Pediatric Cardiology

, Volume 24, Issue 4, pp 338–343

Dobutamine Stress Echocardiography in the Evaluation of Young Patients with Kawasaki Disease

  • M. V. Zilberman
  • G. Goya
  • S. A. Witt
  • B. Glascock
  • T. R. Kimball
Original Article


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.


Dobutamine stress echocardiography Kawasaki disease 


  1. 1.
    Akagi, T, Rose, V, Benson, LN, Newman, A, Freeman, RM 1992Outcome of coronary artery aneurysms after Kawasaki disease.J Pediatr121689694PubMedGoogle Scholar
  2. 2.
    Allen, SW, Shaffer, EM, Harrigan, LA,  et al. 1992Maximal voluntary work and cardiorespiratory fitness in patients who have had Kawasaki syndrome.J Pediatr121221225PubMedGoogle Scholar
  3. 3.
    American Society of Echocardiography Committee on Standards, Sub-Committee on Quantification of 2-Dimensional Echocardiograms1989Recommendations for quantification of the left ventricle by 2-dimensional echocardiography.J Am Soc Echocardiogr2358367PubMedGoogle Scholar
  4. 4.
    Dadiani, AS, Taubert, KA, Takahashi, M,  et al. 1994Guidelines for long-term management of patients with Kawasaki disease.Circulation89916922PubMedGoogle Scholar
  5. 5.
    Genma, Y, Ogawa, S, Zhang, J, Yamamoto, Y 1997Evaluation of myocardial ischemia in Kawasaki disease by dobutamine stress signal-average ventricular late potentials.Cardiovasc Res36323329CrossRefPubMedGoogle Scholar
  6. 6.
    Hamaoka, K, Onouchi, Z, Kamiya, Y, Sakata, K 1998Evaluation of coronary flow velocity dynamics and flow reserve in patients with Kawasaki disease by means of Doppler guide wire.J Am Coll Cardiol31833840CrossRefPubMedGoogle Scholar
  7. 7.
    Hino, Y, Ohkubo, T, Katsube, Y, Ogawa, S 1999Changes in endothelium-derived vascular regulatory factors during dobutamine stress-induced silent ischemia in patients with Kawasaki disease.Jpn Circ J63503508CrossRefPubMedGoogle Scholar
  8. 8.
    Kato, H, Sugamura, T, Akagi, T,  et al. 1994Long-term consequences of Kawasaki disease. A 10 to 21 year follow-up study of 594 patients.Circulation9413791385Google Scholar
  9. 9.
    Kimball, TR, Witt, SA, Daniels, SR 1997Dobutamine stress echocardiography in the assessment of suspected myocardial ischemia in children and young adults.Am J Cardiol9518371843Google Scholar
  10. 10.
    Larsen, RL, Applegate, PM, Dyar, DA,  et al. 1998Dobutamine stress echocardiography for assessing coronary artery disease after transplantation in children.J Am Coll Cardiol30512515Google Scholar
  11. 11.
    Mertes, H, Sawada, SG, Ryan, T,  et al. 1993Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography: experience in 1118 patients.Circulation881519PubMedGoogle Scholar
  12. 12.
    Muzik, O, Paridon, SM, Singh, TP,  et al. 1996Quantification of myocardial blood flow and flow reserve in children with history of Kawasaki disease and normal coronary arteries using positron emission tomography.J Am Coll Cardiol28757762CrossRefPubMedGoogle Scholar
  13. 13.
    Newburger, JW, Takahashi, M, Burns, JC,  et al. 1986The treatment of Kawasaki syndrome with intravenous gammaglobulin.N Engl J Med315341347PubMedGoogle Scholar
  14. 14.
    Noto, N, Ayusawa, M, Karasawa, K,  et al. 1996Dobutamine stress echocardiography for detection of coronary artery stenosis in children with Kawasaki disease.J Am Coll Cardiol2712511256CrossRefPubMedGoogle Scholar
  15. 15.
    Pahl, E, Segal, R, Chrystof, D,  et al. 1995Feasibility of exercise stress echocardiography for the follow up of children with coronary involvement secondary to Kawasaki disease.Circulation91122128PubMedGoogle Scholar
  16. 16.
    Paridon, SM, Ross, RD, Kuhns, LR, Pinsky, WW 1990Myocardial performance and perfusion during exercise in patients with coronary artery disease caused by Kawasaki disease.J Pediatr1165256PubMedGoogle Scholar
  17. 17.
    Sawada, SG, Segar, DS, Ryan, T,  et al. 1991Echocardiographic detection of coronary artery disease during dobutamine infusion.Circulation8316051614PubMedGoogle Scholar
  18. 18.
    Segar, DS, Brown, SE, Sawada, SG, Ryan, T, Feigenbaum, H 1992Dobutamine stress echocardiography: correlation with coronary lesion severity as determined by quantitative angiography.J Am Coll Cardiol1911971202PubMedGoogle Scholar
  19. 19.
    Suzuki, A, Yamagishi, M, Kimura, K,  et al. 1996Functional behavior and morphology of the coronary artery wall in patients with Kawasaki disease assessed by intravascular ultrasound.J Am Coll Cardiol27291296CrossRefPubMedGoogle Scholar
  20. 20.
    Yamakawa, R, Ishii, M, Sugimura, T,  et al. 1998Coronary endothelial dysfunction after Kawasaki disease evaluation by intracoronary injection of acetylcholine.J Am Coll Cardiol3110741080CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • M. V. Zilberman
    • 1
  • G. Goya
    • 1
  • S. A. Witt
    • 1
  • B. Glascock
    • 1
  • T. R. Kimball
    • 1
  1. 1.Non-invasive Cardiac Imaging and Hemodynamic Research LaboratoryCincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, C-4, Cincinnati, OH, 45229-3039USA

Personalised recommendations