PubMed · 13063569
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J T VONK. 1953-02-07. [Master's two step test].. https://pubmed.ncbi.nlm.nih.gov/13063569/
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Kawasaki disease (KD) in children takes the form of acute systemic vasculitis, which causes coronary artery dilation and aneurysm formation in 10% to 15% of the patients. We have recently shown that matrix metalloproteinases (MMPs) are intimately involved in coronary arterial wall destruction and the resultant formation of coronary artery lesions (CALs) in this disease. Plasminogen activators (PAs) are known to be a major pathway of MMP activation, and this suggests that their inhibitor, plasminogen activator inhibitor-1 (PAI-1), also plays important roles in the development of CALs in KD. The present study was conducted to test the hypothesis that circulating levels of PAI-I are related to CAL formation in KD. Plasma levels of PAI-1 were measured by enzyme-linked immunoassay in 37 KD patients without CALs (group 1) and 7 KD patients with CALs (group 2). Blood samples were obtained before and after i.v. gammaglobulin therapy (IVGG), and in the convalescent stage. Levels of PAI-1 were significantly higher in KD patients before IVGG than in 18 age-matched healthy control subjects (p < 0.01). More importantly, both pre-IVGG and post-IVGG levels of PAI-1 were significantly higher in group 2 than in group 1 (p < 0.01). Furthermore, PAI-1 levels of 9 patients from group 1 who showed pre-IVGG PAI-1 levels higher than the minimum PAI-1 level in group 2 significantly decreased after IVGG, whereas PAI-1 levels of group 2 patients remained persistently elevated, further suggesting a close association between PAI-1 and CAL development in KD. Thus, PAI-1 may be useful as a predictive marker for CAL development in KD. Studies of the effects of PA inhibition on coronary outcome may provide evidence that PA is a viable therapeutic target for the prevention of KD-related CALs.
PURPOSE: To improve the signal-to-noise ratio (SNR) of breath-held coronary magnetic resonance angiography (CMRA) without increasing the number or duration of breath holds. MATERIALS AND METHODS: In this BACSPIN (Breathing AutoCorrection with SPiral INterleaves) technique, a single breath-held electrocardiogram (ECG)-gated multi-slice interleaved-spiral data set is acquired, followed by repeated imaging of the same slices during free breathing. Each spiral interleaf from the breath-held data set is used as a standard for comparison with corresponding acquisitions at the same interleaf angle during free breathing. The most closely matched acquisitions are incorporated into a multi-slice, multi-average data set with increasing SNR over time. In-plane translations of the coronary artery can be measured and compensated for each accepted acquisition before combination with the other acquisitions. RESULTS: CMRA was performed on six volunteers, with improved SNR and minimal motional blurring. In some cases, breath holding could be dispensed with completely and the average respiratory position used as a reference. CONCLUSION: BACSPIN provides a promising method for CMRA with improved SNR and limited breath-holding requirements.