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Review
. 2023 Feb;44(2):381-387.
doi: 10.1007/s00246-022-03037-1. Epub 2022 Nov 16.

Exercise Stress Echocardiography in Kawasaki Disease Patients with Coronary Aneurysms

Bruke A Tedla  1 , Jane C Burns  2 , Adrianna H Tremoulet  2 , Chisato Shimizu  2 , John B Gordon  3 , Howaida El-Said  4 , Fraser Golding  4 , Christopher K Davis  4 , Kirsten B Dummer  4
Affiliations
Review

Exercise Stress Echocardiography in Kawasaki Disease Patients with Coronary Aneurysms

Bruke A Tedla et al. Pediatr Cardiol. 2023 Feb.

Abstract

The most significant sequelae of Kawasaki disease (KD) are coronary artery aneurysms, which can lead to risk of future myocardial ischemia. Exercise stress echocardiography allows for non-invasive assessment of myocardial dysfunction. We reviewed our single center experience with exercise stress echocardiography in patients with previous history of KD with coronary aneurysms. We reviewed the records of 53 KD patients who underwent exercise stress echocardiography from 2000 to 2020. Abnormal stress echocardiograms were defined as those showing no increase in biventricular systolic function post-exercise or regional wall motion abnormalities. Computed tomography angiography and cardiac magnetic resonance imaging were reviewed for patients with abnormal stress echocardiograms. Clinical data were reviewed and correlated with stress echocardiogram results. Of the 53 patients, three (5.7%) had an abnormal exercise stress echocardiogram. All three patients were classified as AHA Risk Level 4 or 5 by coronary Z-score (internal dimension normalized for body surface area) and were confirmed to have coronary aneurysms, stenosis, or myocardial tissue perfusion defects on advanced cardiac imaging that could account for the results seen on stress echocardiogram. Exercise stress echocardiography detected signs of myocardial ischemia in a subset of high-risk patients with Kawasaki disease and coronary aneurysms and may be considered as a useful screening tool for this complex patient cohort.

Keywords: Coronary aneurysms; Kawasaki; Stress echocardiography.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient risk level categories and exercise stress echocardiography. Distribution of patients with stress echocardiograms stratified by AHA Risk Level 1–5
Fig. 2
Fig. 2
Coronary artery imaging in three patients with abnormal stress echocardiograms. A Patient 1 with CTA performed in 14 years after KD diagnosis demonstrating a patent RIMA to RCA bypass (yellow arrow). B Patient 2 with CTA performed 9 years after diagnosis demonstrating multiple coronary aneurysms (yellow arrows). C Patient 3 with cardiac catheterization performed 6 years after diagnosis demonstrating a giant coronary aneurysm in LAD (yellow arrow)
Fig. 3
Fig. 3
Clinical timelines of patients with abnormal stress echocardiograms
See this image and copyright information in PMC

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