96 - DIAGNOSTIC VALUE OF 99MTC-MIBI MYOCARDIAL PERFUSION IMAGING IN DETECTING MYOCARDIAL ISCHEMIA OF CHILDREN WITH KAWASAKI DISEASE AND CORONARY ARTERY LESIONS

Background: Kawasaki disease (KD) is a common vasculitis syndrome in children, typically leads to coronary artery lesions (CALs) and results in myocardial ischemia. Although the ^99mTc-MIBI myocardial perfusion imaging (MPI) plays a major role in the diagnosis of ischemic heart disease of adults, the feasibility and accuracy of its applications in children with KD remains uncertain.

Methods: In this retrospective study, data from patient files were collected in 309 Children who had undergone MPI between July 2019 and February 2023. After the exclusion of 152 patients, the data of 177 patients were analyzed, including 149 patients (aged from 6m to 14y) who performed ATP-induced stress MPI and 28 patients who only performed rest MPI. The safety of stress MPI was evaluated and the sensitivity and accuracy of MPI were analyzed comparing with other non-invasive modalities. Results of coronary angiography (CAG) were regarded as the reference standard.
Results: All 149 patients finished ATP stress MPI examination. The sensitivity of MPI in detection myocardial ischemia was 79.17%, which was greater than CMRI, ECG, and Echo (P < 0.05). The negative positive value (NPV) of MPI was 89.9%, and the accuracy was 71.75%, which indicated somewhat advantages over other tests. The area under the curve (AUC) of the MPI was 0.782. The "tandem" combination of MPI and CMRI improved the diagnostic specificity, accuracy, and consistency (P < 0.001). The "parallel" combination enhanced the sensitivity (P < 0.001). The formation of coronary artery collateral circulation was found in most cases with "false negative" MPI results. However, multiple giant coronary aneurysms (GCAs) were found in all cases with "false positive" MPI results, suggesting that even without any stenosis, GCAs may lead to myocardial ischemia.

Conclusion: ATP-induced MPI examination is safety and feasibility to perform in children even young infant. ^99mTc-MIBI MPI has a high diagnostic value in the detection of myocardial ischemia, suggesting it is a preferred non-invasive examination method for evaluating myocardial ischemia during follow-up in children with KD and CALs. Multiple GCAs may be an isolated risk factor in myocardial ischemia and further study is needed.