Prognostic value of stress perfusion cardiac magnetic resonance imaging in Kawasaki disease with coronary artery aneurysms: A 10-year retrospective cohort study

Figures

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  Fig. 1. Freedom from major cardiac events among patients with KD and CAA. (A) Kaplan-Meier survival curves showing freedom from MCE stratified by AHA risk level. Patients with AHA risk level 5 (red) had a lower probability of MCE-free survival compared to those with AHA risk levels 3–4 (blue). (B) Patients with bilateral large or giant CAA (red) had significantly lower MCE-free survival compared to those with single-vessel involvement (blue) (HR 5.6, 95% CI 1.2–26.1; p = 0.03). (C) Among patients with large or giant CAA, those with persistent aneurysms at the time of first stress perfusion cardiac MRI (AHA risk level 5.1; red) showed a trend toward decreased MCE-free survival compared to those with regressed aneurysms (AHA risk levels 5.2–5.4; blue), although not statistically significant (HR 2.3, 95% CI 0.7–7.2; p = 0.16). Shaded areas represent 95% confidence intervals. "Number at risk" tables show the number of patients remaining under observation at each time point. Time 0 represents time of KD diagnosis. AHA American Heart Association, CAA coronary artery aneurysm, KD Kawasaki disease, MCE major cardiac events, spCMR stress perfusion cardiac magnetic resonance imaging

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  Fig. 2. Freedom from new major cardiac events among patients with KD and CAA following initial spCMR. Kaplan-Meier survival curves showing freedom from MCE stratified by results of first spCMR. Patients with inducible perfusion defects (red) had significantly lower event-free survival than those without perfusion abnormalities (blue) (HR 4.2, 95% CI 1.1–15.6; p = 0.03). Shaded areas represent 95% confidence intervals. "Number at risk" tables show the number of patients remaining under observation at each time point. Time 0 represents time of initial spCMR. CAA coronary artery aneurysm, KD Kawasaki disease, MCE major cardiac events, spCMR stress perfusion cardiac magnetic resonance imaging

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  Fig. 3. Clinical decision tree for patients with AHA Risk level 5 based on coronary artery anatomy and spCMR findings. Decision pathway among 44 Kawasaki Disease patients with AHA risk level 5 based on presence of significant coronary luminal narrowing (≥50%) and results of spCMR. Patients without significant stenosis and no inducible perfusion defect (n = 22) remained free of MCE (median follow-up: 2.4 years). Among patients with known stenosis, those with positive spCMR (n = 11) were more likely to be referred for catheterization (n = 8), and most experienced MCE (n = 7). In contrast, patients with stenosis but no inducible perfusion defect (n = 9) were mostly managed with medical therapy (n = 7), except for 2 patients who underwent cardiac catheterization, one of which developed subsequent MCE. This decision tree illustrates how spCMR results combined with anatomic assessment can help individualized management in high-risk KD patients. CA coronary artery, CABG coronary artery bypass graft, LVEF left ventricular ejection fraction, MCE major cardiac event, MI myocardial infarction, spCMR stress perfusion cardiac magnetic resonance imaging