Assessment of cardiac ischemia during acute and long-term follow-up and rheologic assessment of coronary artery lesions after Kawasaki disease

Abstract

Cardiac ischemia is important for the prognosis of Kawasaki disease (KD) in patients with coronary artery lesions. Assessment of cardiac ischemia requires exercise stress testing, which young children may not be able to tolerate. Therefore, pharmacologic stress tests using adenosine, dipyridamole, or dobutamine have primarily been used for young children. Stress myocardial single-photon emission computed tomography is another important method for diagnosing coronary stenotic lesions due to KD. Treadmill and ergometer stress electrocardiography, pharmacologic stress body surface potential mapping, signal-averaged electrocardiography, and echocardiography are also useful for detecting cardiac ischemia. Rheologic indices such as coronary flow reserve (CFR) and myocardial fractional flow reserve (FFRmyo) can also be helpful in detecting cardiac ischemia. Shear stress and CFR significantly decrease in areas with giant aneurysms and in patients with vessels distal to a giant aneurysm. FFRmyo, CFR, and shear stress also decrease in areas distal to a significant stenotic lesion. These findings suggest that vascular endothelial dysfunction, cardiac ischemia, and coronary microcirculation disorder due to decreased perfusion may also be present.