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Dobutamine stress surface mapping of myocardial ischemia in Kawasaki disease
1Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan.
Insights
Dobutamine stress body surface mapping effectively detects and localizes myocardial ischemia in pediatric Kawasaki disease patients. This non-invasive method is more convenient and objective than exercise-based tests, especially for children unable to perform physical exertion.
Area of Science:
- Cardiology
- Pediatric Medicine
- Diagnostic Imaging
Background:
- Kawasaki disease can lead to myocardial ischemia in children.
- Detecting and localizing ischemia often requires methods not dependent on physical exertion.
- Non-invasive diagnostic tools are crucial for this pediatric population.
Purpose of the Study:
- To evaluate dobutamine stress body surface mapping for detecting and localizing myocardial ischemia in children with Kawasaki disease.
- To establish criteria for ischemia detection using body surface mapping parameters.
- To compare the efficacy of this method with existing diagnostic modalities.
Main Methods:
- Dobutamine stress body surface mapping was performed on 115 children with Kawasaki disease.
- Myocardial ischemia was diagnosed using scintigraphy and dobutamine stress.
- Key parameters analyzed included ST depression (nST) and isointegral map values (I(min)).
- Criteria for ischemia detection were defined as nST ≥ 1 and I(min) ≤ 4.
Main Results:
- The sensitivity for detecting myocardial ischemia was 94.1% (nST) and 41.7% (I(min)), with specificities of 98.9% and 96.9%, respectively.
- Localization of myocardial ischemia using body surface mapping showed 100% concordance with stress myocardial scintigraphy.
- The defined criteria proved effective in identifying ischemia.
Conclusions:
- Dobutamine stress body surface mapping is a non-invasive, convenient, and repeatable method for diagnosing myocardial ischemia in pediatric Kawasaki disease patients.
- It is more objective than exercise echocardiography and preferable to exercise scintigraphy.
- This technique is particularly valuable for identifying silent myocardial ischemia in children unable to tolerate physical exercise tests.
Background:
To detect and localize myocardial ischemia, a method that does not require physical exertion is sometimes needed in children with Kawasaki disease.
Methods:
Dobutamine stress body surface mapping was performed in 115 children with a history of Kawasaki disease (58 without coronary artery lesions, 40 who had coronary lesions without myocardial ischemia and 17 with myocardial ischemia). The maximum infusion rate of dobutamine was 30 microg/kg per min. Myocardial ischemia was diagnosed by the presence of an area of hypoperfusion on scintigraphy at rest and/or an increase in hypoperfusion during a dobutamine stress test compared with resting scintigraphy. We studied the number of leads that showed significant ST depression on the isopotential map (nST), the number of the row containing the lead with the smallest negative value on the isointegral map (I(min)), and the localization of myocardial ischemia on the isointegral map. Based on findings in patients without coronary artery lesions, we defined the criteria for detecting myocardial ischemia as nST > or = 1 and I(min) < or = 4.
Results:
The sensitivity of detecting myocardial ischemia was 94.1% using nST and 41.7% using I(min), while the specificity of these methods was 98.9 and 96.9%, respectively. The localization of myocardial ischemia on stress body surface mapping was 100% concordant with that determined by stress myocardial scintigraphy.
Conclusions:
Dobutamine stress body surface mapping for the detection of myocardial ischemia is a non-invasive, more convenient and repeatable test compared with exercise myocardial scintigraphy and it is a more objective test compared with exercise echocardiography. Dobutamine stress body surface mapping is useful for the identification and localization of silent myocardial ischemia in pediatric patients with Kawasaki disease, especially those who cannot perform tests involving physical exercise.