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Impact of Z score system on the management of coronary artery lesions in Kawasaki disease

Part of: Echocardiography

Published online by Cambridge University Press:  08 September 2021

Raymond P. Lorenzoni Open the ORCID record for Raymond P. Lorenzoni [Opens in a new window] ,
Noah Elkins ,
Morgan Quezada ,
Ellen J. Silver ,
Joseph Mahgerefteh Open the ORCID record for Joseph Mahgerefteh [Opens in a new window] ,
Daphne T. Hsu  and
Nadine F. Choueiter
Raymond P. Lorenzoni
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
Noah Elkins
Affiliation:
Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
Morgan Quezada
Affiliation:
Department of Pediatrics, HHS Jacobi Medical Center, Bronx, NY, USA
Ellen J. Silver
Affiliation:
Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
Joseph Mahgerefteh
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
Daphne T. Hsu
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
Nadine F. Choueiter*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA
*
Author for correspondence: N. F. Choueiter, MD, Department of Pediatrics, Division of Pediatric Cardiology, Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. Tel: +1 718-741-2343; Fax: +1 718-920-4351. E-mail: [email protected]
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Abstract

Background:

Coronary artery aneurysms are well-described in Kawasaki disease and the Multisystem Inflammatory Syndrome in Children and are graded using Z scores. Three Z score systems (Boston, Montreal, and DC) are widely used in North America. The recent Pediatric Heart Network Z score system is derived from the largest diverse sample to-date. The impact of Z score system on the rate of coronary dilation and management was assessed in a large real-world dataset.

Methods:

Using a combined dataset of patients with acute Kawasaki disease from the Children’s Hospital at Montefiore and the National Heart, Lung, and Blood Institute Kawasaki Disease Study, coronary Z scores and the rate of coronary lesions (Z ≥ 2.0) and aneurysms (Z ≥ 2.5) were determined using four Z score systems. Agreement among Z scores and the effect on Kawasaki management were assessed.

Results:

Of 333 patients analysed, 136 were from Montefiore and 197 from the Kawasaki Disease Study. Age, sex, body surface area, and rate of coronary lesions did not differ between the samples. Among the four Z score systems, the rate of acute coronary lesions varied from 24 to 55%. The mean left anterior descending Z scores from Pediatric Heart Network and Boston had a large uniform discrepancy of 1.3. Differences in Z scores among the four systems may change anticoagulation management in up to 22% of a Kawasaki population.

Conclusions:

Choice of Z score system alone may impact Kawasaki disease diagnosis and management. Further research is necessary to determine the ideal coronary Z score system.

Keywords

Coronary circulationprognosisKawasaki diseasepediatricsquantification
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 952 - 959
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 2747–2771.CrossRefGoogle Scholar
Ozen, S, Ruperto, R, Dillon, MJ, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2006; 65: 936–941.CrossRefGoogle ScholarPubMed
Feldstein, LR, Tenforde, MW, Friedman, KG, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA 2021; 325: 1074–1087.10.1001/jama.2021.2091CrossRefGoogle ScholarPubMed
de Zorzi, A, Colan, SD, Gauvereau, K, Baker, AL, Sundel, RP, Newburger, JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr 1998; 133: 254–258.CrossRefGoogle ScholarPubMed
McCrindle, BW, Li, JS, Minich, L, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116: 174–179.CrossRefGoogle ScholarPubMed
Manlhiot, C, Millar, K, Golding, F, McCrindle, BW. Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol 2010; 31: 242–249.CrossRefGoogle ScholarPubMed
McCrindle, BW, Rowley, AH, Newburger, JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017; 135: e927–e999.CrossRefGoogle ScholarPubMed
Colan, SD. Personal communication of updated “Boston Z Score” system equations. Personal Communication (Oct 2018).Google Scholar
Dallaire, F, Dahdah, N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011; 24: 60–74.CrossRefGoogle Scholar
Olivieri, L, Arling, B, Friberg, M, Sable, C. Coronary artery Z score regression equations and calculators derived from a large heterogeneous population of children undergoing echocardiography. J Am Soc Echocardiogr 2009; 22: 159–164.CrossRefGoogle Scholar
Ronai, C, Hamaoka-Okamoto, A, Baker, AL, et al. Coronary artery aneurysm measurement and Z score variability in Kawasaki disease. J Am Soc Echocardiogr 2016; 29: 150–157.CrossRefGoogle Scholar
Lopez, L, Colan, S, Stylianou, M, et al. Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: the pediatric heart network normal echocardiogram database. Circ Cardiovasc Imaging 2017; 10: 76.CrossRefGoogle Scholar
Newburger, JW, Sleeper, LA, McCrindle, BW, et al. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med 2007; 356: 663–675.CrossRefGoogle ScholarPubMed
Cantinotti, M, Kutty, S, Franchi, E, et al. Pediatric echocardiographic nomograms: what has been done and what still needs to be done. Trends Cardiovasc Med 2017; 27: 336–349.CrossRefGoogle Scholar
Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465–495, quiz 576-467.CrossRefGoogle ScholarPubMed
Bland, JM, Altman, DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135–160.CrossRefGoogle ScholarPubMed
Lopez, L, Frommelt, PC, Colan, SD, et al. Pediatric heart network echocardiographic Z scores: comparison with other published models. J Am Soc Echocardiogr 2021; 34: 185–192.CrossRefGoogle Scholar
Robinson, DL, Ware, AL, Sauer, MC, et al. Implications of changing Z-Score models for coronary artery dimensions in Kawasaki disease. Pediatr Cardiol 2021; 42: 432–441.10.1007/s00246-020-02501-0CrossRefGoogle ScholarPubMed
Sluysmans, T, Colan, SD. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol (1985) 2005; 99: 445–457.10.1152/japplphysiol.01144.2004CrossRefGoogle ScholarPubMed
Sluysmans, T, Colan, SD. Structural measurements and adjustments for growth, Echocardiography in pediatric and congenital heart disease. Wiley-Blackwell, West Sussex, 2016, p. 61–72.CrossRefGoogle Scholar
Kim, SH, Kim, JY, Kim, GB, Yu, JJ, Choi, JW. Diagnosis of coronary artery abnormalities in patients with Kawasaki disease according to established guidelines and Z score formulas. J Am Soc Echocardiogr 2021; 34: 662–672.e3.CrossRefGoogle ScholarPubMed
Ogata, S, Tremoulet, AH, Sato, Y, et al. Coronary artery outcomes among children with Kawasaki disease in the United States and Japan. Int J Cardiol 2013; 168: 3825–3828.CrossRefGoogle ScholarPubMed
Benseler, SM, McCrindle, BW, Silverman, ED, Tyrell, PN, Wong, J, Yeung, RS. Infections and Kawasaki disease: implications for coronary artery outcome. Pediatrics 2005; 116: e760–e766.CrossRefGoogle ScholarPubMed
Han, RK, Silverman, ED, Newman, A, McCrindle, BW. Management and outcome of persistent or recurrent fever after initial intravenous gamma globulin therapy in acute Kawasaki disease. Arch Pediatr Adolesc Med 2000; 154: 694–699.CrossRefGoogle ScholarPubMed
Fukushige, J, Takahashi, N, Ueda, K, Hijii, T, Igarashi, H, Ohshima, A. Long-term outcome of coronary abnormalities in patients after Kawasaki disease. Pediatr Cardiol 1996; 17: 71–76.CrossRefGoogle ScholarPubMed
Akagi, T, Rose, V, Benson, LN, Newman, A, Freedom, RM. Outcome of coronary artery aneurysms after Kawasaki disease. J Pediatr 1992; 121: 689–694.CrossRefGoogle ScholarPubMed
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