Cortez Daniel, Sharma Nandita, Jone Pei-Ni
Children's Hospital Colorado, Aurora, CO, USA.
University of Colorado School of Medicine, Aurora, CO, USA.
Ann Noninvasive Electrocardiol. 2017 Mar;22(2). doi: 10.1111/anec.12406. Epub 2016 Sep 28.
Kawasaki disease (KD) is the leading cause of acquired heart disease in children. Signal average electrocardiogram changes in patients during the acute phase of KD with coronary artery anomalies (CAA) include depolarization changes. We set out to determine if 12-lead-derived atrioventricular depolarization differences can identify CAA in patients with KD.
A blinded, retrospective case-control study of patients with KD was performed. Deep Q waves, corrected QT-intervals (QTc), spatial QRS-T angles, T-wave vector magnitudes (RMS-T), and a novel parameter for assessment of atrioventricular depolarization difference (the spatial PR angle) and a two dimensional PR angle were assessed. Comparisons between groups were performed to test for significant differences.
One hundred one patients with KD were evaluated, with 68 having CAA (67.3%, mean age 3.6 ± 3.0 years, 82.6% male), and 32 without CAA (31.7%, mean age 2.7 ± 3.2 years, 70.4% male). The spatial PR angle significantly discriminated KD patients with CAA from those without, 59.7° ± 31.1° versus 41.6° ± 11.5° (p < .001). A spatial PR angle cutoff value of 56.9° gave positive/negative predictive values and odds ratios of 93.8%, 43.5%, and 11.5% (95% confidence interval (CI) 2.6-52.2). The two dimensional PR angle either below 7° or above 92° gave positive/negative predictive values and odds ratios of 100.0%, 38.8%, and 21.1% (95% CI 1.2-362.8). No other parameters significantly differentiated the groups.
Atrioventricular depolarization differences, measured by the spatial or two dimensional PR angle differentiate KD patients with CAA versus those without.
川崎病（KD）是儿童后天性心脏病的主要病因。患有冠状动脉异常（CAA）的KD患者急性期的信号平均心电图变化包括去极化变化。我们旨在确定12导联得出的房室去极化差异是否能识别KD患者中的CAA。
对KD患者进行了一项盲法回顾性病例对照研究。评估了深Q波、校正QT间期（QTc）、空间QRS-T角、T波向量幅度（RMS-T），以及一个用于评估房室去极化差异的新参数（空间PR角）和二维PR角。进行组间比较以检验显著差异。
对101例KD患者进行了评估，其中68例有CAA（67.3%，平均年龄3.6±3.0岁，82.6%为男性），32例无CAA（31.7%，平均年龄2.7±3.2岁，70.4%为男性）。空间PR角显著区分了有CAA和无CAA的KD患者，分别为59.7°±31.1°和41.6°±11.5°（p<0.001）。空间PR角截断值为56.9°时，阳性/阴性预测值和比值比分别为93.8%、43.5%和11.5%（95%置信区间（CI）2.6 - 52.2）。二维PR角低于7°或高于92°时，阳性/阴性预测值和比值比分别为100.0%、38.8%和21.1%（95%CI 1.2 - 362.8）。没有其他参数能显著区分这两组。
通过空间或二维PR角测量的房室去极化差异可区分有CAA和无CAA的KD患者。
