Quantitative Evaluation of Severity of Coronary Artery Damage in Kawasaki Disease: Ultrasonic Tissue Characterization Method and Vascular Endothelial Growth Factor

We evaluated the severity of coronary artery (CA) damage quantitatively by an ultrasonic tissue characterization (UTC) method and the plasma levels of vascular endothelial growth factor (VEGF) in patients (pts) with Kawasaki disease (KD), and determined the relationship between the incidence of coronary artery lesion (CAL) and those results. Forty pts with KD, (median age 2.8 years), 10 afebrile and 10 febrile controls, were studied. The 40 KD pts comprised 2 groups: Group A; 32 pts with no CAL, Group; 8 pts with CAL. The UTC of left CA wall was performed to measure the absolute echo-intensity (AEI) value. The AEI value of CA in subacute phase (SAP) (34± 3.2 dB) was significantly higher than acute (AP; 31± 1.7 dB) and convalescent phase (CP;32± 2.6dB). Kinetics of plasma VEGF levels showed similar trend, VEGF levels peaked in the SAP of KD (AP: 197± 60, SAP: 599± 411, CP: 271± 201 pg/ml, p < 0.05). The AEI values and plasma VEGF levels in KD pts in AP, before intravenous immune globulin (IVIG) treatment, were significantly higher than those in febrile (AEI: 18± 2.4dB, VEGF: 104± 36 pg/ml) and afebrile controls (AEI: 17± 1.5dB, VEGF 63± 33pg/ml, p < 0.05). Both AEI values and VEGF levels in AP in pts with CAL (Group B, AEI: 33± 2.0 dB, VEGF: 253± 35 pg/ml) were significantly higher than patients in Group A (AEI: 31± 1.4dB, VEGF: 184± 57 pg/ml, p < 0.05). The AEI value and VEGF levels peaked at the just before the developing of CAL. A significant correlation was found between AEI value and VEGF levels (r = 0.78, p < 0.05). Conclusion The UTC method and plasma VEGF levels may have potential as a predictor of incidence of CAL in pts with KD.