CLINICAL SIGNIFICANCE OF LINEAR SHADOWS INSIDE CORONARY ARTERIAL LESIONS ON TWO-DIMENSIONAL ECHOCARDIOGRAPHY IN PATIENTS WITH KAWASAKI DISEASE

INTRODUCTION: In Kawasaki disease, we have detected linear shadows inside large- or moderate-sized coronary arterial lesions (CALs) on high-resolution two-dimensional echocardiography (2DE). OBJECTIVE: For this study, we wanted to investigate the origin and clinical significance of these linear shadows compared with findings on coronary angiography (CAG), MRI, and intravascular ultrasound. RESULTS: Linear shadows were detected in 11 CALs on high-resolution 2DE in 9 patients with Kawasaki disease. The outer diameters of CALs on 2DE (7.0 ± 2.1 mm) were larger than those on CAG (4.4 ± 1.6 mm), whereas the inner diameters between linear shadows (3.9 ± 1.6 mm) were almost equal to the diameters of CALs on CAG. There was a statistically significant positive correlation (y = 0.99x − 0.10; r2 = 0.77) between the diameters of CALs on CAG and the inner diameters between linear shadows on 2DE. A thickened intima was revealed in the same regions that showed linear shadows on 2DE, in 7 of 11 lesions on MRI, and in all 4 lesions on which intravascular ultrasound was performed. In 3 patients who had been followed up over 3 years, linear shadows inside CALs on 2DE persisted, and the diameter between linear shadows was almost consistent with the diameter of CALs on CAG. CONCLUSIONS: These results suggest that linear shadows inside CALs on 2DE would reflect the existence of a thickened intima. We expected that following up the changes of linear shadows inside CALs was useful for noninvasive evaluation of coronary arterial remodeling such as intimal hypertrophy or stenotic change.