Exercise capacity and incidence of myocardial perfusion defects after Kawasaki disease in children and adolescents

Paridon, Stephen M.; Galioto, Frank M.; Vincent, Julie; Tomassoni, Teresa L.; Sullivan, Nancy; Bricker, J. Timothy

doi:10.1016/0735-1097(95)00003-m

Cited by 74 publications

(36 citation statements)

References 14 publications

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“…However, new evidence suggests that KD may result in long-term damage to the coronary microcirculation, even in the apparent absence of coronary involvement during the acute phase of the illness. 15,20 A study of this type has some limitations. The prevalence of older patients (9 years and older) in our study, compared with other series, may naturally reflect some selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…There have been reports describing the atypical nature of KD in infants 2,13 and, therefore, this group was considered separately. Because several large series have few patients older than 9 years of age, 6,14,15 this was chosen as the lower age limit for the older group.The mean and SEM or the median and range were calculated for all of the descriptive variables. Nominal data were analyzed using 2 analysis or the Fisher's exact test.…”

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confidence: 99%

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Kawasaki Disease in the Older Child

et al. 1998

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ABSTRACT. Objectives. To determine the prevalence of Kawasaki disease in older children and to evaluate its clinical presentation, time to diagnosis, and outcome in comparison with younger patients with the disease.Methodology. A retrospective analysis of all patients discharged with a diagnosis of Kawasaki disease at a pediatric tertiary care hospital over a 12-year period.Results. A total of 133 patients were included in this study; 7.5% were 9 years of age or older at the time of illness. Patients were grouped by age: infants included children age 1 to 8 years of age and children 9 years of age or older. Older children had a higher frequency of abnormal cardiovascular physical examination (50%) versus children (6%) and infants (10%). The older age group and the infants had a higher prevalence of coronary artery abnormalities and poor left ventricular function than did the 1-to 8-year-olds. Eighty percent of the older children had coronary arteries that were either dilated or aneurysmal, and 30% demonstrated left ventricular dysfunction on initial echocardiography. The number of days to diagnosis after meeting the diagnostic criteria was 5.8 ؎ 2.3 for infants, 5.2 ؎ 1.5 for older children, and 1.9 ؎ 0.3 for children. Older children had a complicated course of Kawasaki disease compared with younger patients.Conclusion. We found a higher prevalence of older children with Kawasaki disease at our center than has previously been reported. Older patients, as well as infants, had a higher rate of coronary artery abnormalities than did the children between 1 and 8 years of age. Older age at the time of illness or a delay in treatment may be important factors in determining cardiac involvement in Kawasaki disease. Pediatrics 1998;102(1). URL: http:// www.pediatrics.org/cgi/content/full/102/1/e7; Kawasaki disease, coronary arteries, intravenous immunoglobulin.ABBREVIATIONS. KD, Kawasaki disease; CVS, cardiovascular; ECG, electrocardiography; LV, left ventricular; WBC, white blood cells; ESR, erythrocyte sedimentation rate; IVIG, intravenous immunoglobulin; ASA, acetylsalicylic acid. S ince its first description in the Japanese literature in 1967, 1 much has been written about Kawasaki disease (KD). A systemic vasculitis, KD is characterized by fever, mucocutaneous manifestations, and musculoskeletal changes, and its most devastating effects are on the heart, particularly the coronary arteries. The etiology of KD remains unknown, and its presentation can be diverse.2,3 The illness usually affects infants and children younger than 3 years.1 KD is extremely uncommon in patients 9 years of age and older. 4 -6 The most recent epidemiologic survey from Japan found that Ͻ1% of cases occurred in children 9 years of age and older. 6 Our experience suggested that KD affecting older children was more common than reported previously. Our clinical impression was that most of the older patients were diagnosed late in the course of their illness and, consequently, had more morbidity associated with the illness. Of interest to us were...

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Section: Discussionmentioning

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Kawasaki Disease in the Older Child

et al. 1998

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“…Thallium ( 201 Tl) is often used, and technetium (Tc)-labeled myocardial perfusion agents (Tc-99m sestamibi, Tc-99m tetrofosmin) which are low in radioactive exposure and suitable for scintigraphy are also commonly used. 86, 87 Stress myocardial SPECT is an important method of diagnosis of coronary stenotic lesions after Kawasaki disease, and both exercise stress SPECT and pharmacological stress SPECT are commonly performed. [88][89][90][91][92][93] In addition to myocardial perfusion imaging techniques, …”

Section: Radionuclide Imagingmentioning

confidence: 99%

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2008) - Digest Version -

Group¹

2010

Circ J

159

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“…Regions of interest were defined on apical, anterior, lateral, and inferior walls. Based on the previously established criteria of Paridon, et al, 24) perfusion defect severity was graded as follows: normal = no perfusion defects; mildly decreased perfusion = ≥ 50% perfusion of the surrounding normal myocardium; moderately decreased perfusion = < 50% of the surrounding myocardium; severely decreased perfusion = near or complete absence of regional perfusion. Therefore, after a slight modification of their criteria, we defined a perfusion defect as when less than 50% of the surrounding myocardium (including moderate and severe perfusion defects) was observed.…”

Section: Patientsmentioning

confidence: 99%

<b>Technetium-99m Tetrofosmin Myocardial Perfusion Single Photon Emission Computed Tomography in Syndrome X</b>

Hsu¹,

Shiau

Kao³

et al. 2003

Jpn Heart J

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SUMMARYSyndrome X is used to describe patients with chest pain and a normal coronary angiogram. We reviewed technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion single photon emission computed tomography (SPECT) results and clinical data of 43 syndrome X patients and 30 healthy controls with normal left ventricular ejection fraction and no cardiac abnormalities. The Tc-99m TF myocardial perfusion SPECT results showed 12 (27.9%) syndrome X patients had normal myocardial perfusion and 31 (72.1%) had abnormal myocardial perfusion, including 6 (14.0%) patients with fixed defects, 20 (46.5%) patients with transient defects, and 5 (11.6%) patients with reverse defects. The results of exercise ECG were not related to perfusion defects in Tc-99m TF myocardial perfusion SPECT. In contrast, all of the 30 (100.0%) healthy controls had normal myocardial perfusion SPECT results. We conclude that abnormal Tc-99m TF myocardial perfusion SPECT is common in syndrome X and does not correlate well with the exercise ECG. However, further studies with larger case numbers and long term follow up in patients with myocardial events are necessary to support our findings. (Jpn Heart J 2003; 44: 153-162) Key words: Technetium-99m teterfosmin, Single photon emission computed tomography, Syndrome X SOME 20%-30% of all patients undergoing coronary angiography have normal or near-normal coronary arteries.1) In 1973, Kemp 2) introduced the term syndrome X to describe patients with chest pain and a normal coronary angiogram. Thallium-201 (Tl-201) myocardial perfusion imaging has been employed in the investigation of patients with syndrome X, and often shows regional defects of tracer uptake after stress. [3][4][5] However, the physical limitations of the lower energy emisFrom the

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Exercise capacity and incidence of myocardial perfusion defects after Kawasaki disease in children and adolescents

Abstract: Maximal oxygen consumption is normal after Kawasaki disease regardless of coronary artery status. Stress-induced perfusion defects are frequent even in the absence of coronary abnormalities and are common in the absence of ST segment changes suggestive of ischemia.

Cited by 74 publications

References 14 publications

Kawasaki Disease in the Older Child

Kawasaki Disease in the Older Child

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2008) - Digest Version -

<b>Technetium-99m Tetrofosmin Myocardial Perfusion Single Photon Emission Computed Tomography in Syndrome X</b>

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