Clinical research of Coronary flow reserve in Kawasaki disease

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To evaluate the pathologic significance of the coronary artery lesions associated with Kawasaki disease, we studied coronary arterial flow velocity patterns and flow reserve in coronary lesions using a doppler flow guidewire in 66 childrens with a history of Kawasaki disease. From Selective coronary angiography in these 66 patients, 30 aneurysmal lesions in 22 patients and 8 stenotic lesions in 8 patients were detected. Coronary flow reserve (CFR) was calculated as a ratio of ATP-induced hyperemic to baseline average peak velocity.In the angiographically normal coronary arteries, there were some characteristic findings in CFR in childhood as follows : CFR was significantly lower in LCX as compared with LAD and RCA and CFRs in LCA were significantly lower in the younger-age group than in the elder. In the dilatative coronary lesions, the significant decrease in average peak velocity and diastoli-to-systolic velocity ratio were observed, and were significantly correlated with the size of the lesions. Reduced CFR was also observed in the dilatated lesions, and was correlated with the size of lesions in frequency.In the stenotic coronary lesions, there was a significant sorrelation between the angiographic stenotic ratio and the calculated stenotic ratio on flow velocity change (r2=0.92). In the angiographically normal coronary arteries (6 patients) with any ischemic findings on thallium myocardial scintigraohy, reduced CFR was observed.Evaluation of coronary flow dynamics and flow reserve using a diooler flow guidewire was clinically useful to assess the pathologic significance of coronary lesions in Kawasaki disease.