Dobutamine stress surface mapping of myocardial ischemia in Kawasaki disease.

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.