This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tateno, S. Articles by Kohno, Y. Search for Related Content PubMed PubMed Citation Articles by Tateno, S. Articles by Kohno, Y. Related Collections Angiogenesis Other Treatment

(Circulation. 2001;103:2591.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Alleviation of Myocardial Ischemia After Kawasaki Disease by Heparin and Exercise Therapy

Shigeru Tateno, MD; Masaru Terai, MD; Koichiro Niwa, MD; Toshiaki Jibiki, MD; Hiromichi Hamada, MD; Kumi Yasukawa, MD; Takafumi Honda, MD; Shinji Oana, MD; Yoichi Kohno, MD

From the Departments of Pediatrics, Chiba University School of Medicine (S.T., M.T., T.J., H.H., K.Y., S.O., Y.K.), and Chiba Cardiovascular Center (S.T., K.N., T.H.,), Chiba, Japan.

Correspondence to Masaru Terai, MD, Department of Pediatrics, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan. E-mail terai{at}med.m.chiba-u.ac.jp

Background—Heparin promotes angiogenesis. We evaluated the effects of combined treatment with heparin and exercise on myocardial ischemia in the chronic stage of Kawasaki disease.

Methods and Results—This study was conducted in 7 patients (aged 6 to 19 years) who had a totally occluded coronary artery and stress-induced myocardial ischemia in the collateral-dependent areas. Twice-daily exercise using a bicycle ergometer was performed with increments of 0.5 W/kg every 3 minutes up to maximal exertion for 10 days. Heparin, which immediately increased circulating hepatocyte growth factor, was given intravenously 10 minutes before each exercise period. Newly developed myocardial infarction, ventricular tachyarrhythmia, anginal attack, or hemorrhagic complication was not observed in any patient. Dipyridamole-loading single photon emission computed tomography documented improved myocardial perfusion in the collateral-dependent areas and a significant reduction in total defect scores in all patients after the completion of 20 sessions (P=0.01). In control patients who did not receive the heparin-exercise therapy, however, stress defect scores remained unchanged (n=1) or increased (n=2) during follow-up. Computerized quantitative coronary angiography provided evidence that the heparin-exercise therapy increased the diameter of the occluded artery to which collaterals terminated (P=0.001) but not that of the reference artery with which collaterals were not connected (P=0.96).

Conclusions—The findings suggest that a series of heparin and exercise treatments over 10 days may have a dramatic effect on the alleviation of myocardial ischemia in collateral-dependent regions. This may be a safe, noninvasive revascularization therapy for patients with coronary artery occlusion in the chronic stage of Kawasaki disease.

Key Words: mucocutaneous lymph node syndrome • heparin • angiogenesis • hepatocyte growth factor

This article has been cited by other articles:

				H. Senzaki Long-Term Outcome of Kawasaki Disease Circulation, December 16, 2008; 118(25): 2763 - 2772. [Full Text] [PDF]

				E. Tadamura, M. Yamamuro, S. Kubo, S. Kanao, T. Saga, M. Harada, M. Ohba, R. Hosokawa, T. Kimura, T. Kita, et al. Effectiveness of Delayed Enhanced MRI for Identification of Cardiac Sarcoidosis: Comparison with Radionuclide Imaging Am. J. Roentgenol., July 1, 2005; 185(1): 110 - 115. [Abstract] [Full Text] [PDF]

				M Fujita and K Tambara Recent insights into human coronary collateral development Heart, March 1, 2004; 90(3): 246 - 250. [Abstract] [Full Text] [PDF]