CLINICAL SIGNIFICANCE OF LINEAR SHADOWS INSIDE CORONARY ARTERIAL LESIONS ON TWO-DIMENSIONAL ECHOCARDIOGRAPHY IN PATIENTS WITH KAWASAKI DISEASE
INTRODUCTION: In Kawasaki disease, we have detected linear shadows inside large- or moderate-sized coronary arterial lesions (CALs) on high-resolution two-dimensional echocardiography (2DE).
OBJECTIVE: For this study, we wanted to investigate the origin and clinical significance of these linear shadows compared with findings on coronary angiography (CAG), MRI, and intravascular ultrasound.
RESULTS: Linear shadows were detected in 11 CALs on high-resolution 2DE in 9 patients with Kawasaki disease. The outer diameters of CALs on 2DE (7.0 ± 2.1 mm) were larger than those on CAG (4.4 ± 1.6 mm), whereas the inner diameters between linear shadows (3.9 ± 1.6 mm) were almost equal to the diameters of CALs on CAG. There was a statistically significant positive correlation (y = 0.99x − 0.10; r2 = 0.77) between the diameters of CALs on CAG and the inner diameters between linear shadows on 2DE. A thickened intima was revealed in the same regions that showed linear shadows on 2DE, in 7 of 11 lesions on MRI, and in all 4 lesions on which intravascular ultrasound was performed. In 3 patients who had been followed up over 3 years, linear shadows inside CALs on 2DE persisted, and the diameter between linear shadows was almost consistent with the diameter of CALs on CAG.
CONCLUSIONS: These results suggest that linear shadows inside CALs on 2DE would reflect the existence of a thickened intima. We expected that following up the changes of linear shadows inside CALs was useful for noninvasive evaluation of coronary arterial remodeling such as intimal hypertrophy or stenotic change.
Submitted by Akiko Hamaoka
- Copyright © 2008 by the American Academy of Pediatrics