Implications of Changing Z-Score Models for Coronary Artery Dimensions in Kawasaki Disease
| Autor: | L. LuAnn Minich, Lloyd Y. Tani, Angela P. Presson, Michael Sauer, David Robinson, Adam L. Ware, Zhining Ou, Richard V. Williams, Dongngan T. Truong |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Z-Scores Adolescent Concordance Coronary Artery Disease 030204 cardiovascular system & hematology Mucocutaneous Lymph Node Syndrome 03 medical and health sciences Coronary arteries 0302 clinical medicine Internal medicine Antithrombotic medicine Humans Child Retrospective Studies Original Paper Kawasaki disease business.industry Infant Vascular surgery Reference Standards medicine.disease Coronary Vessels Cardiac surgery medicine.anatomical_structure 030228 respiratory system Echocardiography Child Preschool Pediatrics Perinatology and Child Health Cardiology Female Cardiology and Cardiovascular Medicine business Kappa Artery |
| Zdroj: | Pediatric Cardiology |
| ISSN: | 1432-1971 |
| Popis: | Background Coronary artery abnormalities in Kawasaki disease (KD) are assessed using echocardiographic z-scores. We hypothesized that changing the coronary artery (CA) z-score model would alter diagnosis and management of children with KD. Methods In this retrospective single-center study of children treated for KD (9/2007–1/2020), we collected echocardiographic measurements for the left anterior descending (LAD), right (RCA), and left main (LMCA) coronary arteries during 3 illness phases and calculated Boston and Pediatric Heart Network (PHN) z-scores. Agreement between Boston and PHN z-scores was assessed using Kappa (κ) and Lin’s Concordance Correlation Coefficients (CCC) and Bland–Altman analysis. Results For 904 echocardiograms from 357 children, the median Boston LAD z-score was lower than the PHN (0.3 [IQR − 0.6, 1.5] vs 1.6 [IQR 0.7, 2.8], CCC 0.94 [95% CI 0.93, 0.95], moderate agreement), aggregated across all illness phases. RCA and LMCA z-scores showed substantial agreement. With conversion from Boston to PHN models, the percentage of individual LAD z-scores ≥ 2.5 increased (14.6% to 32.1%). At least one CA z-score classification changed in 213 children (59.7%) across all phases, and 48 children (13.4%) had a change that altered recommended antithrombotic strategy. Agreement between models differed by age, sex, and race. Conclusions Conversion from Boston to PHN z-scores changed at least 1 CA z-score classification in over half of KD patients and changed recommended antithrombotic management in 13%, largely driven by LAD measurements. Since diagnosis and management of KD and KD-like diseases rely upon CA z-scores, the clinical and research implications of these findings merit further exploration. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink