Fully Quantitative CMR First-Pass Perfusion Reveals Myocardial Perfusion Impairment in Kawasaki Disease: Association with Left Ventricular Remodeling (RF_FR_395)

Kawasaki disease (KD) is an acute febrile disease that mainly affects medium-sized arteries, especially the coronary artery (CA), can cause CA dilation. It is also associated with various myocardial injuries, including myocardial perfusion impairment, which is poorly defined. This study aimed to assess the distribution and determinants of myocardial perfusion impairment in patients with KD using fully quantitative CMR first-pass perfusion and explore their relationships with left ventricular (LV) remodeling.

Methods:

This prospective single-center study enrolled children with KD who underwent fully quantitative CMR first-pass perfusion between May 2020 and June 2023. Myocardial blood flow (MBF) was measured and corrected based on the heart rate-blood pressure product (MBFcor). Statistical analyses included ANOVA, Pearson correlation and multivariate linear regression.

Results:

Eighty-seven patients with KD (mean age, 7.5 years ± 2.2 [SD]; 60 males) and 33 age- and sex-matched controls (mean age, 8.2 years ± 2.8; 22 males) were included. Global MBFcor was lower in patients than in controls (2.2 mL/g/min ± 0.5 vs 2.5 mL/g/min ± 0.7; P=.031), especially among patients in the acute phase (2.1 mL/g/min ± 0.5). Subgroup analysis showed that patients with Z score ≥5 had significant decreases in global MBFcor compared with patients with Z score < 5 and controls (2.0 mL/g/min ± 0.5 vs 2.3 mL/g/min ± 0.4 vs 2.5 mL/g/min ± 0.7; P=.005), the same tendency was found in regional MBFcor in the territories of the left anterior descending artery (LAD) and left circumflex artery (LCX) (P<.05 for all). Global MBFcor and regional MBFcor in the territories of the LAD and LCX were correlated with Z score among patients with KD (r=-0.305 [P=.004]; r=-0.30 [P=.005]; and r=-0.30 [P=.005], respectively). Covariate-adjusted multivariable regression analyses demonstrated that Z score and the acute phase were independently associated with global MBFcor (β=-0.29 [P=.005]; and β=-0.22 [P=.031]; respectively). Furthermore, global MBFcor was independently associated with increased LV remodeling index (β=-0.24 [P=.025]).

Conclusion:

Fully quantitative CMR first-pass perfusion revealed myocardial perfusion impairment in children with KD. Myocardial perfusion impairment mainly distributed in patients in acute phase and/or with Z score ≥5. Z score and the acute phase were independently associated with myocardial perfusion impairment; decreased MBFcor was associated with adverse LV remodeling.