PROGNOSTIC VALUE OF DIPYRIDAMOLE-THALLIUM MYOCARDIAL SCINTIGRAPHY IN PATIENTS WITH KAWASAKI-DISEASE

Background-Although coronary artery lesions an critical complications of Kawasaki disease, their long-term outcome is still unclear. It is s ometimes difficult to monitor progressive changes from aneurysms to st enotic lesions because coronary angiography (CAG) cannot be repeated v ery often, especially in infants. Our prospective study was designed t o evaluate the prognostic value of dipyridamole-thallium single-photon -emission CT (SPECT) in the long-term follow-up of patients with Kawas aki disease. Methods and Results-Of 459 consecutive patients with Kawa saki disease, coronary aneurysms were detected in 90 cases by echocard iography during the acute stage. After paired studies of selective CAG and SPECT were conducted, all patients were followed up and monitored for the occurrence of any cardiac events for greater than or equal to 8 years. During the follow-up interval, there were 15 cardiac events (1 death, 5 infarctions, 2 coronary artery bypass graft operations, an d 7 occurrences of unstable angina). Of patients who had some event, t hallium redistribution was found on SPECT in 14 (93%, P<0.001). Of the various clinical and scintigraphic image variables, the presence of t hallium redistribution was the best multivariate independent predictor of a late cardiac event (chi(2)=57.8, P<0.0001). The number of aneury sms detected on CAG added minimal statistical improvement to the model (chi(2)=1.9, P=0.0009). Conclusions-Dipyridamole-thallium SPECT is sa fely performed and is useful and important for risk stratification in the long-term follow-up of patients with Kawasaki disease.