Introduction: Intimal calcification and related silent ruptured plaque in the coronary vessels, which can be defined invasively by a high resolution imaging modality optical coherence tomography (OCT) in vivo, are potential surrogates for acute coronary syndrome in adults long after Kawasaki disease (KD). However, whether such coronary vessel wall abnormality can be predicted noninvasively by using contrast-enhanced multi-detector computed tomography (MDCT) is unknown.
Hypothesis: We hypothesized that contrast-enhanced MDCT predicts OCT-derived intimal calcification and silent ruptured plaque in coronary sequelae in adults in the long-term follow-up period after KD.
Methods: A cross-sectional study using OCT, coronary angiogram (CAG), and contrast-enhanced MDCT, was performed in patients who were followed-up by CAG for ≥ 15 years after a diagnosis of acute KD with CAL (≥6mm). A normal segment from the KD onset was determined by CAG ≤6m after acute KD; regressed aneurysm was determined by serial CAG. MDCT-derived calcified or non-calcified intima was defined as any discernible structure under the luminal surface with CT density below contrast-enhanced lumen but above the surrounding connective tissue, with or without areas ≥ 130 HU.
Results: A total of 11 KD patients (male: 55%) at 25.3 yo (median) (IQR: 22.7-30.3) with a median interval of 22.6 y (IQR: 19.9-25.8; range 15.5-32.1) after KD were recruited. Coronary segments (n=51) investigated by both OCT and MDCT included 19 regressed aneurysms (RAN), 16 persistent aneurysms (PAN) and 8 localized stenoses (LS) as well as 8 normal coronary segments (NS) from KD onset. MDCT revealed calcified intima (17) and non-calcified intima (34); OCT findings included calcified intima (n=20) and ruptured plaque (4). MDCT-derived calcified intima predicted OCT-derived calcified intima ; sensitivity 0.75, specificity 0.94, PPV 0.88, NPV 0.85, accuracy 0.86. MDCT-derived calcified intima predicted OCT-derived ruptured plaque; sensitivity 1.0, specificity 0.72, PPV 0.24, NPV 1.0, accuracy 0.75.
Conclusions: The present findings demonstrate that MDCT-derived calcified intima predicts OCT-derived intimal calcification and silent ruptured plaque in coronary sequelae in adults long after KD.