Zilberman M V, Goya G, Witt S A, Glascock B, Kimball T R
Non-invasive Cardiac Imaging and Hemodynamic Research Laboratory, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, C-4, Cincinnati, OH 45229-3039, USA.
Pediatr Cardiol. 2003 Jul-Aug;24(4):338-43. doi: 10.1007/s00246-002-0327-9. Epub 2003 Jan 15.
There has been no consistent approach to the follow-up of Kawasaki disease patients for remote coronary perfusion abnormalities. Dobutamine stress echocardiography (DSE) has become a standard method for evaluation of perfusion abnormalities in adults with coronary artery disease. In addition, DSE has been used with success in some pediatric patients. The purposes of this study were to evaluate safety and accuracy of DSE in the follow-up of patients with Kawasaki disease, to evaluate whether DSE adds any additional value to the resting echocardiogram, and to determine the association of DSE results with American Heart Association (AHA) risk level categories. DSE was performed 1 month to 13 years after acute Kawasaki disease in 47 patients (range, 3.8-22.6 years; 33 males and 16 females). Patients were stratified according to AHA risk level categories (I-V). Ischemia was defined as a new or worsening regional wall motion abnormality or >1 mm ST segment depression on the electrocardiogram during DSE. In 45/47 patients, DSE was completed successfully (i.e., achievement of target heart rate or development of ischemia). No patients in risk levels lower than V (i.e., patients without coronary artery stenoses) had positive DSE, whereas 2/4 (50%) in the risk level V category had positive DSE, both of whom had coronary occlusion >50% confirmed by angiography. Of the 2 AHA risk level V patients with negative DSE, 1 had extensive collateralization and the other had coronary obstruction <50%. DSE is a safe and feasible method for the evaluation of children with Kawasaki disease. DSE provides a confirmatory benefit and may be a useful screening alternative to cardiac catheterization during follow-up. Patients in AHA risk levels I-IV are unlikely to have dobutamine-induced coronary perfusion abnormalities. Patients in the risk level V category may or may not have positive DSE depending on the degree of both coronary obstruction and collateralization.
对于川崎病患者的远期冠状动脉灌注异常，目前尚无统一的随访方法。多巴酚丁胺负荷超声心动图（DSE）已成为评估成人冠心病灌注异常的标准方法。此外，DSE在一些儿科患者中也取得了成功应用。本研究的目的是评估DSE在川崎病患者随访中的安全性和准确性，评估DSE相对于静息超声心动图是否具有额外价值，并确定DSE结果与美国心脏协会（AHA）风险水平分类之间的关联。对47例急性川崎病后1个月至13年的患者（年龄范围3.8 - 22.6岁；男33例，女16例）进行了DSE检查。根据AHA风险水平分类（I - V）对患者进行分层。缺血定义为DSE期间心电图上新出现或加重的局部室壁运动异常或ST段压低>1 mm。47例患者中有45例成功完成了DSE检查（即达到目标心率或出现缺血）。风险水平低于V级（即无冠状动脉狭窄的患者）中无DSE阳性患者，而V级风险水平的患者中有2/4（50%）DSE阳性，这2例患者经血管造影证实冠状动脉闭塞>50%。在2例DSE阴性的AHA风险水平V级患者中，1例有广泛侧支循环，另1例冠状动脉阻塞<50%。DSE是评估川崎病患儿的一种安全可行的方法。DSE具有确证作用，可能是随访期间替代心导管检查的一种有用的筛查方法。AHA风险水平I - IV级的患者不太可能出现多巴酚丁胺诱导的冠状动脉灌注异常。V级风险水平的患者DSE结果可能为阳性，也可能为阴性，这取决于冠状动脉阻塞程度和侧支循环情况。
