Coronary Artery Aneurysms Diameter Research Articles

Changes in Coronary Aneurysm Diameters After Acute Kawasaki Disease from Infancy to Adolescence.

We clarified the changes in coronary artery diameters based on the degree of coronary artery involvement immediately after acute Kawasaki disease (KD). Two hundred sixteen coronary arteries in 85 patients after KD examined by two-dimensional echocardiography were reviewed from 1995. The maximal internal diameters were measured at 2months, 1year, 3years, 10years and 15years after KD. The coronary arteries were divided into five groups based on the absolute diameter at 2months, as well as six groups based on the Z score at 2months. The maximum diameters were compared at 2months with those during follow-up in each group. The numbers of right coronary, left anterior descending, left coronary, and left circumflex arteries were 84, 73, 55 and 4, respectively. There was a significant relationship between the maximum internal diameter at 2months and subsequent changes in the maximum diameters after KD in the late period in both groups (p < 0.0001). The maximum diameters of coronary artery aneurysms (CAAs) ≥ 8.0mm at 2months did not change significantly after 1year, however, the maximum diameter of CAAs < 8.0mm was significantly smaller in the late period (p < 0.05). Coronary arteries without dilatation at 2months after KD grew normally. CAAs with a maximum diameter ≥ 6.0mm and Z score ≥ 7.5 at 2months after KD persisted in adolescents, whereas coronary arteries with diameters < 6.0mm and Z score < 7.5 could be within normal ranges in the late period.

Safety of warfarin therapy in children with coronary aneurysm due to Kawasaki disease

Objective: To investigate the safety of warfarin for Kawasaki disease (KD) with coronary artery aneurysm (CAA) and its prognosis. Methods: Twenty one children with KD complicated with giant CAA, multiple CAA in one coronary artery or thrombosis in coronary artery were enrolled in this prospective study. Warfarin was used to control the goal international normalized ratio (INR) ranging from 2.0 to 3.0. The CAA diameter, number, location and thrombus in coronary artery were recorded at the beginning of treatment, 1, 2, 3, 4 weeks and 2, 3, 6, 12 months after treatment, as well as the influence on INR, electrocaroliogram, creatine kinase-MB (CK-MB), troponin I. Standardized warfarin bleeding risk training and management was implemented. Children were divided into implementation group and non-implementation group according to the status of actual implementation of their parents. The incidence of bleeding events was compared between the two groups. Comparisons between groups were performed using a Rank sum test and a Fisher exact test. Results: In the 21 patients (15 males and 6 females), the age of onset ranged from 2 months to 6 years. There were 4 cases with grade Ⅱ, 7 cases with grade Ⅲ, 7 cases with grade Ⅳ and 3 cases with grade Ⅴ according to the severity of coronary arterial lesions before treatment. The time of clinical detection of thrombus in 10 children with thrombosis ranged from the fourth day to the fourth month. The dose distribution of warfarin was 0.06-0.10 mg/(kg·d), and the INR was 1.80-2.59. Among the 10 cases with thrombus, 8 cases had disappearance of thrombi and 2 cases with grade Ⅴ had thrombus organization to different degree. After treatment, the coronary artery ectasia of the 4 cases with grade Ⅱ all returned to normal. Among the 7 cases with grade Ⅲ, 3 cases of coronary artery aneurysms returned to normal, and 4 cases did not change. Among the 7 cases with grade Ⅳ , 5 cases of coronary artery aneurysms shrank to grade Ⅲ, and 2 cases remained unchanged. Three cases with grade Ⅴ lesions had no changes in aneurysm. Neither new thrombus nor new CAA was detected during the treatment. There was no significant change in electrocardiogram before and after treatment. No statistically significant difference was found regarding the troponin I (0.07 (0-3.01) vs. 0.04 (0-0.29) μg/L, Z=0.932, P>0.05) and CK-MB (20.6 (11.2-58.2) vs. 29.0 (16.7-47.0) U/L, Z=1.906, P>0.05) before and after treatment. The incidence of bleeding events in the implementation group was significantly lower than that in the non-implementation group (2/15 vs. 4/6, Fisher=5.689, P=0.031). Conclusions: The application of goal INR of 2.0-3.0 and adjustment of warfarin dose according to the severity of CAA combined with standardized and strict warfarin bleeding risk training and management, can increase the safety of warfarin therapy in children with KD, improve the prognosis of coronary artery lesions, promote the dissolution of thrombi, prevent new thrombosis, and effectively reduce the incidence of bleeding complication.

Time Course of Coronary Artery Aneurysms in Kawasaki Disease

To determine the timeframe in which coronary artery aneurysms (CAAs) caused by Kawasaki disease reach their maximum diameter, the timeframe in which they regress to normal size, and the cutoff point of the diameter for CAA regression. We reviewed 195 CAAs of the right coronary artery, left anterior descending artery, and left coronary artery measured by 2-dimensional echocardiography ≥5 times for 1year after Kawasaki disease in 84 patients using medical records from 1995. The maximum diameters of CAAs were investigated retrospectively. The time to CAA regression using both absolute diameter and Z score were investigated. The cutoff points of the diameter of CAA regression in the 2 classifications were identified using receiver operator characteristic curve analysis. One year after Kawasaki disease, a CAA of <3.0mm in absolute diameter and a Z score of <2.5 were defined as CAA regression. The time when CAAs reached their maximum diameter ranged from 11days to 87days, with a median of 35days (n=195). The time to CAA regression ranged from 41 to 386days, with a median of 136days in the absolute diameter classification (n=92); 78% of CAA regression regressed by 200days. The cutoff point for CAA regression at one year was 5.7mm for the absolute diameter (area under the curve, 0.887; P<.0001; n=190) and 9.5 for the Z score (area under the curve, 0.815; P<.0001; n=195). CAAs with a smaller diameter regressed earlier, and most CAAs of <6mm regressed by 6months after Kawasaki disease.

Hemodynamic-Based Evaluation on Thrombosis Risk of Fusiform Coronary Artery Aneurysms Using Computational Fluid Dynamic Simulation Method

Coronary artery aneurysms (CAAs) have been reported to associate with an increased risk for thrombosis. Distinct to the brain aneurysm, which can cause a rupture, CAA’s threat is more about its potential to induce thrombosis, leading to myocardial infarction. Case reports suggest that thrombosis risk varied with the different CAA diameters and hemodynamics effects (usually wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT)) may relate to the thrombosis risk. However, currently, due to the rareness of the disease, there is limited knowledge of the hemodynamics effects of CAA. The aim of the study was to estimate the relationship between hemodynamic effects and different diameters of CAAs. Computational fluid dynamics (CFD) provides a noninvasive means of hemodynamic research. Four three-dimensional models were constructed, representing coronary arteries with a normal diameter (1x) and CAAs with diameters two (2x), three (3x), and five times (5x) that of the normal diameter. A lumped parameter model (LPM) which can capture the feature of coronary blood flow supplied the boundary conditions. WSS in the aneurysm decreased 97.7% apparently from 3.51 Pa (1x) to 0.08 Pa (5x). OSI and RRT in the aneurysm were increased apparently by two orders of magnitude from 0.01 (1x) to 0.30 (5x), and from 0.38 Pa−1 (1x) to 51.59 Pa−1 (5x), separately. Changes in the local volume of the CAA resulted in dramatic changes in local hemodynamic parameters. The findings demonstrated that thrombosis risk increased with increasing diameter and was strongly exacerbated at larger diameters of CAA. The 2x model exhibited the lowest thrombosis risk among the models, suggesting the low-damage (medication) treatment may work. High-damage (surgery) treatment may need to be considered when CAA diameter is 3 times or higher. This diameter classification method may be a good example for constructing a more complex hemodynamic-based risk stratification method and could support clinical decision-making in the assessment of CAA.

Outcomes in Patients Fully Covered With Coronary Artery Aneurysm and Stenosis Lesion by Second Generation Drug-Eluting Stents After 1 Year.

We evaluated the safety and efficacy of second-generation drug-eluting stents (DES) fully covering a coronary artery aneurysm (CAA) and stenosis lesion. Patients (n = 33) with CAA and stenosis lesion (>60%) were enrolled between January 2014 and December 2017. Baseline characteristics and biochemical variables were recorded during hospital admission. Changes in CAA resolution (the reduction on CAA size), minimal lumen diameter (MLD), and diameter stenosis (DS) were determined before, just after, and 1 year after percutaneous coronary intervention (PCI). After DES implantation, MLD and DS after PCI were improved compared with those before PCI (P < .01). Also, thrombolysis in myocardial infarction blood flow was significantly enhanced after PCI (P < .01). One year after PCI, maximal CAA diameter in patients with CAA and stenosis lesion was significantly reduced compared with those just after PCI (P < .01). Meanwhile, CAA resolution ratio in these patients were more than those just after PCI (P < .01). Furthermore, there was a significant reduction about CAA length in these patients (P < .01). Last, there were no clinical events (including cardiac death, myocardial infarction, and revascularization) in the study. Second-generation DES implantation fully covering CAA and stenosis lesion was safe and effective.

A Hemodynamic-Based Evaluation of Applying Different Types of Coronary Artery Bypass Grafts to Coronary Artery Aneurysms

Coronary artery bypass grafts (CABGs), including saphenous vein grafts (SVGs) or left internal mammary artery (LIMA) grafts, are recently applied to treat coronary artery aneurysm (CAA). Surgical outcomes are considered to be related to surgical strategies (types of the bypass graft and whether CAA ligated or not) and the size of the CAA (usually characterized by diameter). However, the understanding of the relationship between the surgical outcomes and the abovementioned factors is limited. Previous studies related to CABG treatments have shown hemodynamic studies could help evaluate surgical outcomes through graft mass flow rate, wall shear stress (WSS), and oscillatory shear index (OSI). It is believed that the hemodynamic study of applying CABGs to CAA, which is not studied yet, could help us understand the different CABG surgeries. The aim of the study was to evaluate the hemodynamic differences among different surgical methods. To do this, eight three-dimensional models were constructed, representing application of SVGs and LIMA grafts to CAAs (whether ligated or not) with diameters two, three, and five times the normal diameter, to perform computational fluid dynamics (CFD) simulation. The lumped-parameter model (LPM) was coupled to the boundary of the 3D models which increase the complexity of the simulation, but it can ensure the stability of the simulation boundary conditions. The results show that SVG (no matter whether ligated or not) hemodynamic characteristics are positive, with an average high graft mass flow rate of 70 ml/min, an average WSS of 0.479 Pa, and a low OSI of 0.001. LIMA with CAA ligation has the same characteristics with higher WSS (average 1.701 Pa). The hemodynamic characteristics of LIMA without CAA ligation are negative, including high reverse mass flow rate and high OSI (0.367). The results indicate that the surgical outcomes of LIMA with CAA ligation are likely to be the best among these models. The surgical outcomes of LIMA without CAA ligation seem to be undesirable due to the high reverse mass flow and high OSI. The CAA diameter may not have a significant effect on surgical outcomes.

Hemodynamic variables in aneurysms are associated with thrombotic risk in children with Kawasaki disease

BackgroundThrombosis is a major adverse outcome associated with coronary artery aneurysms (CAAs) resulting from Kawasaki disease (KD). Clinical guidelines recommend initiation of anticoagulation therapy with maximum CAA diameter (Dmax) ≥8 mm or Z-score ≥ 10. Here, we investigate the role of aneurysm hemodynamics as a superior method for thrombotic risk stratification in KD patients. Methods and resultsWe retrospectively studied ten KD patients with CAAs, including five patients who developed thrombosis. We constructed patient-specific anatomic models from cardiac magnetic resonance images and performed computational hemodynamic simulations using SimVascular. Our simulations incorporated pulsatile flow, deformable arterial walls and boundary conditions automatically tuned to match patient-specific arterial pressure and cardiac output. From simulation results, we derived local hemodynamic variables including time-averaged wall shear stress (TAWSS), low wall shear stress exposure, and oscillatory shear index (OSI). Local TAWSS was significantly lower in CAAs that developed thrombosis (1.2 ± 0.94 vs. 7.28 ± 9.77 dynes/cm2, p = 0.006) and the fraction of CAA surface area exposed to low wall shear stress was larger (0.69 ± 0.17 vs. 0.25 ± 0.26%, p = 0.005). Similarly, longer residence times were obtained in branches where thrombosis was confirmed (9.07 ± 6.26 vs. 2.05 ± 2.91 cycles, p = 0.004). No significant differences were found for OSI or anatomical measurements such us Dmax and Z-score. Assessment of thrombotic risk according to hemodynamic variables had higher sensitivity and specificity compared to standard clinical metrics (Dmax, Z-score). ConclusionsHemodynamic variables can be obtained non-invasively via simulation and may provide improved thrombotic risk stratification compared to current diameter-based metrics, facilitating long-term clinical management of KD patients with persistent CAAs.

Computational blood flow simulations in Kawasaki disease patients: Insight into coronary artery aneurysm hemodynamics.

[first paragraph of article]Coronary artery aneurysms (CAA) as a result of Kawasaki disease (KD) create abnormal flow conditions that can ultimately lead to thrombosis, with associated risks of myocardial infarction and sudden death. The primary long-term clinical decision required for KD patients with aneurysms is whether to treat with anticoagulation therapy. Current clinical guidelines recommend CAA diameter 8 mm or Z-score &gt;10 as the criterion for initiating systemic anticoagulation therapy. In general, these aneurysms cause regions of flow stagnation, but the complexity of their geometry including changes in diameter, tortuosity and even proximal and distal stenoses make it difficult to evaluate thrombotic risk and predict patient outcomes based solely on a single anatomical measurement taken from image data, usually the maximum aneurysm diameter.

Cardiac Events and the Maximum Diameter of Coronary Artery Aneurysms in Kawasaki Disease

To clarify the occurrence of cardiac events based on the maximal diameter of the maximal coronary artery aneurysm (CAA) in Kawasaki disease (KD). Two hundred fourteen patients (160 male and 54 female) who had had at least 1 CAA in the selective coronary angiogram less than 100 days after the onset of KD were studied. We measured the maximal CAA diameters in the major branches of the initial coronary angiograms. Death, myocardial infarction and coronary artery revascularization were included as cardiac events in this study. We divided the patients into three groups based on the maximal CAA diameter (large ≥8.0 mm; medium ≥6.0 mm and <8.0 mm; small <6.0 mm). Further, we also analyzed the cardiac events based on laterality of maximal CAA (bilateral, unilateral) and body surface area (BSA). Cardiac events occurred in 44 patients (21%). For BSA < 0.50 m2, the 30-year cardiac event-free survival in the large and medium groups was 66% (n = 38, 95% CI, 49-80) and 62% (n = 27, 95% CI, 38-81), respectively. For BSA ≥ 0.50 m2, that in large group was 54% (n = 58, 95% CI, 40-67). There were no cardiac events in the medium group for BSA ≥0.50 m2 (n = 36) and the small group (n = 56). In the large analyzed group, the 30-year cardiac event-free survival in the bilateral and unilateral groups was 40% (n = 48, 95% CI, 27-55) and 78% (n = 48, 95% CI, 63-89), respectively (P < .0001). The group with the highest risk of cardiac events was the patient group with the maximal CAA diameter ≥6.0 mm with BSA < 0.50 m2 and the maximal CAA diameter ≥8.0 mm with BSA ≥ 0.50 m2. At 30 years after the onset of KD, cardiac event-free survival was about 60%. Given the high rate of cardiac events in this patient population, life-long cardiovascular surveillance is advised.

Assessment of Coronary Artery Aneurysms Caused by Kawasaki Disease Using Transluminal Attenuation Gradient Analysis of Computerized Tomography Angiograms

Patients with coronary artery aneurysms (CAAs) resulting from Kawasaki disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend CAA diameter ≥8mm as the criterion for initiating systemic anticoagulation. Transluminal attenuation gradient (TAG) analysis has been proposed as a noninvasive method for evaluating functional significance of coronary stenoses using computerized tomography angiography (CTA), but has not previously been used in CAA. We hypothesized that abnormal hemodynamics in CAA caused by KD could be quantified using TAG analysis. We studied 23 patients with a history of KD who had undergone clinically indicated CTA. We quantified TAG in the major coronary arteries and aneurysm geometry was characterized using maximum diameter, aneurysm shape index, and sphericity index. A total of 55 coronary arteries were analyzed, 25 of which had at least 1 aneurysmal region. TAG in aneurysmal arteries was significantly lower than in normal arteries (-23.5 ± 10.7 vs-10.5 ± 9.0, p= 0.00002). Aneurysm diameter, aneurysm shape index, and sphericity index were weakly correlated with TAG (r2= 0.01, p= 0.6; r2= 0.15, p= 0.06; r2= 0.16, p= 0.04). This is the first application of TAG analysis to CAA caused by KD, and demonstrates significantly different TAG values in aneurysmal versus normal arteries. Lack of correlation between TAG and CAA geometry suggests that TAG may provide hemodynamic information not available from anatomy alone. TAG represents a possible extension to standard CTA for KD patients who may improve thrombotic risk stratification and aid in clinical decision making.

Distribution of Kawasaki Disease Coronary Artery Aneurysms and the Relationship to Coronary Artery Diameter.

We investigated how the diameter of coronary artery aneurysm (CAA) relates to the distribution immediately after Kawasaki disease (KD). Two hundred and four pts (155 males and 49 females) who had undergone selective coronary angiography (CAGs) less than 100 days after the onset of KD were studied. We measured the maximum diameter of each artery segment in the initial CAGs. We analyzed the relationship between the maximum diameters and the distribution of CAA. We divided the patients into four groups based on the maximum CAA diameter in each patient (large(L) ≥8mm, medium(M) ≥6 and <8mm, small(S) ≥4 and <6mm, very small(VS) <4mm) and counted the affected segments. There were 87, 61, 36, and 20 patients in groups L, M, S, VS, respectively. The number of segments with CAA in each group was L 6 ± 2, M 4 ± 2, S 2 ± 2, VS 2 ± 1. The number of affected segments in L was significantly more than M, and a large value for L indicated that involvement was significantly more likely to be bilateral. The larger the maximum diameter of CAA, the more extensive disease involvement and the more likely to be bilateral. A large maximum CAA can also indicate coronary involvement in the longitudinal directions. It is an important charcteristic in distribution of CAA caused by KD vasculitis.

Coronary artery aneurysms detected by computed tomography coronary angiography.

Coronary artery aneurysms (CAAs) are incidentally revealed by coronary angiography and consist in a localized dilation of a coronary artery. Although invasive coronary angiography (ICA) is the gold standard imaging technique, it can lead to the underestimation of CAAs diameter in presence of parietal thrombi. Computed tomography coronary angiography (CTCA) is a very sensitive tool in CAAs detection and provides a clear visualization of coronary lumen highlighting intraluminal thrombi. We retrospectively reviewed 390 CTCA performed at our institution, 9 patients (6 men, 3 women) resulted affected by CAAs and represented the aneurysmal group (A group). Matched controls were identified among the non-aneurysmal patients with healthy coronaries to CTCA (NAH group). Clinical variables and imaging findings were compared and correlated. CAAs prevalence in our population was 2.31%. 15 CAAs were detected, mainly on the right coronary artery (RCA) (9 aneurysms) followed by the left anterior descending coronary artery (LAD) (three aneurysms) and the left circumflex coronary artery (CX) (three aneurysms). In six patients (66.7%) CTCA displayed an aneurysmal thrombosis and in 5 patients (55.5%) CAAs were associated to coronary artery stenoses. A statistically significant difference was found between the diameters of coronary vessels measured in healthy segments in A and NAH group. CTCA has led to a non-invasive estimation of CAAs prevalence and characterization of aneurysmal features and coronary anatomy. Overcoming ICA limitations, CTCA has provided a fine analysis of the aneurysms, also in presence of intraluminal thrombi.

Abstract 13850: Severity Assessment of Coronary Artery Aneurysm by Z-score of the Internal Diameter in Kawasaki Disease

Introduction: The severity of coronary artery aneurysms (CAA) in patients with Kawasaki disease (KD) has been recently classified according to the z-score. However, it is not known whether this classification can predict coronary events such as stenosis, obstruction, and thrombosis. Methods: In this multicenter retrospective study, data on height, weight, CAA diameter measured by echocardiography in the acute phase, and the clinical course in KD patients 18 years of age or younger who received a coronary angiography between 1992 and 2011 were collected. Time-dependent occurrence of coronary events was analyzed by Kaplan-Meier method according to small (z-score, &lt; 5.0), medium (≥ 5.0 to &lt; 10.0), and large (≥ 10.0) CAA using a 5 increment scale scheduled to be included in the new American Heart Association criteria. Cox regression analysis was used to identify risk factors for coronary events. The occurrence rate of major cardiac events such as angina pectoris, myocardial infarction, and cardiac death was also analyzed. Results: Data were analyzed for 1,002 patients from 44 institutions. Both the body surface area and CAA diameters were available in 741 cases for the right coronary artery (RCA) and 609 cases for the left anterior descending artery (LAD). Coronary events occurred in 83 (11.2%) of the RCA group and 57 (9.4%) of the LAD group, while major events occurred in 30 cases (3.0%). The 10-year event-free survival rate for coronary events for small, medium, and large aneurysms was 100, 95.5, and 64.9% in the RCA group, and 100, 94.4, and 63.5% for aneurysms in the LAD group, respectively. The rate of major cardiac events was 98.5, 98.1, and 87.6% for the RCA group, and 100, 97.5, and 86.8% for the LAD group, respectively. Cox regression analyses showed that the z-score of the CAA diameter was an independent risk factor for coronary events for the RCA [large versus medium aneurysm; hazard ratio (HR) 2.8, 95% confidence interval (CI) 1.5 to 5.3, p = 0.002] and the LAD [HR 3.2, 95% CI 1.6 to 6.5, p = 0.015] groups. Conclusions: The severity assessment of CAA using the 5-increment z-score for coronary arterial diameter can predict the time-dependent occurrence of coronary events in patients with KD.

Abstract 18858: Assessment of Coronary Artery Aneurysms Caused by Kawasaki Disease Using Transluminal Attenuation Gradient Analysis of Coronary CT Angiograms

Introduction: Patients with coronary artery aneurysms (CAA) resulting from Kawasaki Disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend using CAA diameter &gt;8mm as the criterion for initiating systemic anticoagulation, but this is not based on outcome or simulation data. Transluminal Attenuation Gradient (TAG) has been proposed as a non-invasive method for evaluating the functional significance of coronary stenoses from CT Angiography (CTA). However TAG has not been previously used for the assessment of CAA. Hypothesis: We hypothesized that abnormal flow conditions in CAA caused by KD could be quantified using TAG. Methods: We studied 23 patients with a history of KD who had undergone clinically indicated CTA. We quantified TAG in the major coronary arteries by performing linear regression of the average lumen intensity as a function of vessel length. Aneurysm geometry was characterized using maximum aneurysm diameter, aneurysm shape index (ASI) and sphericity index. Results: A total of 41 arteries were analyzed, 22 of which had at least one aneurysmal region. TAG of aneurysmal arteries was significantly lower than in normal arteries (-22.4±10.5 vs. -9.3±10, p=0.0003). Differences were also significant in aneurysmal vs. normal LAD and RCA sub-groups (-26.7±9.7 vs. -16.5±9.0, p=0.02; -14.7±8.2 vs. -0.1±4.4, p=0.001). Aneurysm diameter, ASI, and sphericity index showed little to no correlation with TAG (r2=0.04, r2=0.18, r2=0.17). Conclusions: This study is the first application of TAG in CAA from KD, and demonstrates significantly different TAG values in aneurysmal compared to normal arteries. Lack of correlation between TAG and CAA geometry suggests that TAG may provide information on hemodynamic conditions not available from anatomy alone. The use of TAG in KD patients represents a possible extension to standard CTA that could aid in clinical decision-making and help to better evaluate the risk of thrombus formation.

Measurements of Coronary Artery Aneurysms Due to Kawasaki Disease by Dual-Source Computed Tomography (DSCT).

Diameters of coronary artery aneurysms (CAAs) complicating acute phase KD can strongly predict the long-term prognosis of coronary artery lesions (CAL). Recently, computed tomographic angiography (CTA) has been used to detect CAL, and the purpose of this study was to determine whether coronary artery diameters measurements by CTA using dual-source computed tomography (DSCT) can be used instead of coronary angiogram (CAG) measurements. Twenty-five patients (22 males and three females) with CAL due to KD, who had undergone both CTA and CAG within one year, were retrospectively evaluated between 2007 and 2013. A prospective electrocardiogram-triggered CTA was performed on a DSCT (SOMATOM(®) Definition, Siemens Healthcare, Germany). Two pediatric cardiologists independently measured the diameters of CAAs twice in each maximum intensity projection (MIP), curved multiplaner reconstruction (MPR) and CAG. We measured 161 segments in total (segment 1-3, 5-7, 11, 13). Diagnostic accuracy was expressed as κ coefficient. A Bland-Altman analysis was also used to assess the intra-observer, inter-observer and inter-modality agreement. The diagnostic quality of CTA was excellent (κ = 0.93). Excellent inter-observer agreement for the diameters of CAAs was obtained for MIP, MPR and CAG and for the intra-observer agreement. The inter-modality agreement was also excellent in measurements of CAA (MPR-CAG: y = 0.9x + 0.40, r = 0.97, p < 0.0001 MIP-CAG: y = x + 0.1, r = 0.94, p < 0.0001). These values in normal coronary arteries were also obtained. We found a significant correlation between CTA and CAG in measuring the coronary arteries. We conclude that measuring coronary artery diameters by CTA is reliable and useful.

Abstract O.62: Estimation Of The Severity Of Coronary Artery Aneurysm By Z-score Of The Internal Diameter In Kawasaki Disease.

Background: The standard values of normal coronary artery internal diameters in Japanese children have been recently established, making it possible to calculate Z-scores based on body surface area. The aim of this study was to clarify the appropriate cut-off points of coronary artery aneurysm (CAA) Z-scores to predict coronary events such as stenosis, obstruction, and thrombosis in patients with Kawasaki disease (KD). Methods: In this multicenter retrospective study, we investigated height, weight, CAA diameters measured by echocardiography in acute phase KD, and coronary events in CAA patients with KD (age 18 years or younger) who had coronary angiography from 1992 to 2011. Results: Interim analysis was performed on data of the 928 patients recruited from 45 institutions. Body surface area (calculated from height and weight) and CAA diameters were available in 702, 680, and 539 cases of right coronary artery (RCA), left main trunk (LMT), left anterior descending artery (LAD), respectively. Coronary events occurred in 62 RCA cases (8.8%), 8 LMT cases (1.2%), and 45 LAD cases (8.3%) . Areas under the ROC curves to predict coronary events were similar for actual diameter, Z-score, and the ratio of actual diameter to that showing a Z-score of zero in each segment. The cut-off points for the actual diameter, Z-score, and ratio which yielding the highest sensitivity plus specificity were 6.3 mm, 9.6, and 3.9 times for RCA; 7.4 mm, 11.1, and 2.8 times for LMT; and 5.3 mm, 8.9, and 3.5 times for LAD. Conclusions: We identified cut-off Z-scores for CAA diameters useful for coronary events prediction. Attention should be paid to coronary events when the Z-score for CAA diameter is over 10.

Abstract 178: Measurements of coronary aneurysms due to Kawasaki Disease by Dual-Source Computed Tomography (DSCT)

Background: Diameters of coronary artery aneurysms (CAAs) due to KD in the acute phase can strongly predict long-term prognosis of coronary artery lesions. Recently, Computed Tomography Angiography (CTA) has been used in the diagnosis of coronary artery lesion (CAL). Purpose: The purpose of this study was to determine whether measurements of coronary artery diameters by CTA using DSCT can be used instead of coronary angiograms (CAG) during cardiac catheterization. Methods: Twenty five pts (22 males and 3 females) with CAL due to KD were evaluated. Their ages ranged from 5 months to 38 years (median 11years). CTA was performed between July 2007 and July 2013, and CAG was done within one year. A prospective Electrocardiogram (ECG) -triggered CTA was performed on a DSCT (SOMATOM® Definition (from July 2007 to October 2009) or SOMATOM® Definition Flash (from October 2009 to July 2013); Siemens Healthcare, Germany). ECG-gated scans were performed in 19 cases and Flash Spiral scans in 6 cases. Two pediatric cardiologists measured the diameters of CAAs twice in each maximum intensity projection (MIP), curved multi planer reconstruction (MPR) and CAG. We measured 161 segments in total (segment1-3,5-7,11,13). Diagnostic accuracy was expressed as κ coefficient. A Bland-Altman analysis was also used to assess the inter-observer, intra-observer and inter-material agreement. Results: The visualization capability of coronary arteries was excellent. One segment was not visualized by CTA. Detection rate in CTA, comparing with CAG, was 99.7%, and the diagnostic quality of CTA was excellent (κ=0.93). Excellent inter-observer agreement for diameters of CAAs was obtained for MIP, MPR and CAG and for the intra-observer agreement. The inter-modality agreement was also excellent (MPR-CAG : y=0.9x+0.40, r=0.97 ,p&lt;0.01 MIP-CAG : y=1.0x+0.1, r=0.94, p&lt;0.01). We also studied the diameters in normal segments. We also obtained good correlation between inter-observer, intra-observer and inter-modality (MPR-CAG : y=1.0x, r=0.89 , p&lt;0.01 MIP-CAG : y=1.0x+0.1, r=0.88, p&lt;0.01). Conclusion: We found a significant good correlation in the measurements of coronary artery between CTA and CAG. Measurement of the diameters of coronary artery by CTA is reliable and useful.

Changes in Coronary Artery Aneurysms Following Treatment with Abciximab

Background: Previously Etheridge et al reported rapid resolution of large coronary artery aneurysms(CAA) after treatment with abciximab(Abc), an antibody to platelet GP IIb/IIIa receptors. We report our experience with this treatment on 8 pts from Southern California and Arizona. Patients and Methods: These pts either presented with CAA prior to IVIG or developed giant CAA despite IVIG. All pts received a standard recommended dose of Abc: 2.5 mg/kg IV bolus followed by continuous infusion of 0.125 mcg/kg/min for 12 to 24 hrs. Largest CAA diameters were echographically measured in each pt before Abc, and at various time points after Abc. Available coronary angiograms were also reviewed. All pts remained on low-dose aspirin. Platelet aggregation study immediately after Abc showed effective inhibition. Additionally, those pts with CAA greater than 7 mm received warfarin. Results: Average duration of follow-up was 215 days (14 to 351). Initially, 7 pts had aneurysms in right coronary artery (RCA) and 8 pts in LCA. At the end of follow-up greater than 50 % reduction in CAA diameter was noted in only in 1 pt, increase in CAA size in 2 pts and no change in the rest. Intracoronary thrombus was noted in 1 pt before Abc with subsequent resolution. Compared to echo, angiographic CAA measurements were slightly smaller. No CA stenosis or thrombotic occlusion was seen. Conclusions: (1) Abc at current dosage is well tolerated by KS pts. (2) Abc has failed to produce dramatic CAA regression. (3) Abc may prevent thrombotic complications in giant CAA. Speculation: The optimum dose of Abc in KS is unknown, and may be higher than the adult dose in order to counter systemic platelet activation.