Exercise electrocardiogram for risk-based screening of severe residual coronary lesion in children after coronary surgery - 10/12/22
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Highlights |
• | Severe coronary lesion may occur gradually in children after coronary surgery. |
• | Maximal stress electrocardiogram offers excellent sensitivity for SCL detection. |
• | Risk markers of SCL are stress chest pain, intramural pathway and C-type pattern. |
• | Post-test positive probability of SCL in high-risk group exceeded 50%. |
Abstract |
Background |
Residual severe coronary artery (CA) lesion (SCL) in children after cardiac surgery involving the CA is a major concern.
Aim |
To evaluate the value of exercise electrocardiogram (eECG) for risk-based screening of SCL.
Methods |
We analysed 135 maximal eECG from 115 children (mean age 13.6±3.7 years) who underwent concomitant CA imaging. SCL was defined as a stenosis exceeding 50%.
Results |
Underlying congenital heart diseases were transposition of the great arteries (TGA) (n = 116), CA pathway anomaly (n = 13) and left CA from the pulmonary artery (n = 6). Eleven SCLs were identified in 10 patients, of which 3 had a known untreated non-severe lesion and 4 had no lesions on previous imaging. In multivariable analysis, risks markers for SCL were effort chest pain (OR: 4.72, 95% CI: 1.23−18.17; P=0.024), intramural pathway (OR: 4.37, 95% CI: 1.14−16.81; P=0.032). Yacoubs C-type CA was added as a risk marker for patients with TGA (P=0.0009). All patients with SCL had a positive eECG (sensitivity: 100%, 95% CI: 72−100). Specificity was 81% (95% CI: 73−87). In the low-risk group (0 risk markers), 3/95 patients had SCL (3%), and the post-test probability of SCL with positive eECG (PPr+) was 15% (95% CI: 8−21). In the high-risk group (≥1 risk marker) comprising 8/40 SCLs (20%), PPr+ was 53% (95% CI: 35−67).
Conclusions |
Most SCL tended to develop gradually, years after surgery. Provided it is near maximal, a negative eECG appears sufficient to exclude SCL. In the high-risk group, PPr+ exceeded 50%.
Le texte complet de cet article est disponible en PDF.Keywords : Paediatric, Coronary artery angioplasty, Exercise electrocardiogram, Risk stratification, Arterial switch
Plan
Vol 115 - N° 12
P. 656-663 - décembre 2022 Retour au numéro
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