Assessment of coronary artery abnormalities and variability of Z‐score calculation in the acute episode of Kawasaki disease—A retrospective study from China

• DOI: 10.1111/eci.13409
• Publication Date: 2020-09-25T16:31:04Z
• Authors: Hui Hui Liu; Zhen Qiu; Guo Zhen Fan; Qi Jiang; Rui Xue Li; Wei Xia Chen; Fei Fei Liu; Yue Wu; Jing Jing Wang; Yang Fang Wu; Huang Huang Luo; Dong Dong Zhang; Peng Hu
• Keywords: Male; China; Immunoglobulins, Intravenous; Infant; Coronary Artery Disease; Mucocutaneous Lymph Node Syndrome; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Echocardiography; Child, Preschool; Practice Guidelines as Topic; Humans; Immunologic Factors; Female; Retrospective Studies

AbstractBackgroundAccurate classification of coronary artery abnormalities (CAAs) is essential for clinical decision‐making and long‐term management in Kawasaki disease (KD) patients. To date, there are several echocardiographic criteria of CAA assessment.Materials and methodsThe Japanese Ministry of Health (JMH) criteria and the Z‐score criteria from 2004 American Heart Association guidelines were adopted and their detective efficacies for CAAs were compared in 251 Chinese patients with KD Z scores were calculated by 6 published methods.ResultsAccording to the JMH criteria, 19 (7.57%) KD patients were classified as CAAs during the acute KD episode. However, the detective number of CAAs was highest and had a 0.68‐fold increase by the Dallaire et al method with a Z‐score cut point of ≥2.5 as compared with the JMH criteria; in contrast, more than 78.95% of patients with CAAs identified by the JMH criteria had a coronary artery Z score ≥2.5. All 6 different Z‐score methods had satisfactory accuracies with a range from 93.23% to 97.61% in screening CAAs. For the 19 patients with CAAs identified by the JMH criteria, their Z scores presented the widest variation calculated by the McCrindle et al method.ConclusionsThe JMH criteria underestimate the prevalence of CAAs as compared with the Z‐score criteria. Quantitative assessment of coronary artery luminal dimensions, normalized as Z scores adjusted for body surface, should be recommended. The larger coronary artery luminal dimensions vary, the more heterogeneous Z scores calculated by different methods have.