Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease

Christina Ronai, Akiko Hamaoka-Okamoto, Annette L. Baker, Sarah D. De Ferranti, Steven D. Colan, Jane W. Newburger, Kevin G. Friedman

Research output: Contribution to journalArticle

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Abstract

Background Coronary artery (CA) Z scores are commonly used for clinical decisions in Kawasaki disease, including treatment, anticoagulation, and duration and frequency of follow-up. The aim of this study was to evaluate CA measurement reproducibility, Z score calculation variability, and the impact of variability on management. Methods Twenty-one patients with Kawasaki disease with right CA (RCA) or left anterior descending CA (LAD) Z scores of 1.5 to 3 (group 1) were randomly selected, and all patients with Kawasaki disease with Z scores of 7 to 14 for either the RCA or LAD (n = 20; group 2) were included from March 2008 to May 2014. Two echocardiographers measured left main CA, LAD, and RCA dimensions. The inter- and intraobserver reliability of absolute measurements was calculated, and the CA Z scores derived from three commonly used formulas were compared. Results Median age at echocardiography was 1.2 years (range, 0.2-11.5 years), and 68% of subjects (n = 28) were male. Interobserver reliability was high for the LAD (intraclass correlation coefficient [ICC], 96.79%) and RCA (ICC, 93.31%) and lower for the left main CA (ICC, 73.54%). Intraobserver reliability was also high for the LAD and RCA (ICC, 99.08% and 97.74%) and lower for the left main CA (ICC, 80.88%). Calculated Z scores were similar among the three formulas for group 1 but varied markedly in group 2. Calculated Z scores using the same CA measurement in each of the three formulas resulted in different clinical management in up to seven of 21 group 1 patients (22%) and in up to 10 of 20 group 2 patients (50%). Conclusions Although CA measurements have high inter- and intraobserver agreement, CA Z scores vary dramatically on the basis of the Z score formula at larger CA dimensions. Discrepancies in CA Z score calculators may affect clinical decision making.

Original languageEnglish (US)
Pages (from-to)150-157
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume29
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Coronary Aneurysm
Mucocutaneous Lymph Node Syndrome
Coronary Vessels

Keywords

  • Coronary aneurysm
  • Echocardiography
  • Kawasaki disease
  • Z scores

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Ronai, C., Hamaoka-Okamoto, A., Baker, A. L., De Ferranti, S. D., Colan, S. D., Newburger, J. W., & Friedman, K. G. (2016). Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease. Journal of the American Society of Echocardiography, 29(2), 150-157. https://doi.org/10.1016/j.echo.2015.08.013

Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease. / Ronai, Christina; Hamaoka-Okamoto, Akiko; Baker, Annette L.; De Ferranti, Sarah D.; Colan, Steven D.; Newburger, Jane W.; Friedman, Kevin G.

In: Journal of the American Society of Echocardiography, Vol. 29, No. 2, 01.02.2016, p. 150-157.

Research output: Contribution to journalArticle

Ronai, C, Hamaoka-Okamoto, A, Baker, AL, De Ferranti, SD, Colan, SD, Newburger, JW & Friedman, KG 2016, 'Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease', Journal of the American Society of Echocardiography, vol. 29, no. 2, pp. 150-157. https://doi.org/10.1016/j.echo.2015.08.013
Ronai, Christina ; Hamaoka-Okamoto, Akiko ; Baker, Annette L. ; De Ferranti, Sarah D. ; Colan, Steven D. ; Newburger, Jane W. ; Friedman, Kevin G. / Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease. In: Journal of the American Society of Echocardiography. 2016 ; Vol. 29, No. 2. pp. 150-157.
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abstract = "Background Coronary artery (CA) Z scores are commonly used for clinical decisions in Kawasaki disease, including treatment, anticoagulation, and duration and frequency of follow-up. The aim of this study was to evaluate CA measurement reproducibility, Z score calculation variability, and the impact of variability on management. Methods Twenty-one patients with Kawasaki disease with right CA (RCA) or left anterior descending CA (LAD) Z scores of 1.5 to 3 (group 1) were randomly selected, and all patients with Kawasaki disease with Z scores of 7 to 14 for either the RCA or LAD (n = 20; group 2) were included from March 2008 to May 2014. Two echocardiographers measured left main CA, LAD, and RCA dimensions. The inter- and intraobserver reliability of absolute measurements was calculated, and the CA Z scores derived from three commonly used formulas were compared. Results Median age at echocardiography was 1.2 years (range, 0.2-11.5 years), and 68{\%} of subjects (n = 28) were male. Interobserver reliability was high for the LAD (intraclass correlation coefficient [ICC], 96.79{\%}) and RCA (ICC, 93.31{\%}) and lower for the left main CA (ICC, 73.54{\%}). Intraobserver reliability was also high for the LAD and RCA (ICC, 99.08{\%} and 97.74{\%}) and lower for the left main CA (ICC, 80.88{\%}). Calculated Z scores were similar among the three formulas for group 1 but varied markedly in group 2. Calculated Z scores using the same CA measurement in each of the three formulas resulted in different clinical management in up to seven of 21 group 1 patients (22{\%}) and in up to 10 of 20 group 2 patients (50{\%}). Conclusions Although CA measurements have high inter- and intraobserver agreement, CA Z scores vary dramatically on the basis of the Z score formula at larger CA dimensions. Discrepancies in CA Z score calculators may affect clinical decision making.",
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AU - Colan, Steven D.

AU - Newburger, Jane W.

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N2 - Background Coronary artery (CA) Z scores are commonly used for clinical decisions in Kawasaki disease, including treatment, anticoagulation, and duration and frequency of follow-up. The aim of this study was to evaluate CA measurement reproducibility, Z score calculation variability, and the impact of variability on management. Methods Twenty-one patients with Kawasaki disease with right CA (RCA) or left anterior descending CA (LAD) Z scores of 1.5 to 3 (group 1) were randomly selected, and all patients with Kawasaki disease with Z scores of 7 to 14 for either the RCA or LAD (n = 20; group 2) were included from March 2008 to May 2014. Two echocardiographers measured left main CA, LAD, and RCA dimensions. The inter- and intraobserver reliability of absolute measurements was calculated, and the CA Z scores derived from three commonly used formulas were compared. Results Median age at echocardiography was 1.2 years (range, 0.2-11.5 years), and 68% of subjects (n = 28) were male. Interobserver reliability was high for the LAD (intraclass correlation coefficient [ICC], 96.79%) and RCA (ICC, 93.31%) and lower for the left main CA (ICC, 73.54%). Intraobserver reliability was also high for the LAD and RCA (ICC, 99.08% and 97.74%) and lower for the left main CA (ICC, 80.88%). Calculated Z scores were similar among the three formulas for group 1 but varied markedly in group 2. Calculated Z scores using the same CA measurement in each of the three formulas resulted in different clinical management in up to seven of 21 group 1 patients (22%) and in up to 10 of 20 group 2 patients (50%). Conclusions Although CA measurements have high inter- and intraobserver agreement, CA Z scores vary dramatically on the basis of the Z score formula at larger CA dimensions. Discrepancies in CA Z score calculators may affect clinical decision making.

AB - Background Coronary artery (CA) Z scores are commonly used for clinical decisions in Kawasaki disease, including treatment, anticoagulation, and duration and frequency of follow-up. The aim of this study was to evaluate CA measurement reproducibility, Z score calculation variability, and the impact of variability on management. Methods Twenty-one patients with Kawasaki disease with right CA (RCA) or left anterior descending CA (LAD) Z scores of 1.5 to 3 (group 1) were randomly selected, and all patients with Kawasaki disease with Z scores of 7 to 14 for either the RCA or LAD (n = 20; group 2) were included from March 2008 to May 2014. Two echocardiographers measured left main CA, LAD, and RCA dimensions. The inter- and intraobserver reliability of absolute measurements was calculated, and the CA Z scores derived from three commonly used formulas were compared. Results Median age at echocardiography was 1.2 years (range, 0.2-11.5 years), and 68% of subjects (n = 28) were male. Interobserver reliability was high for the LAD (intraclass correlation coefficient [ICC], 96.79%) and RCA (ICC, 93.31%) and lower for the left main CA (ICC, 73.54%). Intraobserver reliability was also high for the LAD and RCA (ICC, 99.08% and 97.74%) and lower for the left main CA (ICC, 80.88%). Calculated Z scores were similar among the three formulas for group 1 but varied markedly in group 2. Calculated Z scores using the same CA measurement in each of the three formulas resulted in different clinical management in up to seven of 21 group 1 patients (22%) and in up to 10 of 20 group 2 patients (50%). Conclusions Although CA measurements have high inter- and intraobserver agreement, CA Z scores vary dramatically on the basis of the Z score formula at larger CA dimensions. Discrepancies in CA Z score calculators may affect clinical decision making.

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KW - Echocardiography

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