Kawasaki disease evaluated by two-dimensional echocardiogram and dipyridamole 201Tl-chloride myocardial SPET.

Abstract

Kawasaki disease (mucocutaneous lymph node syndrome) is a disease of unknown aetiology that affects infants and children, with most patients having myocardial involvement. To evaluate the incidence and nature of myocardial involvement, 30 patients with Kawasaki disease underwent both dipyridamole 201Tl-chloride myocardial single photon emission tomography (SPET) and two-dimensional echocardiography (2D-Echo), which were performed within 7 days of each other. The SPET image of 15 of 30 (50%) patients showed 27 segments with myocardial perfusion abnormalities: 6 patients had one or more segments showing redistribution; 6 patients had both one or more segments of reverse redistribution and redistribution; 2 patients had reverse redistribution; and one patient had one redistribution and one fixed defect. Eight of 15 (53.3%) SPET abnormalities included reverse redistribution. Of 15 patients with positive SPET, 13 were male (age 0.3-12 years, mean = 3.55) and 2 were female (age 3-4 years, mean = 3.5). The interval between the onset of disease and SPET ranged from 1 to 594 weeks. Of the 15 patients with a negative SPET, 10 were male (age 0.4-6 years, mean = 2.08) and 5 were female (age 0.2-5 years, mean = 1.8). The interval between the onset of the disease and SPET ranged from 2 to 54 weeks. There were no significant differences in age (P = 0.10), sex (P = 0.41) or interval between the onset of disease and SPET in the patients with positive SPET and those with negative SPET (P = 0.60). With 2D-Echo, 16 (11/15 patients with positive SPET and 5/15 patients with negative SPET) of 30 (53.3%) patients had demonstrable coronary aneurysms. There was no statistical difference (P = 0.4) in the ability to detect myocardial abnormalities between SPET and 2D-Echo. Combining SPET and 2D-Echo, detectability of myocardial involvement was 66.6% (20/30). We conclude (1) that more than 50% of the patients' myocardial involvement was expressed by the myocardial perfusion status on SPET or by coronary aneurysm on 2D-Echo. Combined SPET and 2D-Echo may be of additive benefit for the detection of myocardial involvement. All 15 patients with SPET abnormalities had one or more segments of redistribution and/or reverse redistribution, indicating myocardial ischaemia and/or damaged but viable myocardium.