FEASIBILITY OF EXERCISE STRESS ECHOCARDIOGRAPHY FOR THE FOLLOW-UP OF CHILDREN WITH CORONARY INVOLVEMENT SECONDARY TO KAWASAKI-DISEASE

Background The development of coronary aneurysms as sequelae of Kawasa ki disease can result in myocardial ischemia, infarction, and sudden d eath. Traditionally, these patients have undergone coronary angiograph y and nuclear stress imaging for risk stratification and follow-up. Ho wever, angiography is invasive, and both modalities expose the patient to repeated radiation, which is an important issue in children. The p urpose of this study was to determine the feasibility of performing ex ercise stress echocardiography in children diagnosed with coronary abn ormalities secondary to Kawasaki disease. Methods and Results Treadmil l exercise stress echocardiographic studies were performed in 28 child ren ages 6 to 16 years. All had acute Kawasaki disease 1 to 10 years b efore study, and coronary artery abnormalities were identified during previous echocardiographic imaging. Patients were exercised using a st andard Bruce protocol. Transthoracic echocardiographic images, obtaine d in the parasternal long, short, apical two- and four-chamber views i mmediately before and after exercise, were digitized for review and an alysis. In baseline studies before exercise, wall motion abnormalities were identified in 2 patients; these segments became normal with exer cise. Two patients developed new exercise-induced wall motion abnormal ities that corresponded to angiographically defined critical stenosis of the left anterior descending coronary artery. No patients had resti ng or exercise-induced ECG evidence of ischemia. There were no adverse reactions, and 26 of 28 patients had normal exercise tolerance. Concl usions Among patients with coronary artery involvement resulting from Kawasaki disease, exercise stress echocardiography is a safe, noninvas ive procedure and may identify children with myocardial ischemia that was not detected with ECG stress test alone.