Segmental myocardial contractility versus perfusion in Kawasaki disease with coronary arterial aneurysm

The impact of Kawasaki-related coronary injury on the myocardium was evalua ted in 13 patients with persistent coronary aneurysm after a follow-vp peri od of 7.92 +/- 3.97 years (range 1.8 to 14.3). Myocardial segmental perfusi on and contractility integrity were assessed by resting and exercise echoca rdiography and technetium-99 (Tc-99m) sestamibi scan. Eight patients (61.5% ) had giant aneurysms (greater than or equal to 8 mm) and 9 had multivessel involvement; the mean diameter of the largest aneurysm was 8.6 +/- 2.5 mm (range 5 to 14). During the acute phase, myocardial infarction occurred in 1 patient and coronary thrombosis in another. At the latest echocardiograph ic evaluation, the mean aneurysm diameter was 6.8 +/- 2.4 mm (range 4.5 to 12), there was persistent giant aneurysms in 5 of 8 patients, and 3 of 9 pa tients had multivessel involvment. Coronary angiography demonstrated stenos is in 7 of 10 patients, with multiple levels in 2. At sestamibi scan, all 1 3 patients held perfusion anomalies at rest, whereas only 7 had detectable hypokinesia on echocardiography. With exercise, perfusion returned to near normal in 3 patients, improved in 3, remained unchanged in 4, and worsened in 3 patients. Segmental contractility similarly deteriorated in the latter 3 patients but also in 2 patients whose perfusion scan had improved with e xercise. Three patients, normal at rest, developed segmental hypokinesia du ring exercise. When present, the location of observed changes in contractil ity on stress echocardiography corresponded to that of perfusion defect. In conclusion, abnormal myocardial perfusion is present long term after compl icated Kawasaki disease, the worst anomalies accompanying persistent giant aneurysms. Unfavorable perfusion response was coupled with abnormal contrac tility; however, enhanced perfusion with exercise correlated poorly with se gmental contractility response. (C)1999 by Excerpta Medica, Inc.