Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
J Am Coll Cardiol. 2014 Feb 4;63(4):337-44. doi: 10.1016/j.jacc.2013.09.021. Epub 2013 Oct 16.
This study sought to determine the prognostic value of dobutamine stress echocardiography (DSE) over a 15-year follow-up for predicting cardiac events in adolescent Kawasaki disease (KD) patients with coronary artery lesions (CALs).
Although DSE is an established technique for the detection of coronary artery disease, its prognostic value to predict cardiac events in adolescent KD patients with CALs is unknown.
Fifty-eight adolescent KD patients, including 36 patients with CALs documented by coronary angiography, and 22 patients with normal coronary arteries documented by echocardiography who underwent DSE were reviewed at initial testing (mean age: 13.6 years) and at 15 years' follow-up. Follow-up events were tabulated as major adverse cardiac events (MACEs) that included cardiac death, nonfatal myocardial infarction, and revascularization.
During a mean follow-up of 14.7 years, there were 16 patients with MACEs (acute myocardial infarction: n = 1; old myocardial infarction: n = 7; coronary artery bypass grafting: n = 4; percutaneous coronary intervention: n = 4). Significant coronary artery disease (CAD) (>70% coronary stenosis) was detected in 31.0% of patients at initial testing and 42.1% at follow-up. However, there were no significant differences in wall motion score indices (WMSI) at peak DSE between initial testing and follow-up (p = 0.762). Five of 6 patients (85%) with false-positive DSE results (WMSI: ≥1.25) at initial testing, who had giant aneurysms without CAD, developed CAD with MACEs during follow-up. Cumulative event-free survival rate to 15 years was 25.0% in patients with WMSI ≥1.25 and 91.7% in patients with WMSI <1.25. Cox regression analysis showed the grade of peak WMSI at initial testing to be the only independent predictor of MACEs (relative risk: 3.28; 95% confidence interval: 1.73 to 6.20).
DSE provided independent prognostic information up to 15 years in adolescent KD survivors.
本研究旨在通过 15 年的随访，探讨多巴酚丁胺负荷超声心动图（DSE）对预测川崎病（KD）合并冠状动脉病变（CAL）青少年患者心脏事件的预后价值。
尽管 DSE 是一种用于检测冠状动脉疾病的成熟技术，但它对预测青少年 KD 合并 CAL 患者心脏事件的预后价值尚不清楚。
对 58 例青少年 KD 患者进行回顾性分析，其中 36 例患者经冠状动脉造影证实存在 CAL，22 例患者经超声心动图证实存在正常冠状动脉，所有患者均在初始检查（平均年龄：13.6 岁）和 15 年随访时接受 DSE。随访事件以主要不良心脏事件（MACE）为指标，包括心脏性死亡、非致死性心肌梗死和血运重建。
在平均 14.7 年的随访期间，16 例患者发生 MACE（急性心肌梗死：n=1；陈旧性心肌梗死：n=7；冠状动脉旁路移植术：n=4；经皮冠状动脉介入治疗：n=4）。初始检查时，31.0%的患者存在显著冠状动脉疾病（CAD）（>70%的冠状动脉狭窄），随访时为 42.1%。然而，峰值 DSE 时的室壁运动评分指数（WMSI）在初始检查和随访时无显著差异（p=0.762）。6 例（85%）初始检查时 DSE 结果为假阳性（WMSI：≥1.25）、伴有巨大动脉瘤但无 CAD 的患者，在随访期间发展为伴有 MACE 的 CAD。初始检查时 WMSI≥1.25 的患者 15 年无事件生存率为 25.0%，而 WMSI<1.25 的患者为 91.7%。Cox 回归分析显示，初始检查时峰值 WMSI 分级是唯一独立预测 MACE 的因素（相对危险比：3.28；95%置信区间：1.73 至 6.20）。
DSE 为 KD 幸存者提供了长达 15 年的独立预后信息。
