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(Circulation. 1997;96:3384-3389.)
© 1997 American Heart Association, Inc.

Articles

Silent Myocardial Ischemia in Kawasaki Disease

Evaluation of Percutaneous Transluminal Coronary Angioplasty by Dobutamine Stress Testing

Shunichi Ogawa, MD; Ryuji Fukazawa, MD; Takashi Ohkubo, MD; Jiakun Zhang, MD; Nobuyuki Takechi, MD; Yukio Kuramochi, MD; Yoshiaki Hino, MD; Osamu Jimbo, MD; Yasuhiro Katsube, MD; Mitsuhiro Kamisago, MD; Yukiko Genma, MD; ; Masao Yamamoto, MD

From the Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan.

Correspondence to Shunichi Ogawa, MD, Department of Pediatrics, Nippon Medical School Hospital, 1–1-5 Sendagi, Bunkyo-ku, Tokyo, 113 Japan. E-mail boston{at}nms.ac.jp

Background Myocardial ischemia and myocardial infarction are the most serious complications of coronary artery lesions in children with Kawasaki disease (KD). Therefore, early detection and treatment of myocardial ischemia in patients with KD is essential. We studied the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) in patients with silent myocardial ischemia detected by dobutamine stress ^99mTc myocardial scintigraphy (TMS), body surface mapping (BMS), and signal-averaged ECG late potentials (ELP).

Methods and Results Eight of 76 asymptomatic patients with a coronary stenosis>25% and a positive dobutamine stress test were considered to have silent myocardial ischemia. All eight patients had>95% stenoses demonstrated by coronary angiography (CAG) just before PTCA. After PTCA, CAG showed that all of the coronary artery stenoses had been reduced to<50%. Additionally, intravascular ultrasonography (IVUS) performed in five patients before and after PTCA demonstrated adequate dilation of the coronary stenosis after PTCA. All eight patients underwent dobutamine stress TMS, BMS, and ELP 2 to 3 months after PTCA, which demonstrated no regions of myocardial ischemia. Approximately 6 months later, CAG was performed in all eight patients, and only one patient had developed restenosis.

Conclusions PTCA effectively dilates stenotic coronary arteries in children with KD. Moreover, dobutamine stress TMS, BMS, and ELP are useful for detecting silent myocardial ischemia and estimating the effectiveness of PTCA. Furthermore, IVUS is useful for evaluating the severity of coronary artery lesions before and after PTCA in patients with KD.

Key Words: ischemia • coronary disease • angioplasty • ultrasonography

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