DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20164849

Coronary artery diameter measurement and Z-score regression equation calculation: a comparative study between Indian children between one to five years residing in and around Kolkata with children of South-East Asia and Western population

Satyaki Das, Swapan Kumar Ray, Sukanta Bhattacharya, Kripasindhu Chatterjee, Pradyut Kumar Mandal, Sukanta Sen

Abstract


Background: Congenital coronary anomalies may be isolated, or they may accompany other congenital heart defects, such as Fallot's tetralogy, transposition of the great arteries or pulmonary atresia. The most common cause of acquired abnormalities of the coronary vessels in children is kawasaki disease (KD). The aim of this study was to find the best model to obtain valid and normally distributed Z-scores for coronary artery (CA) diameters in a large, heterogeneous population of healthy children.

Methods: Echocardiography was performed on 300 healthy children. Linear regression models were tested with height, weight, body surface area, and aortic valve diameter. The computed Z scores were tested for normal distribution and stability.

Results: CA diameter was best predicted using regression with the body surface area and age in month. The weighted least squares method yielded normally distributed and very stable Z-score estimates for 3 principal CAs.

Conclusions: This study showed valid methods to estimate Z scores for CA size in children of all ages. Such Z scores are important for risk stratification in patients with Kawasaki disease.


Keywords


Coronary arteries, Echocardiography, Kawasaki, Normal value, Z-scores

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References


Werner B, Kałuzewska WM, Pleskot M, Tarnowska A, Potocka K. Anomalies of the coronary arteries in children. Med Sci Monit. 2001;7(6):1285-91.

Du ZD, Zhang T, Liang L, Meng X, Li T, Kawasaki T, Nakamura Y, Yanagawa H. Epidemiologic picture of Kawasaki disease in Beijing from 1995 through 1999. Pediatr Infect Dis J. 2002;21(2):103-7.

Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis and kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-71.

Weyman A, Feigenbaum H, Dillon JC, Johnston KW, Eggleton RC. Noninvasive visualization of the left main coronary artery by cross-sectional echocardiography. Circulation. 1976;54(2):169-74.

Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, et al. Kawasaki disease Research Committee. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int. 2005;47(2):232-4.

Tsuda E, Kamiya T, Ono Y, Kimura K, Echigo S. Dilated coronary arterial lesions in the late period after Kawasaki disease. Heart. 2005;91(2):177-82.

Tan TH, Wong KY, Cheng TK, Heng JT. Coronary normograms and the coronary-aorta index: objective determinants of coronary artery dilatation. Pediatr Cardiol. 2003;24:328-35.

Zorzi A, Colan SD, Gauvreau K, Baker AL, Sundel RP, Newburger JW. Coronary artery dimensions may be misclassified as normal in Kawasaki disease. J Pediatr. 1998;133:254-8.

Crindle BW, Li JS, Minich LL, Colan SD, Atz AM, Takahashi M, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation. 2007;116(2):174-9.

Huang SK, Lin MT, Chen HC, Huang SC, Wu MH. Epidemiology of Kawasaki disease: prevalence from national database and future trends projection by system dynamics modelling. J Pediatr. 2013;163(1):126-31.

Bois D, Bois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1916;17:863-71.

Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317(17):1098.

Olivieri L, Arling B, Friberg M, Sable C. Coronary artery Z score regression equations and calculators derived from a large heterogeneous population of children undergoing echocardiography. J Am Soc Echocardiogr. 2009;22:159-64.

Capannari TE, Daniels SR, Meyer RA. Sensitivity, specificity and predictive value of two dimensional echocardiography in detecting coronary artery aneurysms in patients with Kawasaki disease. J Am Coll Cardiol. 1986;7:355.

Huwez FU, Houston AB, Watson J. Age and body surface area related normal upper and lower limits of M mode echocardiographic measurements and left ventricular volume and mass from infancy to early adulthood. Br Heart J. 1994;72:276.

Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthychildren. J Am Soc Echocardiogr. 2011;24:60.

Kurotobi S, Nagai T, Kawakami N, Sano T. Coronary diameter in normal infants, children and patients with Kawasaki disease. Pediatr Int. 2002;44:1-4.

Crystal MA, Manlhiot C, Yeung RS. Coronary artery dilation after Kawasaki disease for children within the normal range. Int J Cardiol. 2009;136:27-32.

Sluysmans T, Colan SD. Theoritical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol. 2005;99:444-57.

Chen SJ, Lee WJ, Lin MT, Liu KL, Wang JK, Lue HC. Coronary artery diameters in infants and children with congenital heart disease as determined by computed tomography. Am J Cardiol. 2007;100(11):1696-701.

Chen SJ, Lin MT, Lee WJ, Liu KL, Wang JK, Chang CI, et al. Coronary artery anatomy in children with congenital heart disease by computed tomography. Int J Cardiol. 2007;120(3):363-70.