Impaired Endothelial Function in Epicardial Coronary Arteries After Kawasaki Disease

Mitani, Yoshihide MD
Okuda, Yasuyuki MD, PhD
Shimpo, Hideto MD, PhD
Uchida, Fumiya
Hamanaka, Keiko
Aoki, Kenzo MD, PhD
Sakurai, Minoru MD, PhD

Received August 27, 1996; revision received February 5, 1997; accepted February 11, 1997.
From the Departments of Pediatrics (Y.M., M.S.), Radiology (Y.O.), and Thoracic and Cardiovascular Surgery (H.S.), Mie University School of Medicine, Tsu, Mie, and the Department of Pediatrics (K.A.) and the Clinical Laboratory (F.U., K.H.), Matsusaka City Hospital, Matsusaka, Mie, Japan.
Correspondence to Yoshihide Mitani, MD, Department of Pediatrics, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie Pref, Japan 514.

Circulation 96(2):p 454-461, July 15, 1997.

Background

Intimal lesions observed in the coronary arteries (CAs) of patients who have suffered episodes of Kawasaki disease (KD) raise concern about the premature development of arteriosclerosis. Accordingly, we investigated endothelial function in the epicardial and resistance CAs after KD during long-term observation.

Methods and Results

We assessed the responses of left epicardial and resistance CAs to serial intracoronary infusions of acetylcholine (final concentrations, 0.1 and 1 micro mol/L) and nitroglycerin in subjects by using quantitative angiography and a Doppler flow wire system. Three age-matched groups were evaluated: 8 control subjects (group 1), 10 KD patients with normal left CA from the onset (group 2), and 8 KD patients with a persistent or regressed aneurysm in the left anterior descending CA (LAD) (group 3). Acetylcholine (1 micro mol/L) changed the LAD area to 114.0 +/- 2.6%, 72.7 +/- 3.9% (P < .05 versus group 1), and 88.9 +/- 4.3% (P < .05 versus groups 1 and 2) of baseline in groups 1, 2, and 3, respectively, with a similar degree of increased coronary blood flow in each group. Nitroglycerin increased the LAD area to 143.5 +/- 7.7%, 132.3 +/- 1.9%, and 120.8 +/- 5.6% (P < .05 versus group 1), respectively.

Conclusions

Results demonstrate a persistent endothelial dysfunction in the epicardial but not resistance CAs in patients after KD and enhanced stiffness of persistent or regressed aneurysms. The concern over early arteriosclerosis warrants the surveillance of KD patients from childhood to adulthood. (Circulation. 1997;96:454-461.)