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Yu JJ, Choi HJ, Cho HJ, Kim SH, Cheon EJ, Kim GB, Eun LY, Jung SY, Jun HO, Woo HO, Park SA, Yoon S, Ko H, Ban JE, Choi JW, Song MS, Han JW. Newly Developed Sex-Specific Z Score Model for Coronary Artery Diameter in a Pediatric Population. J Korean Med Sci 2024; 39:e144. [PMID: 38685889 PMCID: PMC11058341 DOI: 10.3346/jkms.2024.39.e144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This study aimed to generate a Z score calculation model for coronary artery diameter of normal children and adolescents to be adopted as the standard calculation method with consensus in clinical practice. METHODS This study was a retrospective, multicenter study that collected data from multiple institutions across South Korea. Data were analyzed to determine the model that best fit the relationship between the diameter of coronary arteries and independent demographic parameters. Linear, power, logarithmic, exponential, and square root polynomial models were tested for best fit. RESULTS Data of 2,030 subjects were collected from 16 institutions. Separate calculation models for each sex were developed because the impact of demographic variables on the diameter of coronary arteries differs according to sex. The final model was the polynomial formula with an exponential relationship between the diameter of coronary arteries and body surface area using the DuBois formula. CONCLUSION A new coronary artery diameter Z score model was developed and is anticipated to be applicable in clinical practice. The new model will help establish a consensus-based Z score model.
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Affiliation(s)
- Jeong Jin Yu
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hee Joung Choi
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Gi Beom Kim
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Lucy Youngmin Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Se Yong Jung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ok Jun
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Institute of Medical Science, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sin-Ae Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Soyoung Yoon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Hoon Ko
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji-Eun Ban
- Department of Pediatrics, Ewha Womans University Medical Center, Seoul, Korea
| | - Jong-Woon Choi
- Department of Pediatrics, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Min Seob Song
- Department of Pediatrics, Inje University Paik Hospital, Busan, Korea
| | - Ji Whan Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim SH. Diagnosis of coronary artery abnormalities in Kawasaki disease: recent guidelines and z score systems. Clin Exp Pediatr 2022; 65:430-438. [PMID: 34922423 PMCID: PMC9441617 DOI: 10.3345/cep.2021.01459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022] Open
Abstract
Kawasaki disease, an acute systemic vasculitis affecting children, is the leading cause of acquired heart disease in developed countries. This vasculitis has a predilection for the coronary artery, and coronary artery abnormalities are the main criteria for its diagnosis. The diagnosis of coronary abnormalities has historically been based on dichotomous criteria, but recent guidelines have accepted the body surface area-adjusted z score system to define coronary abnormalities and classify coronary artery aneurysms. Z score systems have improved risk classifications of coronary aneurysms and improved correlations with clinical prognosis. However, the discrepancy of calculated z scores according to the formula has been noticed in the application of the z score system, which is possibly related to the diagnosis of coronary artery abnormalities. This variability was greater in larger coronary aneurysm dimensions. A careful choice of the z score formula and its consistent use is needed in clinical applications.
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Affiliation(s)
- Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Fan SM, Xia B, Liu WX, Yu W, Wu ZX, Chen SB, Liu QH, Chen WJ, Zhu SL, Jin M, Min JQ, Xu Y. Establishing an appropriate Z score regression equation for Chinese pediatric coronary artery echocardiography: a multicenter prospective cohort study. BMC Pediatr 2021; 21:429. [PMID: 34592941 PMCID: PMC8482596 DOI: 10.1186/s12887-021-02877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Z score utility is emphasized in classifying coronary artery lesions in Kawasaki disease patients. The present study is the largest such multicenter Chinese pediatric study about coronary artery diameter reference values and Z score regression equation to date. It is useful in Chinese pediatric echocardiography. METHODS A multicenter cohort was assembled, which consisted of 852 healthy children between 1 month and 17 years of age, ten children were excluded because their ultrasound images were not clear, or lost in following up. Diameters of the right coronary artery, left coronary artery, and left anterior descending coronary artery were assessed using echocardiography. Data were body surface area (BSA)-corrected using BSA calculated via either the Stevenson BSA formula or the Haycock BSA formula. Coronary artery diameter reference values and Z score regression equations were established for use in the Chinese pediatric population. RESULTS No difference was observed between coronary artery diameter data corrected using BSAste or BSAhay. Of the five assessed regression models, the exponential model exhibited the best fit and was therefore selected as the basis for derivation of the SZ method. When comparing Z scores, those produced by the SZ method conformed to the standard normal distribution, while those produced by the D method did not. In addition, there was a statistically significant difference between Z scores produced by the SZ and D methods (P < 0.05). CONCLUSIONS Coronary artery diameter reference values for echocardiography were successfully established for use in the Chinese pediatric population, and a Z score regression equation more suitable for clinical use in this population was successfully developed.
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Affiliation(s)
- Shu-Min Fan
- Ultrasound Department, Shenzhen Children's Hospital Affiliated to China Medical University, 7019 Yitianroad, Shenzhen, Guangdong, 518038, People's Republic of China
| | - Bei Xia
- Ultrasound Department, Shenzhen Children's Hospital Affiliated to China Medical University, 7019 Yitianroad, Shenzhen, Guangdong, 518038, People's Republic of China.
| | | | - Wei Yu
- Ultrasound Department, Shenzhen Children's Hospital Affiliated to China Medical University, 7019 Yitianroad, Shenzhen, Guangdong, 518038, People's Republic of China
| | - Zhi-Xia Wu
- Ultrasound Department, Shenzhen Children's Hospital Affiliated to China Medical University, 7019 Yitianroad, Shenzhen, Guangdong, 518038, People's Republic of China
| | - Shu-Bao Chen
- Shanghai Children's Medical Center, Medical College of Shanghai Jiaotong University Shanghai, Shanghai, China
| | - Qing-Hua Liu
- Qilu Children's Hospital of Shandong University Jinan, Jinan, Shandong, China
| | - Wen-Juan Chen
- Children's Hospital of Hunan Province Changsha, Changsha, Hunan, China
| | | | - Mei Jin
- Chengdu Women's and Children's Center Hospital Chengdu, Chengdu, Sichuan, China
| | - Jie-Qing Min
- Children's Hospital Affiliated to Kunming Medical University Kunming, Kunming, Yunnan, China
| | - Yang Xu
- The First Affiliated Hospital of Jilin University Changchun, Changchun, Jilin, China
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Implications of Changing Z-Score Models for Coronary Artery Dimensions in Kawasaki Disease. Pediatr Cardiol 2021; 42:432-441. [PMID: 33394108 PMCID: PMC7780608 DOI: 10.1007/s00246-020-02501-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/17/2020] [Indexed: 10/25/2022]
Abstract
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.
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Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology. Eur Radiol 2019; 30:432-441. [PMID: 31428828 PMCID: PMC6890577 DOI: 10.1007/s00330-019-06367-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022]
Abstract
Background Kawasaki disease (KD) is a vasculitis with formation of coronary artery aneurysms (CAAs) that can lead to myocardial ischemia. Echocardiography is the primary imaging modality for the coronary arteries despite limited visualization. Coronary angiography (CAG) is the gold standard yet invasive with high-radiation exposure. To date however, state-of-the-art CT scanners enable high-quality low-dose coronary computed tomographic angiography (cCTA) imaging. The aim of our study in KD is to report (i) the diagnostic yield of cCTA compared to echocardiography, and (ii) the radiation dose. Methods and results We collected data of KD patients who underwent cCTA. cCTA findings were compared with echocardiography results. In 70 KD patients (median age 15.1 years [0.5–59.5 years]; 78% male; 38% giant CAA), the cCTA identified 61 CAAs, of which 34 (56%, with a Z score > 3, in 22 patients) were not detected by echocardiography. In addition, the left circumflex (aneurysmatic in 6 patients) was always visible upon cCTA and not detected upon echocardiography. Calcifications, plaques, and/or thrombi were visualized by cCTA in 25 coronary arteries (15 patients). Calcifications were seen as early as 2.7 years after onset of disease. In 5 patients, the cCTA findings resulted in an immediate change of treatment. The median effective dose (ED) in millisievert differed significantly (p < 0.01) between third-generation dual-source and other CT scanners (1.5 [0.3–9.4] (n = 56) vs 3.8 [1.7–20.0] (n = 14)). Conclusions The diagnostic yield of third-generation dual-source cCTA combined with reduced radiation exposure makes cCTA a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for KD. Key Points • cCTA is a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for Kawasaki disease. • Kawasaki disease patients with proven coronary artery involvement on echocardiography require additional imaging.
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