescent; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D009336:Necrosis; D013997:Time Factors; D018084:Ultrasonography, Interventional; D014657:Vasculitis / Q000209:etiology; D055815:Young Adult
D008055:Lipids