Abstract 2342: In Vivo Plaque Composition and Morphology in Coronary Artery Lesions in the Adolescents and Young Adults Long after Kawasaki Disease: Lessons Learned from Virtual Histology-Intravascular Ultrasound Study
Background: Coronary artery lesions (CALs) late after Kawasaki disease (KD) have been associated with endothelial dysfunction and low-grade inflammation, surrogate markers for atherosclerosis. Virtual histology-intravascular ultrasound (VH-IVUS), a new method to assess coronary plaque composition and morphology in vivo, was recently introduced. We tested the hypothesis that CALs in patients long after KD are accompanied by atheromatous plaque-like features, as assessed by VH-IVUS.
Methods: VH-IVUS was performed in eight Japanese KD patients (age: 19y5m (mean) ±1y10m (SE); an interval after KD: 16y10m±1y9m) with CALs. We investigated each segment and/or coronary artery lesion in each patient: 8 sites with a localized stenosis (LS), 13 sites with an aneurysm (AN), 19 sites with a regressed aneurysm (RA), and 12 sites with normal coronary artery (N) from the onset. After baseline coronary angiography, IVUS data acquired by using a 20 MHz, 2.9F IVUS catheter were reconstructed by a VH-IVUS recorder (Volcano Therapeutics). Plaque components were categorized into four parts: fibrous (F), fibrofatty (FF), necrotic core (NC), and dense calcium (DC) areas.
Results: Plaques were detected in almost all the sites with LS, AN, and RA, while they were sometimes observed in N (33%). FF and NC areas were commonly found, in addition to F and DC areas (percentage of the area of each component in the plaque area, %F: 19.0±4.5; %FF: 29.2±4.5; %DC: 8.6±2.0; %NC: 10.5±2.5). Both %DC and %NC areas were significantly higher in advanced lesions, LS+AN, than in RA+N (%NC: 18.3±5.2 in LA+AN vs 8.1±1.7 in RA+N, p<.05; %DC: 12.3±4.3 in LS+AN vs 3.7±1.2 in RA+N, p<.05). Qualitatively, VH-IVUS findings at the sites with LS revealed thin fibrous cap-like lesions with underlying NC and DC areas.
Conclusions: The present study demonstrated that components consistent sonographically with atheromatous plaques, FF and NC, were commonly observed in patients late after KD; NC and DC areas were more prevalent in advanced lesions; LS sites were associated with thin fibrous cap-like lesions with underlying NC and DC areas. These VH-IVUS findings give us a new insight into the potential role of atherogenesis in the evolution of CALs in the adolescents and young adults long after KD.