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Multimodality Approach to Coronary Ischemic Testing in Pediatric Patients: A Scientific Statement From the American

Laura J Olivieri, Simon Lee, Ming Hui Chen

    Journal of the American Heart Association
    |February 26, 2026
    PubMed

    Insights

    Provocative ischemic testing is crucial for diagnosing pediatric coronary issues like Kawasaki disease. Further research is needed to optimize these tests for children with complex heart conditions.

    Area of Science:

    • Pediatric Cardiology
    • Diagnostic Imaging
    • Cardiovascular Research

    Background:

    • Emerging research highlights the importance of provocative and ischemic coronary testing in pediatric cardiovascular conditions.
    • Guidelines now recommend these tests for various acquired and congenital coronary issues, including Kawasaki disease and multisystem inflammatory syndrome in children.
    • There is a recognized need for specialized and well-considered provocative ischemic testing strategies in pediatric cardiology.

    Purpose of the Study:

    • To review the evidence-based guidelines and scientific statements recommending provocative ischemic testing in children.
    • To explore the strengths and limitations of different testing modalities and provocative agents in pediatric populations.
    • To provide evidence-based adaptations and recommendations for optimizing the use of provocative ischemic testing in children.

    Main Methods:

    • Literature review of evidence-based guidelines and scientific statements.
    • Analysis of existing research on provocative ischemic testing modalities and agents in children.
    • Synthesis of data to formulate recommendations for clinical practice and future research.

    Main Results:

    • Provocative ischemic testing is increasingly recommended for pediatric conditions such as Kawasaki disease, multisystem inflammatory syndrome in children, anomalous aortic origin of coronary arteries, cardiac allograft vasculopathy, and post-surgical congenital heart disease.
    • The study examines the efficacy and limitations of various testing methods and agents specifically in the pediatric population.
    • Evidence-based adaptations are identified to enhance the utility of these diagnostic tools in children.

    Conclusions:

    • There is a clear and growing need for targeted provocative ischemic testing in pediatric cardiology.
    • Further understanding and development of these testing modalities are essential for the pediatric cardiac imaging community.
    • Optimizing the use of current provocative ischemic testing technologies and informing future advancements are critical priorities.

    Keywords:
    AHA scientific statementsanomalous coronary arterycardiac imaging techniquescongenital heart defectscoronary artery diseasemucocutaneous lymph node syndrome

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