title: Cardiovascular Response to Exercise Testing in Children and Adolescents Late After Kawasaki Disease According to Coronary Condition Upon Onset.
abstract: Multiple cardiovascular sequelae have been reported late after Kawasaki disease (KD), especially in patients with coronary artery lesions. In this perspective, we hypothesized that exercise response was altered after KD in patients with coronary aneurysms (CAA-KD) compared to those without history of coronary aneurysms (NS-KD). This study is a post hoc analysis of exercise data from an international multicenter trial. A group of 133 CAA-KD subjects was compared to a group of 117 NS-KD subjects. Subjects underwent a Bruce treadmill test followed to maximal exertion. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed at each stage of the test including recovery. Myocardial perfusion was evaluated by stress and rest Tc-99m sestamibi SPECT imaging. Endurance time was similar between NS-KD and CAA-KD (11.3 ± 2.6 vs. 11.0 ± 2.6 min; p = 0.343). HR, SBP, and DBP responses to exercise were similar between groups (p = 0.075-0.942). Myocardial perfusion defects were present in 16.5 % CAA-KD versus 22.2 % NS-KD (p = 0.255). Analysis based on myocardial perfusion status identified a lower heart rate at 1 min into recovery as well as lower DBP at 1 and 5 min into recovery in patients with abnormal SPECT imaging (p = 0.017-0.042). Compared to patients without CA involvement, the presence of coronary aneurysms at the subacute phase of KD does not induce a differential effect on exercise parameters. In contrast, exercise-induced myocardial perfusion defect late after the onset of KD correlates with abnormal recovery parameters.
authors.affiliation: CHU Sainte-Justine Research Center, Montreal, QC, Canada. hugo.gravel@umontreal.ca.|Department of Kinesiology, Université de Montréal, 2100 Édouard-Montpetit, Office 8202, Montreal, QC, H3C 3J7, Canada. hugo.gravel@umontreal.ca.
authors.forename: Hugo
authors.initials: H
authors.lastname: Gravel
authors.affiliation: CHU Sainte-Justine Research Center, Montreal, QC, Canada.|Department of Kinesiology, Université de Montréal, 2100 Édouard-Montpetit, Office 8202, Montreal, QC, H3C 3J7, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Curnier
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.|Centre de Recherche Clinique Étienne-Le Bel, Sherbrooke, QC, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dallaire
authors.affiliation: CHU Sainte-Justine Research Center, Montreal, QC, Canada.|Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Fournier
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Portman
authors.affiliation: CHU Sainte-Justine Research Center, Montreal, QC, Canada.|Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC, Canada.
authors.forename: Nagib
authors.initials: N
authors.lastname: Dahdah
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D015444:Exercise / Q000502:physiology; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: Aneurysm; Exercise; Kawasaki disease; Myocardial perfusion