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Establishing an appropriate Z score regression equation for Chinese pediatric coronary artery echocardiography: a
Shu-Min Fan1, Bei Xia2, Wei-Xiang Liu3
1Ultrasound Department, Shenzhen Children's Hospital Affiliated to China Medical University, 7019 Yitianroad, Shenzhen, Guangdong, 518038, People's Republic of China.
Insights
This study establishes new Z score regression equations for coronary artery diameter in Chinese children, improving Kawasaki disease diagnosis via echocardiography. These reference values enhance pediatric cardiovascular assessments.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Biostatistics
Background:
- Kawasaki disease diagnosis relies on Z scores for coronary artery lesions.
- Existing Z score methods may lack precision in specific pediatric populations.
- A need exists for localized reference values in Chinese children.
Purpose of the Study:
- To establish coronary artery diameter reference values for Chinese children.
- To develop a Z score regression equation tailored for the Chinese pediatric population.
- To improve the accuracy of echocardiographic assessments in pediatric cardiology.
Main Methods:
- Assembled a multicenter cohort of 852 healthy children (1 month to 17 years).
- Measured coronary artery diameters (right, left, left anterior descending) using echocardiography.
- Applied body surface area (BSA) correction using Stevenson and Haycock formulas; developed Z score regression equations.
Main Results:
- No significant difference in BSA correction using Stevenson (BSAste) vs. Haycock (BSAhay) formulas.
- An exponential regression model provided the best fit for Z score derivation (SZ method).
- SZ method Z scores followed a standard normal distribution, unlike the D method, with statistically significant differences observed (P < 0.05).
Conclusions:
- Successfully established coronary artery diameter reference values for Chinese pediatric echocardiography.
- Developed a clinically applicable Z score regression equation for the Chinese pediatric population.
- The new SZ method offers improved accuracy for assessing coronary artery dimensions in children.
Background:
Z score utility is emphasized in classifying coronary artery lesions in Kawasaki disease patients. The present study is the largest such multicenter Chinese pediatric study about coronary artery diameter reference values and Z score regression equation to date. It is useful in Chinese pediatric echocardiography.
Methods:
A multicenter cohort was assembled, which consisted of 852 healthy children between 1 month and 17 years of age, ten children were excluded because their ultrasound images were not clear, or lost in following up. Diameters of the right coronary artery, left coronary artery, and left anterior descending coronary artery were assessed using echocardiography. Data were body surface area (BSA)-corrected using BSA calculated via either the Stevenson BSA formula or the Haycock BSA formula. Coronary artery diameter reference values and Z score regression equations were established for use in the Chinese pediatric population.
Results:
No difference was observed between coronary artery diameter data corrected using BSAste or BSAhay. Of the five assessed regression models, the exponential model exhibited the best fit and was therefore selected as the basis for derivation of the SZ method. When comparing Z scores, those produced by the SZ method conformed to the standard normal distribution, while those produced by the D method did not. In addition, there was a statistically significant difference between Z scores produced by the SZ and D methods (P < 0.05).
Conclusions:
Coronary artery diameter reference values for echocardiography were successfully established for use in the Chinese pediatric population, and a Z score regression equation more suitable for clinical use in this population was successfully developed.
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