CORONARY ENDOTHELIAL DYSFUNCTION AFTER KAWASAKI-DISEASE - EVALUATION BY INTRACORONARY INJECTION OF ACETYLCHOLINE

Objectives. This study sought to assess the endothelial function of lo ng-term coronary artery lesions in patients with Kawasaki disease (KD) . Background. The vascular function of the coronary arteries in childr en with long-term KD remains uncertain, We report our findings of the vascular response of the coronary arteries to intracoronary injection of acetylcholine (ACh) in patients with KD. Methods. A total of 35 pat ients (25 patients with KD and 10 control subjects) were examined usin g coronary angiography, Individual arteries were divided into four gro ups according to the type of the coronary artery lesion: group 1 consi sted of 25 sites with regressed aneurysms, These aneurysms had develop ed in the acute stage but had subsequently regressed and demonstrated normal findings on the follow-up coronary angiogram. Group 2 consisted of 24 sites with persistent aneurysms, Group 3 involved 60 angiograph ically normal sites in the same patients as those in group 1 or 2, Gro up 1 consisted of 30 sites in control subjects who had congenital hear t disease with normal coronary arteries. During coronary angiography w e infused 15 mu g of ACh chloride into the coronary artery, The lumen diameters were measured using a cine videodensitometric analyzer to st udy the distensibility of the coronary artery wall. Results. The mean (+/-SD) change in diameter was an increase of 11.71 +/- 12.34% in grou p 3 (coronary arteries without lesions in patients with KD) and 12.21 +/- 9.71% in the control group, demonstrating marked vasodilation in b oth groups. in contrast, the changes in the regressed aneurysms of gro up 1 and in the persistent aneurysms of group 2 were -2.65 +/- 12.12% and -0.08 +/- 6.51%, respectively, demonstrating no change or mild vas oconstriction, The change in groups 1 and 2 was significantly less tha n that in group 3 or in the control group. Group 3 showed no significa nt difference from the control group. Conclusions. These findings sugg est that long-term coronary artery lesions, even after aneurysm regres sion, may have impaired endothelial function. A long term follow-up st udy for those patients is essential. (C)1998 by the American College o f Cardiology.