title: Coronary computed tomographic angiographic findings in patients with Kawasaki disease.
abstract: Kawasaki disease (KD) is the leading cause of acquired coronary disease in children and may lead to subsequent myocardial ischemia and infarction. Because coronary computed tomographic angiography (CTA) is the most sensitive noninvasive test in patients with atherosclerosis, the aim of this study was to retrospectively evaluate coronary CTA performed in patients with KD for aneurysm, stenosis, and calcified and noncalcified coronary artery disease (CAD). Clinical histories and prior stress and imaging test results were reviewed. Thirty-two patients underwent coronary CTA for KD, and 385 coronary segments were evaluated. Twenty-three of 32 patients had ≥1 diseased coronary segment. There were 20 aneurysms, 7 lesions, and 75 segments (20%) with nonobstructive CAD (16% noncalcified, 2% calcified, and 2% mixed). All nonobstructive and obstructive CAD was in patients with histories of acute-phase coronary artery dilatation or aneurysm (echocardiographic z score 4 to 44), and were almost always associated with normal stress imaging test results on follow-up. No lesion or CAD was found in coronary computed tomographic angiographic studies performed in a control group referred for other indications (n = 32, 422 segments evaluated). The median coronary computed tomographic angiographic dose-length product was 59 mGy cm (interquartile range 32 to 131), the median unadjusted radiation dose was 0.8 mSv (interquartile range 0.4 to 1.8), and the median age- and size-adjusted radiation dose was 1.3 mSv (interquartile range 0.7 to 2.3). In conclusion, high-risk patients with histories of KD had nonobstructive and obstructive CAD not visualized by other noninvasive imaging tests. In properly selected high-risk patients with KD, coronary CTA may identify a subset at increased risk for future coronary pathology who may benefit from medical therapy.
authors.affiliation: The Children's Heart Clinic, Minneapolis, Minnesota; The Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Advanced Cardiac Imaging, The Minneapollis Heart Institute and Foundation, Minneapolis, Minnesota. Electronic address: khan@chc-pa.org.
authors.forename: B Kelly
authors.initials: BK
authors.lastname: Han
authors.affiliation: Advanced Cardiac Imaging, The Minneapollis Heart Institute and Foundation, Minneapolis, Minnesota.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lesser
authors.affiliation: Advanced Cardiac Imaging, The Minneapollis Heart Institute and Foundation, Minneapolis, Minnesota.
authors.forename: Kristi
authors.initials: K
authors.lastname: Rosenthal
authors.affiliation: The Children's Heart Clinic, Minneapolis, Minnesota.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Dummer
authors.affiliation: Siemens Healthcare, Malvern, Pennsylvania.
authors.forename: Katharine
authors.initials: K
authors.lastname: Grant
authors.affiliation: Advanced Cardiac Imaging, The Minneapollis Heart Institute and Foundation, Minneapolis, Minnesota.
authors.forename: Marc
authors.initials: M
authors.lastname: Newell
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000209:etiology