Cardiorespiratory fitness and exercise testing in patients with Kawasaki syndrome

P47 CARDIORESPIRATORY FITNESS AND EXERCISE TESTING IN PATIENTS WITH KAWASAKI SYNDROME Steven W. Allen, Elaine D. Daberkow, Lisa A. Harrigan, Robert R. Wolfe, Mary P. Glode, James W. Wiggins, University of Colorado Health Science Center, The Childrens Hospital, Denver, Colorado. Exercise studies in 32 male patients mean age 122 months(77252) with Kawasaki Syndrome(KS) were compared to age matched and James protocol matched controls (n=100). Aneurysms were detected in 11 patients with 24 vessels involved in the 11 patients. No patient in the study had aneurysms >8mm. The average time between diagnosis and testing was 64.8 months(I-141). All patients performed bicycle ergometry testing. Metabolic parameters were measured in 15 patients using mass spectrometry or metabolic cart. In these 15 patients anaerobic threshold could be determined in 10. T-test were performed to compare eardloresplratory fitness parameters of total work, mean power, resting heart rate, maximum heart rate, VO 2 maximum, VO 2 at ventilatory anaerobic threshold (VAT), heart rate at VAT and VAT as a percentage of total exercise time and VO 2 maximum. Patients demonstrated normal cardioresplratory fitnes~ by all fitness parameters, with two exceptions. James level I KS patients had lower resting heart rates (p =.01) and James protocol III showed increased total work compared to control.(p=.04) There were no clinically significant differences between KS patients with and without aneurysms. ST-T changes were noted in one patient during exercise testing and this patient underwent successful coronary bypass surgery. These results suggest normal cardiorespiratory fitness for patients post KS. Exercise testing is useful in diagnosing ischemie changes and should be preformed in patients with aneurysms following KS. The long term effect of aneurysms on cardiorespiratory fitness in KS patients remains to be determined.

P48 ECIIOCARDIOGRAPHIC DIAGNOSIS A N D S U R G I C A L TREATMENT OF G I A N T C O R O N A R Y A R T E R I A L A N E U R I S M S Manuela P Lima, S a s h i c a n t a Kaku, A n t 6 n i o J Macedo, F~tima F Pinto, Joe6 M Ramos, b~nuel P Magalhaes, Rui S Bento, Fernanda M Sampayo. Santa Marta Hospital,

Lisboa,

Portugal

A boy aged 2 years and ii months with Kawasaki disease was i n v e s t i g a t e d by 2D-Echo on 14th day of illness. Three giant aneurysms (GA) were seen: one (35x25mm) in the left coronary artery (CA) and two (18xl8mm and lOxl0mm) in the right CA. On 42nd day a thrombus o c c l u d i n g the left CA a n e u r y s m was seen on 2D-Echo. Selective coronary a n g i o g r a p h y (corangio) confirmed 2D-Echo fin dings and d i s c l o s e d o c c l u s i o n of the anterior descending CA. One year later, symptoms and signs of m y o c a r d i a l i s c h a e m i a led to surgery: m y o c a r dial r e v a s c u l a r i z a t i o n w i t h both internal mamma ry arteries (IMA) - right Ib~ was a n a s t o m o s e d to anterior d e s c e n d i n g CA and left IMA was a n a s t o mosed to o b t u s e m a r g i n a l b r a n c h of the left CA. Ten months after s u r g e r y the child is asytaptom~ tic and control c o r a n g i o d e m o n s t r a t e d p e r m e a b i lity of the grafts.

P50

P49 VERY LOW DOSE ACETYL SALICYLIC ACID IN THE ACUTE PHASE OF KAWASAKI DISEASE. Karen N Watanabe Duff),, Cia~n M Duffy, Julie D Paquin, Mare Paquet and Hanna Strawczynski, Montreal Children's Hospital and McGill University, Montreal, Quebec, CANADA. Intravenous gamrrmglobulin (IVGG) in high dosage (1.5 to 2 G~g, total dosage) in combination with acetyl salicylicacid (ASA) in high dosage (I00 mg/kg/day), administered during the acute phase of Kawasaki Disease 0(I)), reduces the incidence of coronary artery lesions(CAL) to 5-I0%, even though therapeuticlevelsof salicylateare not achieved. To determine whether the same effectcould be achieved with very low dosage (5 mg/kg/day) ASA in combination with high dosage (400 mg/kg/day x 4 days) IVGG, we administered this combination to allpatientsadmitted to our centre during the acute phase of KD and within 14 days of onset of fever, over the last 5 years. Patients were followed in accordance with a standard protocol, administered prospectively. 2D echocardiograrns were Performed serially. Sixty patients(37M, 23F), mean age 35.824- 2.5.85 (range 3 to 111) months, were treated with this combination. Mean total duration of fever was 8.78 4- 3.54 (range 5-14) days and mean duration of fever post commencement of therapy was 1.88 + 0.62 (range 1-15) days. Two patientshad documentation of CAL at disease onset. A further4 patlcnts had documentation of CAL at 1 month, for a totalcumulative incidence of CAL of 10%. Only 2 (3.33%) persisted to the 3 month follow up. None was evident at 6 months. Most CAL were dilatations only. Only I aneurysm was noted. Tnese data suggest thatthe administrationof high dosage ASA during the acute phase of KD to reduce the systemic manifestationsof KD and to prevent the development of CAL is not necessary. These effectscan be achieved by a combination of high dos,3.geIVGG and very low dosage ASA. This therapeutic approach removes the risk of toxicity associated with the administrationof high dose ASA.

TREATMENT OF KAWASAKI DISEASE WITH INTRAVENOUS ASPIRIN Tetsurow Umezawa, Norio Matsuo, Tsutomu Saji, Toshikazu Shinbo University Hospital,Mi zonokuchi Teikyo University School of Medicine Kanagawa, Japan We treated 41 Kawasaki disease patients with intravenous aspirin (IVASA), and evaluated the efficacy. Significant linear correlation was recognized between daily IVASA dosage and serum salicylate (SA) concentrations (r=O.81,p150 /~g/ml showed shorter duration of fever (6.5_+2.3 vs 10.9_+9.3 days,p<0.05),shorter duration of positive serum c-reactive protein (15.4_+4.7 vs 20.0_+9.8 days, p<0.01) and lower incidence of CAt (0/13 vs 7/28,NS) than did patients with serum SA concentrations <150 /~g/ml. No major complications were recognized. Based on these findings,we concluded that a beneficial anti-inflammatory effect and probable effect on preventing CAt are achieved when the serum SA concentration is ~ 150 /ig/ml,and that such concentrations could be achieved safely by increasing the daily IVASA dosage to I00 mg/k~'day or more.