Background: Patients with Kawasaki Disease (KD) and a history of coronary artery disease (CAD) are at risk of myocardial ischemia/infarction. Adenosine stress cardiac MRI (CMR) has been increasingly used in adults to evaluate for atherosclerotic CAD. This modality has not been widely used in the evaluation of CAD in children and young adults, but may be useful in those with a history of KD.
Methods: Patients with a history of Kawasaki disease and a clinical indication for a stress cardiac MRI were prospectively enrolled in the study. SSFP cine and delayed enhancement CMR (DE-CMR) were performed in a standard manner. Adenosine stress perfusion was performed with administration of adenosine (140 ug/kg/min) for 2-4 minutes and gadolinium (0.1 mmol/kg) using a standard adult protocol.
Results: A total of 13 procedures were performed between 2010 and 2014 on 8 patients with a history of KD (ages 8 to 22, 3F/5M). Seven of eight patients presented with chest pain. Seven of eight patients had documented moderate to giant aneurysms and one had a previous coronary bypass operation. Scans were performed 3-16 years after initial episodes of KD. Three of 16 (19%) scans demonstrated inducible regional ischemia in the distribution of coronary abnormalities. Of these, all underwent cardiac catheterization and 1 patient subsequently underwent coronary bypass surgery. All patients with negative scans were followed clinically with no evidence of further symptoms.
Conclusion: As a non-invasive imaging modality, adenosine cardiac stress MRI is feasible in patients with KD and coronary abnormalities and may obviate the need for invasive studies in order to rule out significant CAD. Further studies are needed to evaluate this imaging modality as a more definitive test in the evaluation of KD and chest pain.