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Exercise myocardial perfusion stress testing in children with Kawasaki disease
Chee Wen Terence Lim1, Kheng Thye Ho, Swee Chye Quek
1Department of Paediatrics, National University Hospital, Singapore, Singapore.
Insights
Exercise myocardial perfusion stress testing is safe and effective for assessing heart function in children with a history of Kawasaki disease, aiding in coronary risk stratification.
Area of Science:
- Pediatric Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Kawasaki disease is a leading cause of acquired coronary artery disease in children.
- Traditional assessments like echocardiography and treadmill stress testing have limitations in evaluating myocardial perfusion and performance.
- There is a need for advanced methods to assess coronary health in pediatric patients post-Kawasaki disease.
Purpose of the Study:
- To evaluate the safety and utility of exercise myocardial perfusion stress testing in children with a history of Kawasaki disease.
- To compare the findings of myocardial perfusion scans with clinical and echocardiographic data.
- To determine the role of this technique in coronary risk stratification for these patients.
Main Methods:
- Eleven pediatric patients with a history of Kawasaki disease underwent 99mTechnetium-Tetrofosmin myocardial perfusion scans.
- A modified exercise protocol was employed, with all participants being asymptomatic and in New York Heart Association class 1.
- Results were correlated with existing clinical and echocardiographic findings.
Main Results:
- The exercise myocardial perfusion stress test was safely completed by all subjects without adverse events.
- Ten out of eleven patients, including one with a prior myocardial infarction, showed normal test results.
- A single patient exhibited a minor, fixed defect in the left ventricular wall on the scan.
Conclusions:
- Exercise myocardial perfusion stress testing is a safe and valuable tool for assessing myocardial perfusion in children with a history of Kawasaki disease.
- This technique serves as a useful adjunct to conventional methods for coronary risk stratification in this pediatric population.
- The study supports the integration of advanced imaging for comprehensive cardiovascular assessment in post-Kawasaki disease patients.
Aim:
Kawasaki disease is the commonest cause of acquired coronary artery disease in children. Although echocardiography and treadmill stress testing have been the traditional methods of assessing coronary artery abnormalities and detecting myocardial ischaemia, respectively, these are inadequate for assessing perfusion and performance. We studied the safety and utility of exercise myocardial perfusion stress testing in children with previous Kawasaki disease.
Methods:
Eleven subjects (median age 12 years; seven male and four female adolescents) with a history of childhood Kawasaki disease underwent 99mTechnetium-Tetrofosmin myocardial perfusion scan using a modified protocol. All had New York Heart Association effort tolerance class 1 and were asymptomatic at time of testing. Eight of 11 subjects had been treated with intravenous immunoglobulin during the acute phase. Six of 11 subjects had transient coronary artery dilatation. One subject with persistently dilated coronary arteries suffered an acute myocardial infarction 6 months after onset of Kawasaki disease but recovered well. Results were compared with clinical and echocardiographic findings.
Results:
All subjects were able to complete the exercise test. There were no side effects associated with radioisotope injection. Ten of 11 patients, including the one who suffered a myocardial infarction had normal tests. The single subject with an abnormal scan showed a minimal (2%) fixed defect in the left ventricular wall.
Conclusion:
Exercise myocardial perfusion stress is a safe and useful method for the assessment of myocardial perfusion in co-operative children with a history of Kawasaki disease and is a useful addition to conventional methods for coronary risk stratification in such patients.
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