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(Circulation. 1998;98:990-996.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Prognostic Value of Dipyridamole-Thallium Myocardial Scintigraphy in Patients With Kawasaki Disease

Masao Miyagawa, MD; Teruhito Mochizuki, MD; Kenya Murase, PhD; Shuji Tanada, MD; Junpei Ikezoe, MD; Michihito Sekiya, MD; Ken Hamamoto, MD; Shuhei Matsumoto, MD; ; Masaharu Niino, MD

From the Department of Radiology (M.M.) and the Department of Internal Medicine (M.S.), Ehime National Hospital; the Department of Radiology (T.M., K.M., S.T., J.I.) and the Department of Pediatrics (S.M., M.N.), Ehime University School of Medicine; and the Department of Radiology, the City of Yawatahama Hospital (K.H.), Ehime, Japan.

Correspondence to Masao Miyagawa, MD, Department of Radiology, Ehime National Hospital, 366 Yokogawara, Shigenobu, Ehime 791-0281, Japan. E-mail mmiyagaw{at}ehime-nh.go.jp

Background—Although coronary artery lesions are critical complications of Kawasaki disease, their long-term outcome is still unclear. It is sometimes difficult to monitor progressive changes from aneurysms to stenotic lesions because coronary angiography (CAG) cannot be repeated very often, especially in infants. Our prospective study was designed to evaluate the prognostic value of dipyridamole-thallium single-photon-emission CT (SPECT) in the long-term follow-up of patients with Kawasaki disease.

Methods and Results—Of 459 consecutive patients with Kawasaki disease, coronary aneurysms were detected in 90 cases by echocardiography during the acute stage. After paired studies of selective CAG and SPECT were conducted, all patients were followed up and monitored for the occurrence of any cardiac events for 8 years. During the follow-up interval, there were 15 cardiac events (1 death, 5 infarctions, 2 coronary artery bypass graft operations, and 7 occurrences of unstable angina). Of patients who had some event, thallium redistribution was found on SPECT in 14 (93%, P<0.001). Of the various clinical and scintigraphic image variables, the presence of thallium redistribution was the best multivariate independent predictor of a late cardiac event (²=57.8, P<0.0001). The number of aneurysms detected on CAG added minimal statistical improvement to the model (²=1.9, P=0.0009).

Conclusions—Dipyridamole-thallium SPECT is safely performed and is useful and important for risk stratification in the long-term follow-up of patients with Kawasaki disease.

Key Words: prognosis • follow-up studies • nuclear medicine • Kawasaki disease

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