DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR DETECTION OF CORONARY-ARTERY STENOSIS IN CHILDREN WITH KAWASAKI-DISEASE

Objectives. This study was designed to assess the feasibility and diag nostic accuracy of dobutamine stress echocardiography for detection of coronary artery stenosis in children with Kawasaki disease. Backgroun d. Dobutamine stress echocardiography is valuable as an alternative te st for detection of coronary artery disease in adult patients; however , its usefulness for children has been demonstrated only in limited ca ses. Methods. Dobutamine stress echocardiography (up to 30 mu g/kg bod y weight per min) was performed in 50 patients at the convalescent sta ge of Kawasaki disease, including 26 patients with coronary sequelae d ocumented by previous coronary angiography (sequelae group, 3 to 15 ye ars old) and 24 patients with normal coronary arteries documented by e chocardiography (normal group, 7 to 16 years old), who underwent quant itative coronary angiography on a separate day. Left ventricular regio nal wall motion divided into 16 segments was assessed in relation to t he extent of coronary artery disease. A positive test response was def ined as a new or worsened wall motion abnormalities. Results. Signific ant coronary artery disease (greater than or equal to 50% diameter ste nosis of major vessels) was present in 21 patients in the sequelae gro up, There was no significant difference in the maximal dose of dobutam ine between the sequelae and normal groups ([mean +/- SD] 22.4 +/- 5.1 vs. 24.2 +/- 2.5 mu g/kg per min). Heart rate and systolic blood pres sure were significantly increased (p < 0.01) at maximal dose of dobuta mine compared with values at rest in both groups; consequently, the ra te pressure product exceeded 20,000 in 20 (40%) of the 50 patients dur ing dobutamine infusion. Ten patients had self-limiting side effects; however, there were no serious complications from stress-induced ische mia. Ne-v wall motion abnormalities corresponding to the extent of cor onary artery disease were detected in 19 of 21 patients in the sequela e group, whereas no wall motion abnormalities were detected in the nor mal group. Thus, the sensitivity and specificity of dobutamine stress echocardiography for the detection of coronary artery disease were 90% and 100%, respectively. Conclusions. We conclude that dobutamine stre ss echocardiography is a safe and accurate diagnostic method for detec tion of coronary artery stenosis in Kawasaki disease. Moreover, this i s a possible alternative method for patients unable to exercise adequa tely, even if they are small children.