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Cardiovascular Research 1997 36(3):323-329; doi:10.1016/S0008-6363(97)00196-X
© 1997 by European Society of Cardiology
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Copyright © 1997, European Society of Cardiology

Evaluation of myocardial ischemia in Kawasaki disease by dobutamine stress signal-averaged ventricular late potentials

Yukiko Genma, Shunichi Ogawa*, Jiakun Zhang and Masao Yamamoto

Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113, Japan

* Corresponding author. Tel.: (+81-3) 3822 2131 ext. 744; Fax: (+81-3) 5685 1792.

Objective: To determine the possibility of diagnosing myocardial ischemia from signal-averaged electrocardiographic late potentials (LPs) in patients with Kawasaki disease. Methods: Dobutamine stress LPs were obtained in 85 children with a history of Kawasaki disease (48 without coronary artery lesions, 19 with coronary artery lesions without myocardial ischemia, and 18 with myocardial ischemia). The infusion of dobutamine was started at 5 µg/kg/min, increased to 30 µg/kg/min. The presence of LPs was determined by the filtered QRS duration, the root mean square voltage during the last 40 ms, and the duration of the signal under 40 µV. Results: Among the children without coronary lesions, LPs were detected in 4.2% at rest and in 2.1% with dobutamine stress. Among the group with coronary lesions but without ischemia, LPs were found in 5.3% at rest and in 5.3% with stress. In the group with ischemia, LPs were present in 44.4% at rest and in 77.8% with stress. The sensitivity for myocardial ischemia was 72.7% at rest and 87.5% with stress (p<0.05), and the specificity was 86.5% at rest and 94.2% with stress. Conclusion: LPs associated with dobutamine stress testing are useful for identifying myocardial ischemia in children with Kawasaki disease, especially in those who cannot tolerate testing involving physical exercise.

KEYWORDS Signal-averaged electrocardiography; Dobutamine stress test; Myocardial ischemia; Kawasaki disease


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