Multimodality Approach to Coronary Ischemic Testing in Pediatric Patients: A Scientific Statement From the American Heart Association

As new research reveals the value of provocative and ischemic coronary testing in various acquired and congenital coronary issues in children, an unmet need for targeted and thoughtful provocative ischemic testing emerges as a high priority for our field. A number of evidence-based guidelines and scientific statements for conditions including Kawasaki disease, multisystem inflammatory syndrome in children associated with coronary aneurysms, anomalous aortic origin of the coronary arteries, cardiac allograft vasculopathy, and surgically repaired congenital heart disease involving coronary artery manipulation now recommend provocative ischemic testing in children. The strengths and limitations of various testing modalities and provocative agents are explored, including the evidence for use in children. In addition, evidence-based adaptations and recommendations for optimizing use of these technologies in children are noted. The pediatric cardiac imaging community requires more information to understand appropriate use of existing provocative ischemic modalities and to help develop the technology for future use.