Background: Coronary artery lesions (CALs) late after Kawasaki disease (KD) were characterized by endothelial dysfunction and low-grade inflammation, surrogate markers for atherosclerosis. We tested the hypothesis that CALs in patients long after KD are accompanied by atheroma-like features, as assessed by virtual histology-intravascular ultrasound (VH-IVUS), a new method to assess coronary plaque composition and morphology in vivo.
Methods and Results: VH-IVUS was performed in 13 Japanese KD patients (age: 19y3m (mean)±4y6m (SD); an interval after KD: 17y4m±5y0m). We investigated 6 sites with localized stenosis, 15 sites with an aneurysm, 29 sites with a regressed aneurysm, and 50 sites with a normal coronary segment. Plaque components were categorized into four parts: fibrous, fibrofatty, necrotic core (NC), and dense calcium (DC) areas. Qualitatively, the normal segment had no or trivial IVUS-visible plaque area, while the CAL exhibited a heterogenous plaque area with 4 components in different amounts and proportions. Quantitatively, a combined group of CALs had a higher absolute value of fibrous, DC, and NC areas than the normal segment (p< .05, respectively). In further analyzing 3 subtypes of CALs, localized stenosis, an advanced lesion, exhibited higher absolute and relative values of DC and NC areas, and a lower relative value of the fibrous area than regressed and persistent aneurysms (p< .05, respectively).
Conclusions: The present limited but initial VH-IVUS findings give a new insight into the potential role of atherogenesis in the evolution of CALs in the adolescents and young adults long after KD, and therefore warrant further investigation.