This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pahl, E. Articles by Chaudhry, F. A. Search for Related Content PubMed PubMed Citation Articles by Pahl, E. Articles by Chaudhry, F. A. Pubmed/NCBI databases Medline Plus Health Information Kawasaki Disease

(Circulation. 1995;91:122-128.)
© 1995 American Heart Association, Inc.

Feasibility of Exercise Stress Echocardiography for the Follow-up of Children With Coronary Involvement Secondary to Kawasaki Disease

Presented at the 66th Scientific Session of the American Heart Association, Atlanta, Ga, November 1993.

Elfriede Pahl, MD; Rajesh Sehgal, MD; Dale Chrystof, RDMS; William H. Neches, MD; Catherine L. Webb, MD; C. Elise Duffy, MD; Stanford T. Shulman, MD; Farooq A. Chaudhry, MD

From the Departments of Pediatrics (E.P.) and Medicine (R.S., F.C.), Northwestern University Medical School, Chicago, Ill; the Department of Pediatrics (W.H.N.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; and The Heart Institute for Children (C.E.D.), Rush Presbyterian St Luke's Medical Center, Chicago, Ill.

Correspondence to Elfriede Pahl, MD, Division of Cardiology, The Children's Memorial Hospital, 2300 Children's Plaza, Box 21, Chicago, IL 60614.

Background The development of coronary aneurysms as sequelae of Kawasaki disease can result in myocardial ischemia, infarction, and sudden death. Traditionally, these patients have undergone coronary angiography and nuclear stress imaging for risk stratification and follow-up. However, angiography is invasive, and both modalities expose the patient to repeated radiation, which is an important issue in children. The purpose of this study was to determine the feasibility of performing exercise stress echocardiography in children diagnosed with coronary abnormalities secondary to Kawasaki disease.

Methods and Results Treadmill exercise stress echocardiographic studies were performed in 28 children ages 6 to 16 years. All had acute Kawasaki disease 1 to 10 years before study, and coronary artery abnormalities were identified during previous echocardiographic imaging. Patients were exercised using a standard Bruce protocol. Transthoracic echocardiographic images, obtained in the parasternal long, short, apical two- and four-chamber views immediately before and after exercise, were digitized for review and analysis. In baseline studies before exercise, wall motion abnormalities were identified in 2 patients; these segments became normal with exercise. Two patients developed new exercise-induced wall motion abnormalities that corresponded to angiographically defined critical stenosis of the left anterior descending coronary artery. No patients had resting or exercise-induced ECG evidence of ischemia. There were no adverse reactions, and 26 of 28 patients had normal exercise tolerance.

Conclusions Among patients with coronary artery involvement resulting from Kawasaki disease, exercise stress echocardiography is a safe, noninvasive procedure and may identify children with myocardial ischemia that was not detected with ECG stress test alone.

Key Words: aneurysm • Kawasaki disease • pediatrics • echocardiography

This article has been cited by other articles:

				J. W. Newburger, M. Takahashi, M. A. Gerber, M. H. Gewitz, L. Y. Tani, J. C. Burns, S. T. Shulman, A. F. Bolger, P. Ferrieri, R. S. Baltimore, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association Pediatrics, December 1, 2004; 114(6): 1708 - 1733. [Abstract] [Full Text] [PDF]

				J. W. Newburger, M. Takahashi, M. A. Gerber, M. H. Gewitz, L. Y. Tani, J. C. Burns, S. T. Shulman, A. F. Bolger, P. Ferrieri, R. S. Baltimore, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association Circulation, October 26, 2004; 110(17): 2747 - 2771. [Abstract] [Full Text] [PDF]

				M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography) J. Am. Coll. Cardiol., September 3, 2003; 42(5): 954 - 970. [Full Text] [PDF]

				M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) Circulation, September 2, 2003; 108(9): 1146 - 1162. [Full Text] [PDF]

				J. W Newburger and J. C Burns Kawasaki disease Vascular Medicine, August 1, 1999; 4(3): 187 - 202. [Abstract] [PDF]

				J. Rychik, H. Levy, J. W. Gaynor, W. M. DeCampli, and T. L. Spray OUTCOME AFTER OPERATIONS FOR PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 924 - 931. [Abstract] [Full Text] [PDF]

				M. Miyagawa, T. Mochizuki, K. Murase, S. Tanada, J. Ikezoe, M. Sekiya, K. Hamamoto, S. Matsumoto, and M. Niino Prognostic Value of Dipyridamole-Thallium Myocardial Scintigraphy in Patients With Kawasaki Disease Circulation, September 8, 1998; 98(10): 990 - 996. [Abstract] [Full Text] [PDF]