Predictors of Coronary Artery Visualization in Kawasaki Disease
Predictors of Coronary Artery Visualization in Kawasaki Disease
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DOI：
10.1016/j.echo.2010.10.015
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发表时间：
2011-01-01
影响因子：
6.5
通讯作者：
Colan, Steven D.
中科院分区：
文献类型：
--
作者：
Margossian, Renee;Lu, Minmin;Colan, Steven D.
背景：超声心动图是评估川崎病冠状动脉（CA）异常的首选成像方式。小系列研究已经建立了检测异常的高特异性和敏感性，但单个 CA 节段的可视化率和与成功相关的因素尚不清楚。 方法：在儿科心脏网络对川崎病主要类固醇治疗的随机试验中，超声心动图在当地由核心实验室进行解读。探索了核心实验室确定的本地实验室 CA 可视化的单变量和多变量预测因素，并评估了本地和核心实验室测量的 CA 大小的一致性。结果：在 27 个月内，总共获得了 199 名患者的 589 幅超声心动图。左主干、左前降支近端和远端以及右近端 CA 的可视化率范围为 91% 至 98%，但远端右侧 (65%)、回旋支 (86%) 和后降支 (54%) CA 的可视化率较低。对于远端右侧 CA 和回旋 CA，可视化率在研究过程中有所改善 (P < .05)。在多变量分析中，局部中心、CA 段以及从研究开始到超声心动图检查的时间是可视化的独立预测因素（所有 P 值 < .001）。对于可视化率因中心而异的节段，较高的可视化百分比与较大的中心体积相关（P = .001）。常规镇静使用也与较高的可视化率相关。结论：川崎病成功的 CA 可视化与所评估的节段相关，并受到中心体积和镇静使用的影响。随着时间的推移，可视化率的提高表明了学习曲线，并强调了儿科多中心试验中核心实验室监督的价值。 (J Am Soc Echocardiogr 2011；24:53-9。)
Background: Echocardiography is the imaging modality of choice for the evaluation of coronary artery (CA) abnormalities in Kawasaki disease. Small series have established high specificity and sensitivity for detecting abnormalities, yet visualization rates of individual CA segments and factors associated with success are unknown.Methods: In the Pediatric Heart Network's randomized trial of primary steroid treatment for Kawasaki disease, echocardiograms were interpreted locally and by a core laboratory. Univariate and multivariate predictors of CA visualization by the local lab as determined by the core lab were explored, and agreement of CA size measured locally and by the core lab was assessed.Results: A total of 589 echocardiograms from 199 patients were obtained over 27 months. Visualization rates for the left main, proximal and distal left anterior descending, and proximal right CAs ranged from 91% to 98% but were lower for the distal right (65%), circumflex (86%), and posterior descending (54%) CAs. For the distal right and circumflex CAs, visualization rates improved over the course of the study (P < .05). In multivariate analysis, local center, CA segment, and time from study start to echocardiography were independent predictors of visualization (all P values < .001). For segments for which visualization rates varied by center, higher percentage visualization was associated with larger center volume (P = .001). Routine sedation use was also associated with higher visualization rates.Conclusions: Successful CA visualization in Kawasaki disease is associated with the segment being evaluated and is influenced by center volume and sedation use. Increased visualization rates over time suggest a learning curve and underscore the value of core lab oversight in pediatric multicenter trials. (J Am Soc Echocardiogr 2011;24:53-9.)