Exercise stress echocardiographic assessment of myocardial function in paediatric patients with Kawasaki disease

Kawasaki disease is an acute childhood vasculitis that may cause coronary artery aneurysms, raising concern for long-term myocardial dysfunction. Exercise stress echocardiography provides a noninvasive assessment of systolic and diastolic reserve, yet data comparing exercise responses in Kawasaki disease patients with contemporary coronary risk stratification are limited.

We retrospectively analysed exercise stress echocardiograms in patients with a history of Kawasaki disease-related coronary artery aneurysm (maximum coronary artery z-score ≥2.5) and age-matched controls without cardiac disease. Two-dimensional echocardiography was performed at rest and during early recovery following a standardised ergometer exercise test. Left ventricular and left atrial strain and mitral inflow velocities were measured. Within-group pre- and post-exercise changes were assessed using paired t-tests. Linear mixed-effects models evaluated differences in the magnitude of exercise-induced change between groups.

There were 34 and 27 patients in the Kawasaki disease and control cohorts, respectively. The Kawasaki disease cohort had a mean maximal coronary z-score of 3.8 ± 2.1. Both groups demonstrated significant pre- to post-exercise changes in left ventricular longitudinal strain and mitral A velocity. Additional systolic and diastolic parameter changes were observed within the Kawasaki disease cohort. Mixed-effects modelling revealed no significant differences in the magnitude of exercise-induced change between Kawasaki disease patients and controls.

In paediatric patients with a remote history of Kawasaki disease and mild to moderate coronary artery aneurysms, exercise stress echocardiography demonstrated no differences in the magnitude of exercise-induced changes in systolic and diastolic indices compared to controls.