Key result
Peak WMSI ≥1.25 on DSE is linked to a ~3-fold increase in MACE after Kawasaki disease.
Why the study?
The prognostic value of dobutamine stress echocardiography to predict cardiac events in adolescent Kawasaki disease patients with coronary artery lesions was unknown.
Does dobutamine stress echocardiography predict long-term major adverse cardiac events in adolescent patients with Kawasaki disease?
Cohort (n=58)
Does dobutamine stress echocardiography predict long-term major adverse cardiac events in adolescent patients with Kawasaki disease?
Relative Risk: 3.28 (95% CI 1.73–6.2)
Dobutamine stress echocardiography provides independent prognostic information for predicting major adverse cardiac events up to 15 years in adolescent survivors of Kawasaki disease.
OBJECTIVES: 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). BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: DSE provided independent prognostic information up to 15 years in adolescent KD survivors.
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Noto et al. (2013) conducted a cohort in Kawasaki disease with coronary artery lesions (n=58). Peak wall motion score index (WMSI) ≥1.25 on dobutamine stress echocardiography vs. WMSI <1.25 was evaluated on Major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and revascularization) (RR 3.28, 95% CI 1.73-6.20). A peak wall motion score index ≥1.25 on dobutamine stress echocardiography independently predicted major adverse cardiac events in adolescent Kawasaki disease survivors (RR 3.28; 95% CI 1.73-6.20).
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