Imaging
MANPHOOL SINGHAL, n/a
PROFESSOR
Postgraduate Institute of Medical Education and Research, Chandigarh, INDIA
Chandigarh, Chandigarh, India
Background: Coronary Artery Abnormalities (CAAs) of KD remain the most well-recognized complications of KD. However, myocarditis is also a significant issue. It is usually symptomatic but may, at times, be an important clinical manifestation of KD. Myocardium can also be affected as a consequence of thrombosis in CAAs. Hitherto, ECHO / CT coronary angiography had been the preferred imaging modalities for follow-up - both of these have limitations for the assessment of myocardium. Cardiac Magnetic Resonance Imaging (CMRI) is now being increasingly recognized as a useful imaging modality for myocardial and coronary artery assessment during follow-up in KD.
The aim of this study was to ascertain the myocardial structure and function along with coronary arteries on follow-up of children with KD.
Methods: This prospective observational study was conducted between July 2021 - September 2022 in a tertiary care center in Chandigarh, North India. Two groups (10 children in each) with varying patterns of coronary artery involvement at presentation and having at least 10 years of follow-up were enrolled in the study. These groups were as follows: Group-1: CAAs with spontaneous defervescence (SD); and Group-2: persistent CAAs (PCAAs).
Cardiac MRI (CMRI) was done on 3 Tesla – Philips Ingenia platform. ECHO was also carried out on the same day (Philips Epic 7). Details of the methodology are presented in Figure 1.
Results: Results of CMR and ECHO are tabulated in Table 1. Synopsis of CMR findings is enumerated.
Group 1 (SD): mean age: 20.3 years (range 16- 28 years. CMRI: 3/10- myocardial dysfunction on follow-up with 3/10 (30%) having ejection fraction (EF) < 55%. Three children had 3 had raised native T1 (values >1250 ms) but no Late Gadolinium Enhancement (LGE).
Group-2 (PCAAs): mean age: 13.8 years (range 10-16 years). CMR- 3/10: areas of myocardial fibrosis (raised T1 values with LGE in one patient) and LV systolic dysfunction (EF < 55% with regional wall motion abnormalities (RWMA) in 2/10)
Conclusion: Our study shows that KD not only affects coronary arteries but also impacts myocardial function. Newer imaging techniques like parametric mapping along with late gadolinium enhancement (LGE) provide detailed myocardial tissue characterization. These changes cannot be diagnosed on ECHO. We conclude that CMRI is a ‘one-stop’ modality for patients with KD on long-term follow-up for assessment of myocardial dysfunction and coronary arteries. It should be considered during long-term follow-up of children with KD.