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Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease.

Abstract：

BACKGROUND:In 2017, the AHA published revised guidelines for the diagnosis of Kawasaki disease (KD). In the absence of compelling data supporting or refuting the utility of lack of tapering (LT) and perivascular brightness (PB), expert panel consensus removed LT and PB from consideration. We hypothesize that LT and PB are unreliable, subjective findings, non-specific to KD, which can be seen in systemic febrile illnesses without KD and in normal controls. METHODS:We performed a single-center retrospective study from 1/2008 to 12/2016. De-identified coronary artery (CA) echocardiographic clips from patients 0-10 years old were interpreted blindly by six pediatric cardiologists. Subjects were grouped as follows: (1) healthy: afebrile with benign murmur, (2) KD: IVIG treatment, 4-5 clinical criteria at presentation, (3) incomplete KD (iKD): IVIG, 1-3 clinical criteria, (4) Febrile: ≥3 days of fever, no IVIG, KD not suspected. The presence or absence of LT and PB was recorded. Inter-rater and intra-rater reliabilities were analyzed using intra-class correlation coefficient, Fleiss' Kappa and Cohen's Kappa coefficients. RESULTS:We interpreted 117 echocardiograms from healthy (27), KD (30), iKD (32), and febrile (28) subjects. Analysis showed moderate agreement in CA z score measurements. LT and PB were observed by most readers in control groups. LT exhibited fair inter-reader agreement (reliability coefficient 0.36) and PB slight inter-reader agreement (reliability coefficient 0.13). Intra-rater reliability was inconsistent for both parameters. CONCLUSIONS:LT and PB are subjective, poorly reproducible features that can be seen in febrile patients without KD and in healthy children.

journal_name

Pediatr Cardiol

journal_title

Pediatric cardiology

authors

Rabinowitz EJ,Rubin LG,Desai K,Hayes DA,Tugertimur A,Kwon EN,Dhanantwari P,Misra N,Stoffels G,Blaufox AD,Mitchell E

doi

10.1007/s00246-018-1971-z

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

147-153

issue

1

eissn

0172-0643

issn

1432-1971

pii

10.1007/s00246-018-1971-z

journal_volume

40

pub_type

杂志文章

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