Key result
In children recovering from Kawasaki disease, coronary arteries with initial diameters >4.00 mm often showed morphological regression but failed to recover responsiveness to dipyridamole, with the mean dilatation ratio decreasing from 0.4% to -0.6%.
Why the study?
Does coronary artery responsiveness to dipyridamole recover over time in children with Kawasaki disease and dilated coronary segments?
Observational (n=22)
No
Does coronary artery responsiveness to dipyridamole recover over time in children with Kawasaki disease and dilated coronary segments?
In children recovering from Kawasaki disease, coronary arteries with initial dilation >4.00 mm often regress in size but fail to recover normal vasodilatory responsiveness to dipyridamole.
Answers are grounded in this paper and cite their sources.
Serial angiography may detect evolving coronary damage post-Kawasaki; leaves open routine clinical utility.
I evaluated the damage to coronary arteries by means of repeated dipyridamole loading coronary angiography in patients with a history of Kawasaki disease. 116 patients underwent coronary angiography and 22 of these patients entered this study because of the discovery of dilated segments in their coronary arteries. Those 22 patients had suffered from Kawasaki disease from the age of 2 months to 11 years (mean 2 years, 7 months) and the initial coronary angiography was performed on average 3 months after the onset of the disease. The follow-up coronary angiography was 12 to 35 (mean 21) months after the initial study. 300 μg/Kg dipyridamole was infused into left main coronary artery over 30 seconds and coronary angiography was performed before and 2 minutes after the dipyridamole infusion. Coronary diameters before and after infusion were measured and the dilatation ratios (DR) were calculated in segments 2, 5, 6, 11 and in other dilated segments if present. DR was defined as DR= (DA-DB) /DB, where DB is the diameter before and DA the diameter after the dipyridamole infusion. The results were as follows : (1) Most of DBs which had been less than 8.00 mm regressed in the follow-up study, while DBs which had been more than 8.00 mm showed no significant change. (2) In the segments where the DBs were 3.003.99 mm in the initial study, the mean DR increased from 0.6% to 6.5% in the follow-up study. On the other hand, in the segments where the DBs were more than 4.00 mm in the initial study, the mean DR decreased from 0.4% to -0.6% in the follow-up study.I conclude that coronary arteries where the DBs are more than 4.00 mm often improve in terms of the dilatation in children recovering from Kawasaki disease. However, the responsiveness to dipyridamole does not recover. When a coronary artery with normal diameter showed apparent low DR, it might be suspected that the artery had been dilated to more than 4.00 mm and regressed later.
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HIROSHI TABATA (1990) conducted an observational in Kawasaki disease with dilated coronary artery segments (n=22). Dipyridamole loading coronary angiography vs. Initial study (baseline) was evaluated on Mean dilatation ratio (DR) in response to dipyridamole in coronary segments with initial diameter >4.00 mm. In children recovering from Kawasaki disease, coronary arteries with initial diameters >4.00 mm often showed morphological regression but failed to recover responsiveness to dipyridamole, with the mean dilatation ratio decreasing from 0.4% to -0.6%.
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