Diagnosis of coronary artery lesions in children based on Z-score regression model

WANG Yong; JIANG Jia-Ying; DENG Yan; LI Bo; SHUAI Ping; HU Xiao-Ping; ZHANG Yin-Yan; WU Han; YE Lu-Wei; PENG Qian

doi:10.7499/j.issn.1008-8830.2405030

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Chinese Journal of Contemporary Pediatrics ›› 2025, Vol. 27 ›› Issue (2) : 176-183. DOI: 10.7499/j.issn.1008-8830.2405030

CLINICAL RESEARCH

Diagnosis of coronary artery lesions in children based on Z-score regression model

WANG Yong, JIANG Jia-Ying, DENG Yan, LI Bo, SHUAI Ping, HU Xiao-Ping, ZHANG Yin-Yan, WU Han, YE Lu-Wei, PENG Qian

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Abstract

Objective To construct a Z-score regression model for coronary artery diameter based on echocardiographic data from children in Sichuan Province and to establish a Z-score calculation formula. Methods A total of 744 healthy children who underwent physical examinations at Sichuan Provincial People's Hospital from January 2020 to December 2022 were selected as the modeling group, while 251 children diagnosed with Kawasaki disease at the same hospital from January 2018 to December 2022 were selected as the validation group. Pearson correlation analysis was conducted to analyze the relationships between coronary artery diameter values and age, height, weight, and body surface area. A regression model was constructed using function transformation to identify the optimal regression model and establish the Z-score calculation formula, which was then validated. Results The Pearson correlation analysis showed that the correlation coefficients for the diameters of the left main coronary artery, left anterior descending artery, left circumflex artery, and right coronary artery with body surface area were 0.815, 0.793, 0.704, and 0.802, respectively (P<0.05). Among the constructed regression models, the power function regression model demonstrated the best performance and was therefore chosen as the optimal model for establishing the Z-score calculation formula. Based on this Z-score calculation formula, the detection rate of coronary artery lesions was found to be 21.5% (54/251), which was higher than the detection rate based on absolute values of coronary artery diameter. Notably, in the left anterior descending and left circumflex arteries, the detection rate of coronary artery lesions using this Z-score calculation formula was higher than that of previous classic Z-score calculation formulas. Conclusions The Z-score calculation formula established based on the power function regression model has a higher detection rate for coronary artery lesions, providing a strong reference for clinicians, particularly in assessing coronary artery lesions in children with Kawasaki disease.

Key words

Kawasaki disease / Coronary artery lesion / Coronary artery / Z-score / Echocardiography / Child

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WANG Yong, JIANG Jia-Ying, DENG Yan, LI Bo, SHUAI Ping, HU Xiao-Ping, ZHANG Yin-Yan, WU Han, YE Lu-Wei, PENG Qian. Diagnosis of coronary artery lesions in children based on Z-score regression model[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(2): 176-183 https://doi.org/10.7499/j.issn.1008-8830.2405030

References

1 李燕羽, 袁晨辰, 蔡艾媛, 等. 血小板与淋巴细胞比值对中国川崎病患儿冠状动脉病变预测价值的Meta分析[J]. 中国当代儿科杂志, 2023, 25(12): 1219-1226. PMID: 38112138. PMCID: PMC10731965. DOI: 10.7499/j.issn.1008-8830.2306097.
2 张华勇, 张勇. 5岁以上川崎病儿童合并冠状动脉病变的预测指标与风险模型构建[J]. 中国当代儿科杂志, 2024, 26(5): 461-468. PMID: 38802905. PMCID: PMC11135057. DOI: 10.7499/j.issn.1008-8830.2309103.
3 Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. PMID: 32641591. DOI: 10.1253/circj.CJ-19-1094.
4 McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
5 de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease: the SHARE initiative[J]. Rheumatology (Oxford), 2019, 58(4): 672-682. PMID: 30535127. DOI: 10.1093/rheumatology/key344.
6 Marchesi A, Tarissi de Jacobis I, Rigante D, et al. Kawasaki disease: guidelines of the Italian Society of Pediatrics, part I—definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase[J]. Ital J Pediatr, 2018, 44(1): 102. PMID: 30157897. PMCID: PMC6116535. DOI: 10.1186/s13052-018-0536-3.
7 中华医学会儿科学分会心血管学组, 中华儿科杂志编辑委员会. 川崎病冠状动脉病变的临床处理建议（2020年修订版）[J]. 中华儿科杂志, 2020, 58(9): 718-724. PMID: 32872711. DOI: 10.3760/cma.j.cn112140-20200422-00421.
8 中华医学会儿科学分会心血管学组, 中华医学会儿科学分会风湿学组, 中华医学会儿科学分会免疫学组, 等. 川崎病诊断和急性期治疗专家共识[J]. 中华儿科杂志, 2022, 60(1): 6-13. PMID: 34986616. DOI: 10.3760/cma.j.cn112140-20211018-00879.
9 陕西省川崎病诊疗中心/陕西省人民医院儿童病院, 国家儿童医学中心/首都医科大学附属北京儿童医院, 上海交通大学医学院附属儿童医院, 等. 中国儿童川崎病诊疗循证指南（2023年）[J]. 中国当代儿科杂志, 2023, 25(12): 1198-1210. PMID: 38112136. PMCID: PMC10731970. DOI: 10.7499/j.issn.1008-8830.2309038.
10 焦富勇, 穆志龙, 杜忠东, 等. 儿童不完全性川崎病的诊治[J]. 中国当代儿科杂志, 2023, 25(3): 238-243. PMID: 36946156. PMCID: PMC10032064. DOI: 10.7499/j.issn.1008-8830.2209127.
11 Newburger JW, Takahashi M, Gerber MA, 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[J]. Pediatrics, 2004, 114(6): 1708-1733. PMID: 15574639. DOI: 10.1542/peds.2004-2182.
12 金虹, 梁翊常, 张新春. 正常儿童冠状动脉超声心动图研究[J]. 中华儿科杂志, 1988, 26(5): 257-259. DOI: 10.3760/cma.j.issn.0578-1310.1988.05.101.
13 Kurotobi S, Nagai T, Kawakami N, et al. Coronary diameter in normal infants, children and patients with Kawasaki disease[J]. Pediatr Int, 2002, 44(1): 1-4. PMID: 11982862. DOI: 10.1046/j.1442-200x.2002.01508.x.
14 Tan TH, Wong KY, Cheng TK, et al. Coronary normograms and the coronary-aorta index: objective determinants of coronary artery dilatation[J]. Pediatr Cardiol, 2003, 24(4): 328-335. PMID: 12360388. DOI: 10.1007/s00246-002-0300-7.
15 McCrindle BW, Li JS, Minich LL, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements[J]. Circulation, 2007, 116(2): 174-179. PMID: 17576863. DOI: 10.1161/CIRCULATIONAHA.107.690875.
16 Olivieri L, Arling B, Friberg M, et al. Coronary artery Z score regression equations and calculators derived from a large heterogeneous population of children undergoing echocardiography[J]. J Am Soc Echocardiogr, 2009, 22(2): 159-164. PMID: 19084373. DOI: 10.1016/j.echo.2008.11.003.
17 Crystal MA, Manlhiot C, Yeung RS, et al. Coronary artery dilation after Kawasaki disease for children within the normal range[J]. Int J Cardiol, 2009, 136(1): 27-32. PMID: 18619690. DOI: 10.1016/j.ijcard.2008.04.019.
18 Manlhiot C, Millar K, Golding F, et al. Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease[J]. Pediatr Cardiol, 2010, 31(2): 242-249. PMID: 20024653. DOI: 10.1007/s00246-009-9599-7.
19 郑淋, 杜忠东, 金兰中, 等. 超声心动图评价儿童冠状动脉内径正常参考值范围及其临床意义[J]. 中华儿科杂志, 2013, 51(5): 371-376. PMID: 23941845. DOI: 10.3760/cma.j.issn.0578-1310.2013.05.011.
20 夏焙, 许娜, 何学智, 等. 儿童超声心动图冠状动脉正常参考值及临床意义[J]. 中华医学超声杂志（电子版）, 2013, 10(1): 42-51. DOI: 10.3877/cma.j.issn.1672-6448.2013.01.010.
21 Kuo HC, Chen SH, Chen IF, et al. Novel multiple Z-score models for detection of coronary artery dilation: application in Kawasaki disease[J]. Pediatr Rheumatol Online J, 2024, 22(1): 108. DOI: 10.1186/s12969-024-01040-9.
22 Zhang YQ, Chen SB, Huang GY, et al. Coronary artery indexed diameter and Z score regression equations in healthy Chinese Han children[J]. J Clin Ultrasound, 2015, 43(1): 39-46. PMID: 24975134. DOI: 10.1002/jcu.22176.
23 Fan SM, Xia B, Liu WX, et al. Establishing an appropriate Z score regression equation for Chinese pediatric coronary artery echocardiography: a multicenter prospective cohort study[J]. BMC Pediatr, 2021, 21(1): 429. PMID: 34592941. PMCID: PMC8482596. DOI: 10.1186/s12887-021-02877-9.
24 Liu HH, Qiu Z, Fan GZ, et al. Assessment of coronary artery abnormalities and variability of Z-score calculation in the acute episode of Kawasaki disease: a retrospective study from China[J]. Eur J Clin Invest, 2021, 51(3): e13409. PMID: 32916764. DOI: 10.1111/eci.13409.
25 Yang Y, Wang L, Yang Y, et al. Z-score regression model for coronary artery diameter in healthy Chinese Han children[J]. Acta Radiol, 2023, 64(2): 798-805. PMID: 35306860. DOI: 10.1177/02841851221085685.
26 de Zorzi A, Colan SD, Gauvreau K, et al. Coronary artery dimensions may be misclassified as normal in Kawasaki disease[J]. J Pediatr, 1998, 133(2): 254-258. PMID: 9709715. DOI: 10.1016/s0022-3476(98)70229-x.
27 Ronai C, Hamaoka-Okamoto A, Baker AL, et al. Coronary artery aneurysm measurement and Z score variability in Kawasaki disease[J]. J Am Soc Echocardiogr, 2016, 29(2): 150-157. PMID: 26386984. DOI: 10.1016/j.echo.2015.08.013.
28 Kobayashi T, Fuse S, Sakamoto N, et al. A new Z score curve of the coronary arterial internal diameter using the lambda-mu-sigma method in a pediatric population[J]. J Am Soc Echocardiogr, 2016, 29(8): 794-801.e29. PMID: 27288089. DOI: 10.1016/j.echo.2016.03.017.
29 Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthy children[J]. J Am Soc Echocardiogr, 2011, 24(1): 60-74. PMID: 21074965. DOI: 10.1016/j.echo.2010.10.004.
30 Ogata S, Tremoulet AH, Sato Y, et al. Coronary artery outcomes among children with Kawasaki disease in the United States and Japan[J]. Int J Cardiol, 2013, 168(4): 3825-3828. PMID: 23849968. PMCID: PMC4002741. DOI: 10.1016/j.ijcard.2013.06.027.
31 Kim SH, Kim JY, Kim GB, et al. Diagnosis of coronary artery abnormalities in patients with Kawasaki disease according to established guidelines and Z score formulas[J]. J Am Soc Echocardiogr, 2021, 34(6): 662-672.e3. PMID: 33422668. DOI: 10.1016/j.echo.2021.01.002.