儿童川崎病冠状动脉病变心肌缺血的评估

Assessment for myocardial ischemia related to coronary artery abnormalities in children with Kawasaki disease

合并冠状动脉瘤的川崎病患儿需定期接受心肌缺血的评估。血液标志物和静息心电图在有心肌缺血症状的儿童中可能异常,而负荷试验有助于早期发现无症状的心肌缺血儿童,其选择取决于不同医疗机构的经验和患儿的年龄。运动平板试验在国内应用广泛,但敏感度不及其他负荷影像学检查。多巴酚丁胺负荷超声心动图和药物负荷核素心肌灌注显像均有较高敏感度,后者在儿科临床实用可行,值得广泛推广。负荷磁共振心肌显像也是一种很有前途的新技术。

The patients with a history of Kawasaki disease and coronary artery aneurysms should be regularly evaluated for myocardial ischemia.Blood biomarkers and rest electrocardiogram may be abnormal in children with symptoms of myocardial ischemia,and stress testing is more helpful in early detection of inducible ischemia in those asymptomatic children.The choice of stress testing modality mainly depends on institutional expertise and the age of the child.Treadmill exercise testing,which is widely carried out in China,is less sensitive than stress imaging modalities in detecting inducible ischemia.Dobutamine stress echocardiography and pharmacologic stress radionuclide myocardial perfusion imaging have shown high sensitivity to detect inducible ischemia,and the latter is more practicable in pediatric clinic and is worthy of promotion.Stress myocardial magnetic resonance imaging is also a new promising technology.