REGRESSED CORONARY ANEURYSM AFTER KAWASAKI DISEASE: AN OPTICAL COHERENCE TOMOGRAPHY (OCT) STUDY FROM A SINGLE INSTITUTION

Abstract

Coronary artery aneurysms (CAA) are a serious complication of Kawasaki disease (KD). CAA size regresses in nearly 50% of the cases on follow up. Nevertheless, patients with regressed CAA have an increased risk of ischemic heart disease, myocardial infarction and sudden cardiac death on long-term follow-up. Actual imaging techniques often describe these segments as normal, whereas studies have shown significant endothelial and smooth muscle dysfunction. Optical Coherence Tomography (OCT) is a high-resolution intracoronary imaging modality that characterizes coronary artery wall structure. KD patients scheduled for routine coronary angiography underwent OCT imaging between March 2013 and April 2015. The aim of the study was to compare microstructural coronary changes in coronary artery segments with no history of CAA to segments with regressed CAA, and segments with persistent CAA. OCT was performed on 27 patients at 12.4 ± 5.5 years, 9.3 ± 5.3 years following onset of KD. Overall, 22/27 (81.5%) had a history of CAA. Of those, 11/22 (50.0%) had regressed CAA at time of OCT. Data was analyzed according to echocardiographic and angiographic progress of CAA segments. All 19/19 (100.0%) persistent CAA segments and 20/23 (87.0%) regressed CAA segments had significant intimal hyperplasia, compared to 2/19 (10.5%) with no history of segmental CAA (P<0.001), amounting 475.0 ± 179.1 μm, 305.4 ± 164.2 μm and 79.6 ± 78.2 μm respectively (p<0.001). Also, partial disappearance of the media was found more frequently in segments with persistent CAA, 17/19 (89.5%), followed by segments with regressed CAA, 12/23 (52.2%), and those with no history of CAA, 1/19 (5.3%); p<0.001. Neovascularization was found more often in segments with persistent CAA, 8/19 (42.1%), compared to segments with regressed CAA, 3/23 (13.0%), and no history of CAA, 0/19; p=0.002. Calcifications were identified almost exclusively in patients with persistent CAA, 6/19 (31.6%), compared to 1/23 (4.3%) for segments with regressed CAA and 0/19 for segments with no history of CAA (p=0.004). Macrophage accumulation was identified more often in segments with persistent CAA compared to those with regressed CAA and no history of CAA, in 10/19 (52.6%), 3/23 (13.0%) and 3/19 (15.8%) respectively (p=0.007). Despite normal angiographic appearance, regressed CAA segments displayed significant intimal hyperplasia and disruption of the media, among other anomalies, similarly to segments with persistent CAA. These features represent an increased risk for adverse coronary events. The additional diagnostic value of OCT following KD may bring prognostic potential in future chronological series.View Large Image Figure ViewerDownload (PPT)