A New  Z  Score Curve of the Coronary Arterial Internal Diameter Using the Lambda-Mu-Sigma Method in a Pediatric Population

Kobayashi, Toshimitsu; Fuse, Shigeto; Sakamoto, Naoko; Mikami, Masashi; Ogawa, Satoshi; Hamaoka, Kenji; Arakaki, Yoshio; Nakamura, Tsuneyuki; Nagasawa, Hiroyuki; Kato, Taichi; Jibiki, Toshiaki; Iwashima, Satoru; Yamakawa, Masaru; Ohkubo, Takashi; Shimoyama, Shinya; Aso, Kentaro; Sato, Seiichi; Saji, Tsutomu; Kato, Hitoshi; Akita, Chisato; Kubo, Takashi; Suzuki, Takahiro; Ishikawa, Takamichi; Watanabe, Masayuki; Seki, Mitsuru; Ikeda, Kentaro; Ishii, Yoichiro; Kobayashi, T.; Hasegawa, Eiichi; Shiraiwa, Hiromi; Hayashi, Kyoko; Tabata, Chisato; Miyauchi, Motoki; Miyamoto, Junko; Wada, Mitsuru; Takasugi, Hisashi; Yamamoto, Masaki; Yamada, Katsuhiko; Hasegawa, S.; Tsukano, Shinya; Ozawa, Sayaka; Ohnuma, Yoshiko; Ichida, Fukiko; Kawamura, Seiji; Suganuma, Eisuke; Matsuda, Shinichi; Sekine, Kotaro; Kondo, Satoshi; Miura, Masaru; Kobayashi, Toshiko; Fukushima, Naoya; Kure, Tomomi; Nomura, Yoshio; Eguchi, Daisuke; Katsumata, Nobuyuki; Fujiwara, Masako; Nakamura, Kento; Furuno, Kenji; Hirasawa, Itsumi; Miki, Midori; Kanai, Takashi; Yoshimoto, Hiroyoshi; Kudo, Yoshiyuki; Yamakawa, Ryoji; Suda, Kenji; Haseyama, Keiji; Kajino, Hiroki; Masuda, Kiminori; Yasuda, Kenji; Teraguchi, Masayuki; Sasaki, Sachiko; Kamura, Yukie; Oyama, Kotaro; Sano, Tetsuya; Takei, Kota; Furukawa, Takuo; Ueno, Michihiko; Fujii, Takanari; Matsubara, Hiromi; Nishiyama, Mitsunori; S, Doi

doi:10.1016/j.echo.2016.03.017

Cited by 152 publications

(110 citation statements)

References 20 publications

Supporting

Mentioning

109

Contrasting

Order By: Relevance

“…The previous AHA guidelines provided nomograms for generating Z scores but did not specify the source of the normative data, the method of calculating BSA, and the regression method used for analysis. 1 The most rigorous systems, based on larger populations and with careful statistical modeling, are those reported for Japanese subjects by Kobayashi et al 145 149 formula. These systems also have the advantage of providing normative data for the left circumflex branch.…”

Section: Imaging Standardsmentioning

confidence: 99%

“…141 Several different formulas for calculating Z scores have been derived (Table 5). 138,139,[142][143][144][145][146] These systems differ regarding the number, age range, and race of the normal subjects, the formula used to calculate BSA, and the regression method used for analysis. The previous AHA guidelines provided nomograms for generating Z scores but did not specify the source of the normative data, the method of calculating BSA, and the regression method used for analysis.…”

Section: Imaging Standardsmentioning

confidence: 99%

“…140 An analysis of 1082 patients from centers in the United States and Japan used 2 different sources of normal values for calculation of Z scores. 141 Using the Z-score equations of Kobayashi et al, 145 26% of US subjects and 39% of Japanese subjects had a maximal Z score ≥2.5, with 4.1% and 3.1%, respectively, having a Z score ≥5. Using the Z-score equations of Dallaire et al, 146 30% of US subjects and 44% of Japanese subjects had a maximal Z score ≥2.5, with 5.8% and 6.2%, respectively, having a Z score ≥5.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

Self Cite

2,606

4,124

View full text Add to dashboard Cite

BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

show abstract

Section: Imaging Standardsmentioning

confidence: 99%

Section: Imaging Standardsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

Self Cite

2,606

4,124

View full text Add to dashboard Cite

show abstract

“…CAL status was evaluated in accordance with the Research Committee on Kawasaki Disease criteria . Additionally, Z‐score of coronary artery diameter for the following 3 segments: proximal right coronary artery; left main coronary artery; and proximal left anterior descending artery, was calculated as a secondary endpoint . Maximum Z‐score was defined as the largest Z‐score in the 3 segments during the study period.…”

Section: Methodsmentioning

confidence: 99%

Sivelestat sodium hydrate treatment for refractory Kawasaki disease

Ebata

Yasukawa

Nagai

et al. 2019

Pediatrics International

View full text Add to dashboard Cite

Background There is still no definite treatment for refractory Kawasaki disease (KD). In this pilot study, we evaluated the safety and efficacy of a new protocol consisting of sivelestat sodium hydrate (SSH) combined with additional i.v. immunoglobulin (IVIG) for KD resistant to initial IVIG therapy. Methods This study is a prospective non‐randomized, open‐label and single‐arm study undertaken in a population of refractory KD patients at Chiba University Hospital from December 2006 to March 2016. The subjects had KD resistant to initial IVIG (2 g/kg) and received SSH (0.2 mg/kg/h for 5 days) combined with additional IVIG (2 g/kg) as a second‐line therapy. We evaluated the safety and efficacy of the treatment during the study period. Results Forty‐six KD patients were enrolled in this study and no serious adverse event was noted. Of these, 45 patients were evaluated for the incidence of coronary artery lesions, which occurred in one patient (2.2%; 95% CI: 0.5–15.2). Twenty‐eight (62.2%) responded promptly and were afebrile after the therapy. The median total duration of fever was 8 days (range, 6–28 days). Conclusions Additional IVIG combined with SSH as a second‐line therapy for KD refractory to initial IVIG therapy was safe and well tolerated and could be a promising option for severe KD. Further investigations are expected to clarify the safety and timing of SSH treatment for KD.

show abstract

“…They also analyzed z-score boundaries for the left main CA (mm) against the BSA on comparison with those previously published by McCrindle et al and Olivieri et al They found that their greater representation of small children and infants allowed the identification of a steeper slope at a low BSA than those observed by others. Kobayashi et al generated the sex-specific z-score of each internal CA diameter using lambda-mu-sigma (LMS) models in a large Japanese pediatric population (≤18 years old, n=3,851) (13).…”

Section: Coronary Z-scorementioning

confidence: 99%

Recent updates on echocardiography and ultrasound for Kawasaki disease: beyond the coronary artery

Noto

Komori

Ayusawa

et al. 2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

Kawasaki disease (KD) is an acute inflammatory process affecting the arterial wall that results in panvasculitis in infants and young children. A recent review of autopsies of KD patients, mostly accompanied with coronary artery abnormalities (CAAs), revealed that there were the threeassociated vasculopathic processes: acute necrotizing arteritis, subacute or chronic vasculitis, and luminal myofibroblastic proliferation (LMP) (1). Acute arteritis is predominantly characterized by neutrophilic infiltrate that can lead to necrosis in the vessel wall. Subacute vasculitis begins weeks after the onset of fever, can still be detected months to years later, and is closely associated with LMP. LMP is associated with the subacute process that occurs months to years after the disease onset and can result in luminal narrowing, which can lead to cardiac ischemia. These vascular remodeling processes have been provisionally designated as "KD vasculopathy". In this review, we focused on the latest updates on echocardiography and ultrasound for KD according to the processes of KD vasculopathy. Correspondence to: Nobutaka Noto, MD, PhD. Noto Children's Clinic, 4-12-6 Heiwadai, Nerima-ku, Tokyo 179-0083, Japan.Email: info@noto-clinic.com.Abstract: Kawasaki disease (KD) is a systemic vasculitis with a predilection for damage to the coronary arteries. In the acute phase, clinical decision making for KD relies on the measurements of the coronary z-score obtained by 2-dimensional echocardiography (2DE). In the convalescent phase, KD patients with coronary artery abnormalities (CAAs) eventually show arteriosclerotic vascular remodeling characterized by marked intimal proliferation and neoangiogenesis after KD vasculitis, which often induces myocardial ischemia. To date, several well-established surrogate markers including dobutamine stress echocardiography (DSE), the carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD), have been made available for risk assessment and the prediction of cardiovascular disease (CVD) in KD patients. Additionally, the use of carotid contrast-enhanced ultrasonography (CEUS), has enabled the visualization and quantification of the adventitial vasa vasorum (VV) network, assessing active vascular remodeling at remote arterial sites in KD patients with CAAs. However, there was no evidence of major vascular structural changes in KD patients in whom CAAs had never been detected. Thus, assessment of multiple modalities using 2DE may provide direct information not only on the vascular health but also on the stratification of the risk of CVD in KD patients with CAAs.

show abstract

A New Z Score Curve of the Coronary Arterial Internal Diameter Using the Lambda-Mu-Sigma Method in a Pediatric Population

Cited by 152 publications

References 20 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Sivelestat sodium hydrate treatment for refractory Kawasaki disease

Recent updates on echocardiography and ultrasound for Kawasaki disease: beyond the coronary artery

Contact Info

Product

Resources

About