Key result
Thallium redistribution on dipyridamole-thallium SPECT was present in 93% of patients with events and was the best independent predictor of late cardiac events (chi2=57.8, P<0.0001).
Why the study?
The long-term outcome of coronary artery lesions in Kawasaki disease remains unclear, and frequent monitoring with coronary angiography is challenging, particularly in infants.
Cohort (n=459)
Dipyridamole-thallium SPECT is a strong independent predictor of late cardiac events in patients with Kawasaki disease, providing valuable long-term risk stratification.
Answers are grounded in this paper and cite their sources.
Thallium redistribution on SPECT may aid risk stratification in Kawasaki disease; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Although coronary artery lesions are critical complications of Kawasaki disease, their long-term outcome is still unclear. It is sometimes difficult to monitor progressive changes from aneurysms to stenotic lesions because coronary angiography (CAG) cannot be repeated very often, especially in infants. Our prospective study was designed to evaluate the prognostic value of dipyridamole-thallium single-photon-emission CT (SPECT) in the long-term follow-up of patients with Kawasaki disease. METHODS AND RESULTS: Of 459 consecutive patients with Kawasaki disease, coronary aneurysms were detected in 90 cases by echocardiography 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 > or =8 years. During the follow-up interval, there were 15 cardiac events (1 death, 5 infarctions, 2 coronary artery bypass graft operations, and 7 occurrences of unstable angina). Of patients who had some event, thallium redistribution was found on SPECT in 14 (93%, P<0.001). Of the various clinical and scintigraphic image variables, the presence of thallium redistribution was the best multivariate independent predictor of a late cardiac event (chi2=57.8, P<0.0001). The number of aneurysms detected on CAG added minimal statistical improvement to the model (chi2=1.9, P=0.0009). CONCLUSIONS: Dipyridamole-thallium SPECT is safely performed and is useful and important for risk stratification in the long-term follow-up of patients with Kawasaki disease.
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Miyagawa et al. (1998) conducted a cohort in Kawasaki disease (n=459). Dipyridamole-thallium SPECT (thallium redistribution) vs. Absence of thallium redistribution was evaluated on Late cardiac event (death, infarction, coronary artery bypass graft, or unstable angina) (p=<0.0001). Thallium redistribution on dipyridamole-thallium SPECT was present in 93% of patients with events and was the best independent predictor of late cardiac events (chi2=57.8, P<0.0001).
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