Exercise stress echocardiographic assessment of myocardial function in paediatric patients with Kawasaki disease

Background: Kawasaki disease is an acute childhood vasculitis that may cause coronary artery aneurysms, raising concern for long-term myocardial dysfunction. Exercise stress echocardiography provides a noninvasive assessment of systolic and diastolic reserve, yet data comparing exercise responses in Kawasaki disease patients with contemporary coronary risk stratification are limited. Materials and methods: We retrospectively analysed exercise stress echocardiograms in patients with a history of Kawasaki disease-related coronary artery aneurysm (maximum coronary artery z -score ≥2.5) and age-matched controls without cardiac disease. Two-dimensional echocardiography was performed at rest and during early recovery following a standardised ergometer exercise test. Left ventricular and left atrial strain and mitral inflow velocities were measured. Within-group pre- and post-exercise changes were assessed using paired t -tests. Linear mixed-effects models evaluated differences in the magnitude of exercise-induced change between groups. Results: There were 34 and 27 patients in the Kawasaki disease and control cohorts, respectively. The Kawasaki disease cohort had a mean maximal coronary z -score of 3.8 ± 2.1. Both groups demonstrated significant pre- to post-exercise changes in left ventricular longitudinal strain and mitral A velocity. Additional systolic and diastolic parameter changes were observed within the Kawasaki disease cohort. Mixed-effects modelling revealed no significant differences in the magnitude of exercise-induced change between Kawasaki disease patients and controls. Conclusions: In paediatric patients with a remote history of Kawasaki disease and mild to moderate coronary artery aneurysms, exercise stress echocardiography demonstrated no differences in the magnitude of exercise-induced changes in systolic and diastolic indices compared to controls.