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The feasibility of high-dose dobutamine stress echocardiography in children

Published online by Cambridge University Press:  19 August 2008

Elfriede Pahl ,
Dale Chrystof ,
Catherine L. Webb ,
Stanford T. Shulman  and
Farooq A. Chaudhry
Elfriede Pahl*
Affiliation:
Divisions of Cardiology and Infectious Disease, Department of Pediatrics (E.P., D.C., C.L.W., S.T.T.), The Children's Memorial Hospital and the Department of Medicine (F.C.), Northwestern University Medical School, Chicago, Il.
Dale Chrystof
Affiliation:
Divisions of Cardiology and Infectious Disease, Department of Pediatrics (E.P., D.C., C.L.W., S.T.T.), The Children's Memorial Hospital and the Department of Medicine (F.C.), Northwestern University Medical School, Chicago, Il.
Catherine L. Webb
Affiliation:
Divisions of Cardiology and Infectious Disease, Department of Pediatrics (E.P., D.C., C.L.W., S.T.T.), The Children's Memorial Hospital and the Department of Medicine (F.C.), Northwestern University Medical School, Chicago, Il.
Stanford T. Shulman
Affiliation:
Divisions of Cardiology and Infectious Disease, Department of Pediatrics (E.P., D.C., C.L.W., S.T.T.), The Children's Memorial Hospital and the Department of Medicine (F.C.), Northwestern University Medical School, Chicago, Il.
Farooq A. Chaudhry*
Affiliation:
Divisions of Cardiology and Infectious Disease, Department of Pediatrics (E.P., D.C., C.L.W., S.T.T.), The Children's Memorial Hospital and the Department of Medicine (F.C.), Northwestern University Medical School, Chicago, Il.
*
Elfriede Pahl, MD, Division of Cardiology, The Children's Memorial Hospital, 2300 Children's Plaza, Box 21, Chicago, IL60614, 312/880-4553 (ph), 312/880-8111 (fax), email address: epahl@nwu.edu
Farooq A. Chaudhry, MD, 250 East Superior, Suite 520, Chicago, IL60611, 312/908-4963 (ph), 312/908-8133 (fax).
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Abstract

We recently reported our experience with exercise stress echocardiography in children with prior history of Kawasaki disease and coronary arterial involvement. Dobutamine stress echocardiography has been used in adults (doses up to 50 μg/kg/min) for diagnosis and risk stratification of coronary arterial disease. To date, no studies have assessed the safety and utility of high-dose dobutamine for the detection of abnormalities of wall motion in children, although low dose dobutamine (5 μg/kg/min) has been used to assess left ventricular function after use of anthracycline in children. Our study group consisted of 10 children known to have Kawasaki disease, and 16 children who had undergone heart transplantation. After baseline transthoracic echocardiographic imaging, dobutamine was infused in an incremental fashion, 10–40 μg/kg/min intravenously, to attain peak heart rate. Heart rate and blood pressure were monitored continuously, and 4 standard echocardiographic images were acquired at each stage of dobutamine infusion and at recovery. Images were digitized, and the left ventricular segments were reviewed to assess wall motion. No patients suffered serious side effects such as arrhythmias or hypotension. Studies were complete in all 26 patients. One study proved positive, with a new abnormality of wall motion identified corresponding to a critical right coronary arterial stenosis. Peak heart rate and blood pressure were similar for the 2 groups. High dose dobutamine stress echocardiography, therefore, is feasible and safe in children, and may detect flow-limiting coronary arterial stenoses noninvasively. The technique may safely be applied to other subsets of children where assessment of ischemia and contractile reserve is warranted.

Keywords

Dobutaminestrees echocardiographychildrenKawasakitransplant
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 56 - 62
Copyright
Copyright © Cambridge University Press 1997

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