Genma Y, Ogawa S, Zhang J, Yamamoto M
Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
Cardiovasc Res. 1997 Dec;36(3):323-9. doi: 10.1016/s0008-6363(97)00196-x.
To determine the possibility of diagnosing myocardial ischemia from signal-averaged electrocardiographic late potentials (LPs) in patients with Kawasaki disease.
Dobutamine stress LPs were obtained in 85 children with a history of Kawasaki disease (48 without coronary artery lesions, 19 with coronary artery lesions without myocardial ischemia, and 18 with myocardial ischemia). The infusion of dobutamine was started at 5 micrograms/kg/min, increased to 30 micrograms/kg/min. The presence of LPs was determined by the filtered QRS duration, the root mean square voltage during the last 40 ms, and the duration of the signal under 40 microV.
Among the children without coronary lesions, LPs were detected in 4.2% at rest and in 2.1% with dobutamine stress. Among the group with coronary lesions but without ischemia, LPs were found in 5.3% at rest and in 5.3% with stress. In the group with ischemia, LPs were present in 44.4% at rest and in 77.8% with stress. The sensitivity for myocardial ischemia was 72.7% at rest and 87.5% with stress (p < 0.05), and the specificity was 86.5% at rest and 94.2% with stress.
LPs associated with dobutamine stress testing are useful for identifying myocardial ischemia in children with Kawasaki disease, especially in those who cannot tolerate testing involving physical exercise.
确定从川崎病患者的信号平均心电图晚期电位（LPs）诊断心肌缺血的可能性。
对85例有川崎病病史的儿童进行多巴酚丁胺负荷试验LPs检测（48例无冠状动脉病变，19例有冠状动脉病变但无心肌缺血，18例有心肌缺血）。多巴酚丁胺输注起始剂量为5微克/千克/分钟，逐渐增加至30微克/千克/分钟。通过滤波后的QRS波时限、最后40毫秒的均方根电压以及40微伏以下信号的持续时间来确定LPs的存在。
在无冠状动脉病变的儿童中，静息时LPs检测阳性率为4.2%，多巴酚丁胺负荷试验时为2.1%。在有冠状动脉病变但无缺血的组中，静息时LPs检测阳性率为5.3%，负荷试验时为5.3%。在有缺血的组中，静息时LPs检测阳性率为44.4%，负荷试验时为77.8%。静息时心肌缺血的敏感性为72.7%，负荷试验时为87.5%（p<0.05），特异性静息时为86.5%，负荷试验时为94.2%。
多巴酚丁胺负荷试验相关的LPs有助于识别川崎病患儿的心肌缺血，特别是那些不能耐受体育锻炼相关检查的患儿。
