Quantification of myocardial blood flow and flow reserve in children with a history of Kawasaki disease and normal coronary arteries using positron emission tomography
Quantification of myocardial blood flow and flow reserve in children with a history of Kawasaki disease and normal coronary arteries using positron emission tomography
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DOI：
10.1016/0735-1097(96)00199-4
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发表时间：
1996-09-01
影响因子：
24
通讯作者：
DiCarli, MF
中科院分区：
文献类型：
--
作者：
Muzik, O;Paridon, SM;DiCarli, MF
目标.本研究的目的是通过正电子发射断层扫描（PET）定量测量来确定有川崎病史和心外膜冠状动脉正常的儿童的心肌血流和血流储备是否会受到全面损害。川崎是一种急性炎症过程的动脉壁，导致泛血管炎，在幼儿。有川崎病史和正常心外膜冠状动脉的儿童，以前被认为有正常的冠状动脉血流储备。然而，最近的研究报道了运动引起的单光子正电子发射断层扫描（SPECT）成像的局部灌注异常。我们对10名有川崎病史的儿童和10名健康的年轻成人志愿者在静息和腺苷负荷时用氮-13氨和PET评估了心肌血流量和血流储备。所有儿童在PET研究前4至15年患有急性川崎病。超声心动图检查显示，在急性期和随访期，所有患儿均无心外膜冠状动脉异常。川崎患者和健康成人志愿者的静息血流量（标准化为心率-血压乘积，心脏作功指数）相似（82 +/-14 vs. 77 +/-16 ml/100 g/min [平均值+/-SD]，p = NS）。然而，川崎患者的充血血流量明显低于对照组（263 +/-64 vs. 340 +/-57 ml/100 g/min，p = 0.01），因此，川崎患者的心肌血流储备估计值低于健康青年志愿者（3.2 ± 0.7 vs. 4.6 ± 0.9，p = 0.003）。此外，川崎患者的总冠状动脉阻力高于健康成人志愿者（33 +/-vs. 24 +/-5 mm Hg/ml/g/min，p = 0.04）。灌注图像定量分析显示无局部灌注异常的证据。既往有川崎病病史且心外膜冠状动脉正常的儿童，静息心肌血流量正常，但充血性血流和血流储备减少。异常充血的血液形态和储备表明血管舒张能力受损，可能是由于冠状动脉微循环的残余损伤。
Objectives. The purpose of this investigation was to determine whether myocardial blood flow and flow reserve, based on quantitative measurements derived from positron emission tomographic (PET) imaging, would be globally impaired in children with a previous history of Kawasaki disease and normal epicardial coronary arteries.Background. Kawasaki disease is an acute inflammatory process of the arterial walls that results in panvasculitis in early childhood. Children with a history of Kawasaki disease and normal epicardial coronary arteries were previously considered to have normal coronary flow reserve. However, recent studies have reported exercise-induced regional perfusion abnormalities on single photon positron emission tomographic (SPECT) imaging.Methods. We assessed myocardial blood flow and flow reserve at rest and during adenosine stress with nitrogen-13 ammonia and PET in 10 children with a history of Kawasaki disease and in 10 healthy young adult volunteers. All children had acute Kawasaki disease 4 to 15 years before the PET study. None of the children had epicardial coronary artery abnormalities at the acute stage of the disease or during follow-up, as assessed by echocardiography.Results. Rest blood flows normalized to the rate-pressure product, an index of cardiac work, were similar in both the patients with Kawasaki disease and healthy adult volunteers (82 +/- 14 vs. 77 +/- 16 ml/100 g per min [mean +/- SD], p = NS). However, hyperemic blood flows were significantly lower in the patients with Kawasaki disease than in the control subjects (263 +/- 64 vs. 340 +/- 57 ml/100 g per min, p = 0.01), As a result, estimates of myocardial flow reserve were lower in the patients with Kawasaki disease than in the healthy young adult volunteers (3.2 +/- 0.7 vs. 4.6 +/- 0.9, p = 0.003). In addition, total coronary resistance was higher in the patients with Kawasaki disease than in the healthy adult volunteers (33 +/- vs. 24 +/- 5 mm Hg/ml per g per min, p = 0.04). Quantitative analysis of perfusion images demonstrated no evidence of regional perfusion abnormalities.Conclusions. Children with a previous history of Kawasaki disease and normal epicardial coronary arteries exhibit normal rest myocardial blood flows but reduced hyperemic flows and flow reserve. The abnormal hyperemic blood hows and how reserve suggest an impaired vasodilatory capacity, possibly due to residual damage of the coronary microcirculation.