Abstract 18858: Assessment of Coronary Artery Aneurysms Caused by Kawasaki Disease Using Transluminal Attenuation Gradient Analysis of Coronary CT Angiograms
Introduction: Patients with coronary artery aneurysms (CAA) resulting from Kawasaki Disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend using CAA diameter >8mm as the criterion for initiating systemic anticoagulation, but this is not based on outcome or simulation data. Transluminal Attenuation Gradient (TAG) has been proposed as a non-invasive method for evaluating the functional significance of coronary stenoses from CT Angiography (CTA). However TAG has not been previously used for the assessment of CAA.
Hypothesis: We hypothesized that abnormal flow conditions in CAA caused by KD could be quantified using TAG.
Methods: We studied 23 patients with a history of KD who had undergone clinically indicated CTA. We quantified TAG in the major coronary arteries by performing linear regression of the average lumen intensity as a function of vessel length. Aneurysm geometry was characterized using maximum aneurysm diameter, aneurysm shape index (ASI) and sphericity index.
Results: A total of 41 arteries were analyzed, 22 of which had at least one aneurysmal region. TAG of aneurysmal arteries was significantly lower than in normal arteries (-22.4±10.5 vs. -9.3±10, p=0.0003). Differences were also significant in aneurysmal vs. normal LAD and RCA sub-groups (-26.7±9.7 vs. -16.5±9.0, p=0.02; -14.7±8.2 vs. -0.1±4.4, p=0.001). Aneurysm diameter, ASI, and sphericity index showed little to no correlation with TAG (r2=0.04, r2=0.18, r2=0.17).
Conclusions: This study is the first application of TAG in CAA from KD, and demonstrates significantly different TAG values in aneurysmal compared to normal arteries. Lack of correlation between TAG and CAA geometry suggests that TAG may provide information on hemodynamic conditions not available from anatomy alone. The use of TAG in KD patients represents a possible extension to standard CTA that could aid in clinical decision-making and help to better evaluate the risk of thrombus formation.
Author Disclosures: N. Grande Gutierrez: None. O. Shirinsky: None. N.V. Gagarina: None. G.A. Lyskina: None. R. Fukazawa: None. S. Ogawa: None. J.C. Burns: None. A.L. Marsden: None. A.M. Kahn: None.
- © 2015 by American Heart Association, Inc.