Muzik O, Paridon S M, Singh T P, Morrow W R, Dayanikli F, Di Carli M F
Department of Radiology, Children's Hospital of Michigan, Detroit 48201-2196, USA.
J Am Coll Cardiol. 1996 Sep;28(3):757-62. doi: 10.1016/0735-1097(96)00199-4.
The purpose of this investigation was to determine whether myocardial blood flow and flow reserve, based on quantitative measurements derived from positron emission tomographic (PET) imaging, would be globally impaired in children with a previous history of Kawasaki disease and normal epicardial coronary arteries.
Kawasaki disease is an acute inflammatory process of the arterial walls that results in panvasculitis in early childhood. Children with a history of Kawasaki disease and normal epicardial coronary arteries were previously considered to have normal coronary flow reserve. However, recent studies have reported exercise-induced regional perfusion abnormalities on single-photon positron emission tomographic (SPECT) imaging.
We assessed myocardial blood flow and flow reserve at rest and during adenosine stress with nitrogen-13 ammonia and PET in 10 children with a history of Kawasaki disease and in 10 healthy young adult volunteers. All children had acute Kawasaki disease 4 to 15 years before the PET study. None of the children had epicardial coronary artery abnormalities at the acute stage of the disease or during follow-up, as assessed by echocardiography.
Rest blood flows normalized to the rate-pressure product, an index of cardiac work, were similar in both the patients with Kawasaki disease and healthy adult volunteers (82 +/- 14 vs. 77 +/- 16 ml/100 g per min [mean +/- SD], p = NS). However, hyperemic blood flows were significantly lower in the patients with Kawasaki disease than in the control subjects (263 +/- 64 vs. 340 +/- 57 ml/100 g per min, p = 0.01). As a result, estimates of myocardial flow reserve were lower in the patients with Kawasaki disease than in the healthy young adult volunteers (3.2 +/- 0.7 vs. 4.6 +/- 0.9, p = 0.003). In addition, total coronary resistance was higher in the patients with Kawasaki disease than in the healthy adult volunteers (33 +/- 11 vs. 24 +/- 5 mm Hg/ml per g per min, p = 0.04). Quantitative analysis of perfusion images demonstrated no evidence of regional perfusion abnormalities.
Children with a previous history of Kawasaki disease and normal epicardial coronary arteries exhibit normal rest myocardial blood flows but reduced hyperemic flows and flow reserve. The abnormal hyperemic blood flows and flow reserve suggest an impaired vasodilatory capacity, possibly due to residual damage of the coronary microcirculation.
本研究旨在确定，对于曾患川崎病且心外膜冠状动脉正常的儿童，基于正电子发射断层扫描（PET）成像定量测量得出的心肌血流量和血流储备是否会出现整体受损。
川崎病是一种动脉壁的急性炎症过程，可导致儿童早期的全身性血管炎。曾患川崎病且心外膜冠状动脉正常的儿童以前被认为冠状动脉血流储备正常。然而，最近的研究报告了单光子正电子发射断层扫描（SPECT）成像显示的运动诱发的局部灌注异常。
我们用氮-13氨和PET评估了10名曾患川崎病的儿童以及10名健康年轻成人志愿者静息状态下和腺苷负荷状态下的心肌血流量和血流储备。所有儿童在PET研究前4至15年患过急性川崎病。通过超声心动图评估，在疾病急性期或随访期间，这些儿童均无心外膜冠状动脉异常。
以心率-压力乘积（一项心脏作功指标）校正后的静息血流量在川崎病患者和健康成人志愿者中相似（82±14 vs. 77±16 ml/100g每分钟[均值±标准差]，p=无显著差异）。然而，川崎病患者的充血血流量显著低于对照组（263±64 vs. 340±57 ml/100g每分钟，p=0.01）。结果，川崎病患者的心肌血流储备估计值低于健康年轻成人志愿者（3.2±0.7 vs. 4.6±0.9，p=0.003）。此外，川崎病患者的总冠状动脉阻力高于健康成人志愿者（33±11 vs. 24±5 mmHg/ml每克每分钟，p=0.04）。灌注图像的定量分析未显示局部灌注异常的证据。
曾患川崎病且心外膜冠状动脉正常的儿童静息心肌血流量正常，但充血血流量和血流储备降低。充血血流量和血流储备异常提示血管舒张能力受损，可能是由于冠状动脉微循环的残留损伤所致。
