Predictors of Coronary Artery Visualization in Kawasaki Disease

• Published in: Journal of the American Society of Echocardiography Vol. 24; no. 1; pp. 53 - 59
• Main Authors: Margossian, Renee, MD, Lu, Minmin, MS, LuAnn Minich, L., MD, Bradley, Timothy J., MD, Cohen, Meryl S., MD, Li, Jennifer S., MD, Printz, Beth F., MD, Shirali, Girish S., MD, Sleeper, Lynn A., ScD, Newburger, Jane W., MD, MPH, Colan, Steven D., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 2011
• Subjects: Cardiovascular; Child, Preschool; Comorbidity; Core laboratory; Coronary artery; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary Vessels - diagnostic imaging; Echocardiography - statistics & numerical data; Female; Humans; Incidence; Kawasaki disease; Male; Mucocutaneous Lymph Node Syndrome - diagnostic imaging; Mucocutaneous Lymph Node Syndrome - epidemiology; Pediatric; Reproducibility of Results; Risk Assessment; Risk Factors; Sedation; Sensitivity and Specificity; United States - epidemiology; Left anterior descending; Coronary artery; Sedation; Digital Imaging and Communications in Medicine; LAD; Body mass index; BSA; RCA; Right coronary artery; Kawasaki disease; PD; Pediatric Heart Network; Core laboratory; PHN; KD; Body surface area; Left main coronary artery; DICOM; LMCA; Pediatric; CA; BMI; Posterior descending
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2010.10.015

Background Echocardiography is the imaging modality of choice for the evaluation of coronary artery (CA) abnormalities in Kawasaki disease. Small series have established high specificity and sensitivity for detecting abnormalities, yet visualization rates of individual CA segments and factors associated with success are unknown. Methods In the Pediatric Heart Network’s randomized trial of primary steroid treatment for Kawasaki disease, echocardiograms were interpreted locally and by a core laboratory. Univariate and multivariate predictors of CA visualization by the local lab as determined by the core lab were explored, and agreement of CA size measured locally and by the core lab was assessed. Results A total of 589 echocardiograms from 199 patients were obtained over 27 months. Visualization rates for the left main, proximal and distal left anterior descending, and proximal right CAs ranged from 91% to 98% but were lower for the distal right (65%), circumflex (86%), and posterior descending (54%) CAs. For the distal right and circumflex CAs, visualization rates improved over the course of the study ( P < .05). In multivariate analysis, local center, CA segment, and time from study start to echocardiography were independent predictors of visualization (all P values < .001). For segments for which visualization rates varied by center, higher percentage visualization was associated with larger center volume ( P = .001). Routine sedation use was also associated with higher visualization rates. Conclusions Successful CA visualization in Kawasaki disease is associated with the segment being evaluated and is influenced by center volume and sedation use. Increased visualization rates over time suggest a learning curve and underscore the value of core lab oversight in pediatric multicenter trials.