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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: nchoueit@montefiore.org
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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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