Advanced Cardiac Imaging Techniques for Detection of Myocardial Ischemia in Children with Coronary Artery Abnormalities.

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiology and Therapy Pub Date : 2026-09-01 Epub Date: 2026-08-07 DOI:10.1007/s40119-026-00469-1
Justin B Jin, Jason L Williams, Siew May Wang, Simon Lee
{"title":"Advanced Cardiac Imaging Techniques for Detection of Myocardial Ischemia in Children with Coronary Artery Abnormalities.","authors":"Justin B Jin, Jason L Williams, Siew May Wang, Simon Lee","doi":"10.1007/s40119-026-00469-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery disease in children arises from a diverse group of non-atherosclerotic conditions that may result in myocardial ischemia, ventricular dysfunction, and sudden cardiac death. Important etiologies include post-inflammatory vasculopathy following Kawasaki disease, transplant-related cardiac allograft vasculopathy, congenital coronary anomalies such as anomalous aortic origin of a coronary artery, and complications after coronary reimplantation during congenital heart surgery. The detection of myocardial ischemia in children is uniquely challenging, as symptoms are frequently absent or atypical, and traditional screening tools such as resting electrocardiography and transthoracic echocardiography lack sufficient sensitivity.</p><p><strong>Methods: </strong>A narrative review was performed of the literature on non-invasive myocardial ischemia evaluation in pediatric patients with acquired and congenital coronary artery disease, focusing on Kawasaki disease, congenital coronary anomalies, cardiac allograft vasculopathy, and postoperative conditions involving coronary artery manipulation. PubMed and Google Scholar were searched and supplemented by reference lists and guideline documents. Original studies, reviews, consensus statements, and society guidelines were qualitatively synthesized by disease category and imaging modality, with emphasis on diagnostic performance, clinical applications, safety considerations, limitations, and evidence gaps.</p><p><strong>Results: </strong>Multimodality imaging plays a central role in the evaluation of pediatric coronary pathology. Stress echocardiography provides a widely available, radiation-free method for detecting inducible regional wall motion abnormalities but requires specialized expertise. Stress perfusion cardiac magnetic resonance imaging offers comprehensive assessment of ventricular function, myocardial perfusion, and scar tissue without ionizing radiation and is increasingly incorporated into surveillance strategies. Nuclear perfusion imaging remains a well-established technique but is used less frequently due to radiation exposure and modest specificity in some populations. Coronary computed tomography angiography provides high-resolution anatomic characterization of coronary origin, course, and luminal patency and is particularly valuable in congenital coronary anomalies and postsurgical coronary assessment.</p><p><strong>Conclusions: </strong>Optimal evaluation of pediatric coronary disease requires the integration of anatomic and functional imaging tailored to the underlying pathology and patient characteristics. Despite advances in multimodality imaging, pediatric-specific data remain limited, and many diagnostic thresholds are extrapolated from adult populations. Further multicenter studies are needed to refine risk stratification and establish evidence-based surveillance strategies for children at risk of myocardial ischemia.</p>","PeriodicalId":9561,"journal":{"name":"Cardiology and Therapy","volume":" ","pages":"439-462"},"PeriodicalIF":3.2000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542046/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiology and Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s40119-026-00469-1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Coronary artery disease in children arises from a diverse group of non-atherosclerotic conditions that may result in myocardial ischemia, ventricular dysfunction, and sudden cardiac death. Important etiologies include post-inflammatory vasculopathy following Kawasaki disease, transplant-related cardiac allograft vasculopathy, congenital coronary anomalies such as anomalous aortic origin of a coronary artery, and complications after coronary reimplantation during congenital heart surgery. The detection of myocardial ischemia in children is uniquely challenging, as symptoms are frequently absent or atypical, and traditional screening tools such as resting electrocardiography and transthoracic echocardiography lack sufficient sensitivity.

Methods: A narrative review was performed of the literature on non-invasive myocardial ischemia evaluation in pediatric patients with acquired and congenital coronary artery disease, focusing on Kawasaki disease, congenital coronary anomalies, cardiac allograft vasculopathy, and postoperative conditions involving coronary artery manipulation. PubMed and Google Scholar were searched and supplemented by reference lists and guideline documents. Original studies, reviews, consensus statements, and society guidelines were qualitatively synthesized by disease category and imaging modality, with emphasis on diagnostic performance, clinical applications, safety considerations, limitations, and evidence gaps.

Results: Multimodality imaging plays a central role in the evaluation of pediatric coronary pathology. Stress echocardiography provides a widely available, radiation-free method for detecting inducible regional wall motion abnormalities but requires specialized expertise. Stress perfusion cardiac magnetic resonance imaging offers comprehensive assessment of ventricular function, myocardial perfusion, and scar tissue without ionizing radiation and is increasingly incorporated into surveillance strategies. Nuclear perfusion imaging remains a well-established technique but is used less frequently due to radiation exposure and modest specificity in some populations. Coronary computed tomography angiography provides high-resolution anatomic characterization of coronary origin, course, and luminal patency and is particularly valuable in congenital coronary anomalies and postsurgical coronary assessment.

Conclusions: Optimal evaluation of pediatric coronary disease requires the integration of anatomic and functional imaging tailored to the underlying pathology and patient characteristics. Despite advances in multimodality imaging, pediatric-specific data remain limited, and many diagnostic thresholds are extrapolated from adult populations. Further multicenter studies are needed to refine risk stratification and establish evidence-based surveillance strategies for children at risk of myocardial ischemia.

先进的心脏成像技术检测冠状动脉异常儿童心肌缺血。
儿童冠状动脉疾病起源于多种非动脉粥样硬化性疾病,可导致心肌缺血、心室功能障碍和心源性猝死。重要的病因包括川崎病后炎症性血管病变、与移植相关的同种异体心脏移植物血管病变、先天性冠状动脉异常(如冠状动脉主动脉起源异常)以及先天性心脏手术中冠状动脉再植后的并发症。儿童心肌缺血的检测具有独特的挑战性,因为症状经常不存在或不典型,传统的筛查工具,如静息心电图和经胸超声心动图缺乏足够的灵敏度。方法:回顾性分析小儿获得性和先天性冠状动脉疾病无创心肌缺血评价的文献,重点分析川崎病、先天性冠状动脉异常、同种异体心脏移植血管病变和冠状动脉操作术后情况。检索PubMed和谷歌Scholar,并通过参考文献列表和指南文件进行补充。原始研究、综述、共识声明和社会指南根据疾病类别和成像方式进行定性合成,重点是诊断性能、临床应用、安全考虑、局限性和证据差距。结果:多模态成像在小儿冠状动脉病理评估中发挥核心作用。应力超声心动图提供了一种广泛可用的、无辐射的方法来检测可诱导的局部壁运动异常,但需要专门的专业知识。应激灌注心脏磁共振成像可以在没有电离辐射的情况下全面评估心室功能、心肌灌注和疤痕组织,并越来越多地纳入监测策略。核灌注成像仍然是一种成熟的技术,但由于辐射暴露和某些人群的适度特异性,使用频率较低。冠状动脉计算机断层血管造影提供冠状动脉起源、病程和腔内通畅的高分辨率解剖特征,在先天性冠状动脉异常和术后冠状动脉评估中特别有价值。结论:对儿童冠状动脉疾病的最佳评估需要根据潜在病理和患者特征结合解剖和功能成像。尽管多模式成像技术取得了进步,但儿科特异性数据仍然有限,许多诊断阈值是从成人人群中推断出来的。需要进一步的多中心研究来完善风险分层,并为有心肌缺血风险的儿童建立循证监测策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Cardiology and Therapy
Cardiology and Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍: Aims and Scope Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged. Areas of focus include, but are not limited to, ischaemic heart disease and acute cardiac care, myocardial, valvular, pericardial and congenital heart disease, vascular and pulmonary disease (including hypertension), arrhythmias, heart failure, non-invasive diagnostic techniques, and invasive and interventional cardiology as well as cardiovascular surgery. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols and short communications such as commentaries and editorials. Cardiolology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. Rapid Publication The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of cardiovascular therapies. Personal Service The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning authors will always have an editorial contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research. Digital Features and Plain Language Summaries Cardiology and Therapy offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by key summary points, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article. The journal also provides the option to include various types of digital features including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations. All additional features are peer reviewed to the same high standard as the article itself. If you consider that your paper would benefit from the inclusion of a digital feature, please let us know. Our editorial team are able to create high-quality slide decks and infographics in-house, and video abstracts through our partner Research Square, and would be happy to assist in any way we can. For further information about digital features, please contact the journal editor (see ‘Contact the Journal’ for email address), and see the ‘Guidelines for digital features and plain language summaries’ document under ‘Submission guidelines’. For examples of digital features please visit our showcase page https://springerhealthcare.com/expertise/publishing-digital-features/ Publication Fees Upon acceptance of your article for publication, authors will be required to pay the mandatory Rapid Service Fee of £3650/€4500/$5100. The journal will consider fee discounts for developing countries and this is decided on a case by case basis. Open Access All articles published by Cardiology and Therapy are published open access. Peer Review Process Upon submission, manuscripts are assessed by the editorial team to ensure they fit within the aims and scope of the journal and are also checked for plagiarism. All suitable submissions are then subject to a comprehensive single-blind peer review. Reviewers are selected based on their relevant expertise and publication history in the subject area. The journal has an extensive pool of editorial and advisory board members who have been selected to assist with peer review based on the afore-mentioned criteria. At least two extensive reviews are required to make the editorial decision, with the exception of some article types such as Commentaries, Editorials and Letters which are generally reviewed by one member of the Editorial Board. Where reviewer recommendations are conflicted, the editorial board will be contacted for further advice and a presiding decision. Manuscripts are then either accepted, rejected or authors are required to make major or minor revisions (both reviewer comments and editorial comments may need to be addressed). Once a revised manuscript is re-submitted, it is assessed along with the responses to reviewer comments and if it has been adequately revised it will be accepted for publication. Accepted manuscripts are then copyedited and typeset by the production team before online publication. Appeals against decisions following peer review are considered on a case by case basis and should be sent to the journal editor. Preprints We encourage posting of preprints of primary research manuscripts on preprint servers, authors’ or institutional websites, and open communications between researchers whether on community preprint servers or preprint commenting platforms. Posting of preprints is not considered prior publication and will not jeopardize consideration in our journals. Authors should disclose details of preprint posting during the submission process or at any other point during consideration in one of our journals. Once the preprint is published, it is the author’s responsibility to ensure that the preprint record is updated with a publication reference, including the DOI and a URL link to the published version of the article on the journal website. Copyright Cardiology and Therapy is published under the Creative Commons Attribution-Noncommercial License, which allows users to read, copy, distribute, and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited. The author assigns the exclusive right to any commercial use of the article to Springer. For more information about the Creative Commons Attribution-Noncommercial License, click here: http://creativecommons.org/licenses/by-nc/4.0. Contact For more information about the journal, including pre-submission enquiries, please contact matthew.evans@springer.com
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信
小红书