Improved Classification of Coronary Artery Abnormalities Based Only on Coronary Artery z-Scores After Kawasaki Disease
Improved Classification of Coronary Artery Abnormalities Based Only on Coronary Artery z-Scores After Kawasaki Disease
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DOI：
10.1007/s00246-009-9599-7
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发表时间：
2010-02-01
影响因子：
1.6
通讯作者：
McCrindle, Brian W.
中科院分区：
文献类型：
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作者：
Manlhiot, Cedric;Millar, Kyle;McCrindle, Brian W.
川崎（KD）后冠状动脉异常（CAA）的相互竞争的定义和分类是根据临床经验任意定义的。我们试图提出一个仅基于冠状动脉z评分的CAA分类系统。回顾了1990年至2007年期间对有KD既往史的患者进行的所有超声心动图检查。将冠状动脉管腔尺寸转换为体表面积调整的z分数，并与当前的分类系统进行比较。共有1356例既往有KD病史的患者接受了4379次超声心动图检查。美国心脏协会（AHA）定义的不同CAA类别之间的冠状动脉z评分分布存在重要重叠。AHA分类低估了19-32%的小型CAA和35-78%的中型CAA的严重程度。我们确定CAA的最佳定义是，如果z分数是千分之2.5到< 5.0，则为小;如果z分数是千分之5.0到< 10.0，则为大;如果z分数是千分之10.0，则为巨。这种分类似乎适用于旋支分支，尽管该分支缺乏正常值。目前的AHA分类可能无法准确分类KD患者中的CAA。准确的分类对于在患者年龄和体型上一致地定义管理和预后非常重要。
Competing definitions and classifications of coronary artery abnormalities (CAAs) after Kawasaki disease (KD) have been arbitrarily defined based on clinical experience. We sought to propose a classification system for CAAs based only on coronary artery z-scores. All echocardiograms performed between 1990 and 2007 on patients with a previous history of KD were reviewed. Coronary artery luminal dimensions were converted to body-surface-area-adjusted z-scores and compared to current classification systems. A total of 1356 patients with a previous history of KD underwent 4379 echocardiograms. There was important overlap in the distributions of coronary artery z-scores between the different CAA classes as defined by the American Heart Association (AHA). The AHA classification underestimated the severity of CAAs in 19-32% of small CAAs and 35-78% of medium CAAs. We determined the optimal definition of CAA to be small if the z-score is a parts per thousand yen2.5 to < 5.0, large if the z-score is a parts per thousand yen5.0 to < 10.0, and giant if the z-score is a parts per thousand yen10.0. This classification seems to appropriately apply to the circumflex branch despite a lack of normal values for this branch. The current AHA classification might not accurately classify CAAs in KD patients. Accurate classification is important for defining management and prognosis consistently across patient age and size.