Long-term follow-up with stress echocardiograms of patients with Kawasaki's disease

Area of Science:

• Cardiology
• Pediatric Cardiology
• Diagnostic Imaging

Background:

• Kawasaki disease (KD) can lead to coronary artery aneurysms and obstruction, especially in patients not treated with intravenous gamma-globulin.
• Long-term cardiovascular complications in KD patients necessitate ongoing monitoring.

Purpose of the Study:

• To evaluate the utility of stress echocardiography in asymptomatic patients with a history of Kawasaki disease.
• To estimate the prevalence of abnormal stress echocardiogram findings in this patient population.

Main Methods:

• Stress echocardiograms were performed on 28 patients with a history of KD, including 4 with known coronary artery aneurysms.
• Patients were stratified based on the timing of intravenous gamma-globulin treatment (≤10 days, >10 days, or no treatment).
• Statistical analysis using a binomial model was employed to estimate the failure rate of stress echocardiography.

Main Results:

• All stress echocardiogram tests in the study cohort were negative.
• The estimated individual failure rate for detecting abnormalities was less than 7%.
• Sample size calculations indicated a need for significantly larger cohorts (184-640 patients per group) to detect small differences in abnormal stress echo rates.

Conclusions:

• The probability of an abnormal stress echocardiogram in asymptomatic patients with a history of KD is estimated to be at most 7%.
• A much larger, more comprehensive study is required to accurately determine the risk of abnormal stress echocardiograms in KD survivors.
• Current findings suggest stress echocardiography may have limited utility in screening asymptomatic KD patients without known coronary artery issues.