Sarno LA. J Cardiopulm Rehabil Prev. 2020 Jan;40(1):E1-E4.
Kawasaki disease (KD) is a form of idiopathic vasculitis that affects medium-sized arteries throughout the body. The onset of KD is usually in infancy i.e. about 1 years. , coronary artery lesions (CALs) in KD can be a risk factor for future atherosclerosis. Atherosclerotic findings on virtual histological (VH)-IVUS, such as marked intimal thickening, severe calcification, and the presence of fatty components and necrotic tissue are noted in more serious lesions. In the early stages of the disease, CALs that accompany KD are dilated ones, mainly coronary artery aneurysms. After the acute phase of KD, CALs tend to become narrow, and sometimes there is a normal appearance on coronary angiography i.e. regression. In late-stage KD, endothelial dysfunction, decreased vascular elasticity, increased levels of high-sensitivity C-reactive protein, oxidative stress, and inflammatory cytokines are seen. However, it is not clear when these VH-IVUS findings start to occur. Therefore, Sarno LA, et al. evaluated coronary arteries using VH-IVUS in patients with early-stage KD and tried to determine whether these atherosclerotic findings on VH-IVUS were different from that in patients with late-stage KD.
A total of 18 patients with KD of age 1 to 32 years with CALs and who underwent cardiac catheterization were involved in the study. VH-IVUS findings was compared between two groups—those with the disease for <1 year (group A) and those with it for >10 years (group B). The coronary arteries were divided based on coronary angiography findings into normal, regressed (dilated CALs regressed to a normal size), and aneurysmal lesions. The Wilcoxon signed-rank test was used in the statistical analysis. In normal areas, the area percentages of fibrous, fibro-fatty, dense calcium, necrotic core, and early atherosclerotic lesions were 14.8±31.2%, 4.9±10.4%, 0.0±0.0%, 0.3±0.9%, and 4.9±10.4%, respectively and area percentages of fibrous, fibro-fatty, dense calcium, necrotic core, and early atherosclerotic lesions were 12.7±31.0%, 2.5±6.1%, 0.2±0.4%, 1.3±3.3%, and 3.8±9.4%, respectively. In regressed areas, the area percentages of fibrous, fibro-fatty, dense calcium, necrotic core, and early atherosclerotic lesions were 46.4±18.7%, 25.2±19.6%, 12.6±12.0%, 15.8±10.9%, and 41.0±15.7%, respectively and area percentages of fibrous, fibro-fatty, dense calcium, necrotic core, and early atherosclerotic lesions were 44.1±27.3%, 18.4±14.6%, 24.4±30.7%,13.0±9.4%, and 31.4±12.8%, respectively. In aneurysmal area, area percentages of fibrous, fibro-fatty, dense calcium, necrotic core, and atherosclerotic lesions were 46.8±18.8%, 28.3±12.9%, 11.3± 12.2%, 13.8±14.0%, and 42.0±9.0%, respectively and early atherosclerotic lesions were 33.4± 20.9%, 14.6±21.1%,24.3±15.9%, 27.6±17.2%, and 42.3±14.0%, respectively (Table 1). In both regressed and aneurysmal lesions, marked intimal proliferation and atherosclerotic findings (fibro-fatty and necrotic core lesions) was observed. In addition, there was no difference in the area percentage of atherosclerosis between the groups.
Thus, VH-IVUS revealed that atherosclerotic-like findings exist in CALs in patients with KD, even within a year of onset. The findings were almost the same in those with the disease for >10 years. Because there is no histological evidence of atherosclerosis in KD, these VH-IVUS findings may indicate complex histological findings of KD. Nevertheless, early interventions to help reduce the risk factors of atherosclerosis may be required in these patients.
Table 1: The area percentage of coronary atherosclerotic lesions detected by VH-IVUS
