Prediction of Coronary Artery Aneurysms in Children With Kawasaki Disease Before Starting Initial Treatment.
Prediction of Coronary Artery Aneurysms in Children With Kawasaki Disease Before Starting Initial Treatment.
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DOI：
10.3389/fped.2021.748467
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发表时间：
2021
影响因子：
2.6
通讯作者：
Chi H
中科院分区：
文献类型：
--
作者：
Huang CY;Chiu NC;Huang FY;Chao YC;Chi H
背景：准确预测冠状动脉瘤（CAAs）仍然是一个临床挑战。我们的目的是调查是否冠状动脉尺寸调整体表面积（Z评分）的基线超声心动图和临床变量前的主要治疗可以预测存在的晚期CAA。研究方法：我们对因川崎住院并在发病10天内接受静脉注射免疫球蛋白的儿童进行了回顾性研究。我们将晚期CAAs定义为在发病11-60天时左主干、右冠状动脉或左前降支的最大Z评分（Zmax）≥2.5。分析晚期CAA与临床参数和基线最大Z评分之间的相关性。结果：在314例纳入儿童中，31例（9.9%）有晚期CAA。男性、高C反应蛋白和高基线Zmax是晚期CAA的危险因素。晚期CAA与基线Zmax ≥2.0 vs. <2.0显著相关（25 [32.5%] vs. 6 [2.5%]，P < 0.001）。基线Zmax ≥2.0与<2.0的患者中晚期CAA的比值比为18.5（95%置信区间，7.23至47.41，P < 0.001）。基线Zmax ≥2.0对晚期CAA的敏感性、特异性、阳性预测值和阴性预测值分别为80.6%、81.6%、32.5%和97.5%。结论：本研究的结果表明，基线超声心动图上冠状动脉的Zmax ≥2.0可用于预测晚期CAA高风险儿童，并允许进行靶向早期强化治疗。
Background: Precisely predicting coronary artery aneurysms (CAAs) remains a clinical challenge. We aimed to investigate whether coronary dimensions adjusted for body surface area (Z scores) on baseline echocardiography and clinical variables before primary treatment could predict the presence of late CAAs. Methods: We conducted a retrospective study including children hospitalized for Kawasaki disease and received intravenous immunoglobulin within 10 days of illness. We defined late CAAs as a maximum Z score (Zmax) ≥2.5 of the left main, right, or left anterior descending coronary artery at 11–60 days of illness. Associations between late CAAs and clinical parameters and baseline maximum Z scores were analyzed. Results: Among the 314 included children, 31 (9.9%) had late CAAs. Male, higher C-reactive protein, and higher baseline Zmax were risk factors of late CAAs. Late CAAs were significantly associated with baseline Zmax ≥2.0 vs. <2.0 (25 [32.5%] vs. 6 [2.5%], P < 0.001). The odds ratio for late CAAs among the patients with baseline Zmax ≥2.0 vs. <2.0 was 18.5 (95% confidence interval, 7.23 to 47.41, P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of baseline Zmax ≥2.0 for the presence of later CAAs were 80.6, 81.6, 32.5, and 97.5%, respectively. Conclusions: Findings from this study suggest that Zmax ≥2.0 of coronary arteries on baseline echocardiography may be used to predict children at a high risk of late CAAs and allow for targeted early intensification therapy.
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影响因子：
8
作者：
Dionne, Audrey;Burns, Jane C.;Friedman, Kevin G.
通讯作者：
Friedman, Kevin G.
影响因子：
3.6
作者：
Belay, ED;Maddox, RA;Schonberger, LB
通讯作者：
Schonberger, LB
影响因子：
37.8
作者：
FUJIWARA, T;FUJIWARA, H;NAKANO, H
通讯作者：
NAKANO, H
影响因子：
3.5
作者：
Ogata, Shohei;Tremoulet, Adriana H.;Sato, Yuichiro;Ueda, Kayla;Shimizu, Chisato;Sun, Xiaoying;Jain, Sonia;Silverstein, Laura;Baker, Annette L.;Tanaka, Noboru;Ogihara, Yoshihito;Ikehara, Satoshi;Takatsuki, Shinichi;Sakamoto, Naoko;Kobayashi, Tohru;Fuse, Shigeto;Matsubara, Tomoyo;Ishii, Masahiro;Saji, Tsutomu;Newburger, Jane W.;Burns, Jane C.
通讯作者：
Burns, Jane C.
影响因子：
5.2
作者：
Cameron, Scott A.;Carr, Michael;Rowley, Anne H.
通讯作者：
Rowley, Anne H.