Long term outcome of Kawasaki disease using dobutamine stress echocardiography

Objectives: Dobutamine stress echocardiography (DSE) was used in conjunction with a rigorous education program to promote awareness and provide early detection of the sequelae of this disease. Methods: DSE was performed in 10 volunteers recalled at random from our Kawasaki registry. None of the patients (pts) had coronary abnormalities at any stage of the illness. We used 6 minute stages of increasing dobutamine infusions of 5, 10, 20, 30, and 40 mcg/kg/min. Indices of left ventricular function were measured at rest, each stage of infusion, and during recovery. Findings: The average age at the time of DSE was 14.4 years (range 7.7-22.1), and the average interval from disease to the time of study was 10.3 years (range 6.7-14.8). At baseline: 70% of pts had increased end systolic wall stress with a mean of 67.8 gm/cm² (normal 47.5 +/- 7 range 40.6-92.3); 50% of pts had increased mean velocity of circumferential fiber shortening with a patient mean of 1.16 circ/sec (normal 1.05 +/-.08 range 0.95-1.42); 50% of pts had decreased left ventricular mass with a mean of 57.6 gm/m² (normal 74 +/-20 range 25.1-88.4); and 80% of pts had increased or slightly increased stress velocity relationships. At maximum dobutamine infusion, all pts demonstrated elevated stress velocity relationships indicating good ventricular systolic reserve. Only one of the pts had wall motion abnormalities with lack of thickening of the posterior wall. Conclusion: We detected abnormalities of wall stress and mass while systolic function was normal and abnormal wall motion uncommon.