Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
J Am Soc Echocardiogr. 2011 Jan;24(1):53-9. doi: 10.1016/j.echo.2010.10.015.
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.
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.
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.
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.
超声心动图是评估川崎病冠状动脉（CA）异常的首选影像学检查方法。一些小系列研究已经证实了其在检测异常方面具有很高的特异性和敏感性，但对于单个 CA 节段的可视化率以及与成功相关的因素尚不清楚。
在儿科心脏网络的川崎病一线类固醇治疗的随机试验中，超声心动图由当地实验室和核心实验室进行解读。通过核心实验室确定了当地实验室确定的 CA 可视化的单变量和多变量预测因素，并评估了当地和核心实验室测量的 CA 大小的一致性。
在 27 个月的时间里，从 199 名患者中总共获得了 589 份超声心动图。左主干、近端和远端左前降支以及近端右冠状动脉的可视化率从 91%到 98%不等，但远端右（65%）、回旋支（86%）和后降支（54%）的可视化率较低。对于远端右和回旋支 CA，可视化率在研究过程中有所提高（P<.05）。多变量分析显示，当地中心、CA 节段以及从研究开始到超声心动图的时间是可视化的独立预测因素（所有 P 值<.001）。对于可视化率因中心而异的节段，较高的百分比可视化与更大的中心体积相关（P=.001）。常规镇静的使用也与更高的可视化率相关。
川崎病中成功的 CA 可视化与正在评估的节段有关，并且受到中心体积和镇静使用的影响。随着时间的推移，可视化率的增加表明存在学习曲线，并强调了核心实验室监督在儿科多中心试验中的价值。
