Carotid Intima-Media Thickness and Ankle-Brachial Index and Their Correlation with Coronary Artery Dilatation in Children with Kawasaki Disease

Objective. To investigate the correlation between carotid intima-media thickness (IMT), ankle-brachial index (ABI), and coronary artery dilatation (CAD) in children with Kawasaki disease (KD) and to evaluate the effectiveness of CAD. Methods. A total of 68 children diagnosed with KD from January 2019 to January 2021 in our hospital were included. According to the results of cardiac color Doppler ultrasound, the children with KD were divided into a noncoronary artery dilation group (NCAD), with 41 children with KD who did not have coronary artery lesions, and a coronary artery dilation group (CAD), with 27 children with KD who had coronary artery dilation. 27 healthy children undergoing physical examination in our hospital at the same time were selected as the normal control group. Laboratory index of all subjects was measured individually. The carotid IMT, ABI, and coronary artery diameter of all subjects were measured and compared. Pearson correlation was used to analyze the correlation between carotid IMT, ABI, and the severity of coronary artery disease. The ROC curve was used to evaluate the efficacy of carotid IMT and ABI in predicting coronary artery disease. Results. The ALB of children in the CAD group was lower than that in the NCAD group P < 0.05 . The IMT of carotid artery and the diameter of coronary artery in children of the CAD group and the NCAD group were higher than those of the normal control group, and the IMT of the CAD group was higher than that of the NCAD group. The ABI of children in the CAD group and the NCAD group was lower than that of the normal control group, and the ABI of children in the CAD group was lower than that of the NCAD group P < 0.05 . Correlation analysis showed that carotid artery IMT of children with KD was positively correlated with coronary artery diameter, while ABI was negatively correlated with coronary artery diameter. The AUC of carotid IMT for CAD in children with KD was 0.668 (95% CI: 0.538–0.797), that of ABI for CAD in children with KD was 0.646 (95% CI: 0.513–0.780), and that of the combination of carotid IMT and ABI for CAD was 0.874 (95% CI: 0.785–0.963). Conclusion. The changes of carotid artery IMT and ABI in children with KD have a certain correlation with CAD, and the joint detection of carotid artery IMT and ABI can provide clinical reference value for predicting the degree of coronary artery disease in children with KD.

Normal coronary diameters in coronary angiogram at Patan Hospital, Nepal

This study aims to assess the normal coronary diameters of patient who underwent coronary angiogram in Patan Hospital. Angiographic and demographic data of a total of 307 patients (155 males, 152 females; mean age 62.09±11.06 years) who underwent elective coronary angiography in Patan Hospital due to suspicion of coronary artery disease between 2017 and 2020 and in whom coronary angiography documented normal coronary arteries without any intra-luminal irregularity were analyzed retrospectively. Proximal diameters of the main epicardial coronary arteries were measured quantitatively using automated software analysis (Allura, Philips). The mean diameter of unadjusted/adjusted left main coronary artery, proximal left anterior descending artery, proximal left circumflex artery, proximal right coronary artery were 4.87±0.85mm/2.8±0.54, 3.8±0.7/2.19±0.439, 3.4±0.7/1.98±0.44, 3.6±0.85/2.07±0.53 respectively. Our study findings contradict the traditional belief that females have narrower coronary arteries than males. Our study showed the females have statistically significant larger unadjusted Right Coronary Artery diameter and adjusted Left Main Coronary Artery diameter. We believe that our findings may contribute to the global data pool of normal coronary diameters and can be utilized in future studies as a database.

Establishing an appropriate Z score regression equation for Chinese pediatric coronary artery echocardiography: a multicenter prospective cohort study

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.

Establishing an Appropriate Z Score Regression Equation for Chinese Pediatric Coronary Artery Echocardiography: A Multicenter Prospective Cohort Study

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.

Effects of Umbilical Cord Blood Stem Cells on Coronary Artery Damage in Mice with Kawasaki Disease By High-Frequency Ultrasound

Objective: to use lactobacillus casein cell wall extract (LCWE) to induce Kawasaki disease (KD) mouse model, and analyse the process of coronary artery damage and effects of umbilical cord blood stem cells by high-frequency ultrasound in small animals. Methods: LCWE was prepared and 18 BALB/c pups were randomly divided into two groups: 15 in KD model group and 3 in the normal control group. KD model was induced by a single intraperitoneal injection of 0.5ml LCWE in the model group, and changes of the coronary artery were observed at 2d, 21d and 30d after the injection, respectively. From the 16th day of modeling, 300 μL PBS was injected intraperitoneally daily in the control group and model group. The hUC-MSCs 300 μL (105/mL) were intraperitoneally injected daily for 10 consecutive days in the stem cell group. The mice were sacrificed in batches on day 2, 15, 21 and 30, and the morphological changes of coronary arteries were observed by echocardiography and histopathology. Results: the change of coronary artery diameter could be accurately measured by high-frequency small animal ultrasound. At 21d, the coronary arteries of the model group were widened compared with those of the control group. At 30d, there was no significant difference between the model group and the previous model group. Histopathology showed slight swelling of the epicardium of aortic valve, mitral valve, right ventricle and atrium, scattered infiltration of a few neutrophils, dilatation of the coronary artery lumen, necrosis and disintegration of a small number of myocardial cells, and significant hyperplasia of local fibrous connective tissue accompanied by solid calcium salt deposits. After hUC-MSCs intervention treatment, B-ultrasound showed a decrease in the main coronary artery diameter, histopathology showed multiple lymphocytes, eosinophilic granulocytes, and mononuclear cell infiltration in the left atrial appendage of mice, and no obvious vascular inflammatory reaction or other obvious abnormalities were observed. Conclusion: high-frequency ultrasound can be used to clearly obtain the coronary artery image of KD mice and dynamically observe the evolution process of coronary artery diameter, which provides more diagnostic basis for the treatment of clinical KD. And hUC-MSCs intervention reduced the pathological lesion of coronary artery inflammation in mice compared with the model group.

Alcohol consumption may not affect the diameter of the coronary arteries in men with chest pain

Objective The effect of alcohol consumption on the risk of coronary heart disease is controversial. Several studies have assessed the effects of alcohol on the formation of atherosclerotic plaques, but few studies have evaluated the chronic effects of alcohol consumption on the coronary artery diameter. We investigated whether alcohol consumption affects the coronary artery diameter. Methods This prospective study enrolled men who were undergoing coronary angiography at the First Affiliated Hospital of Chongqing Medical University from November 2016 to December 2017. The participants were categorized into three groups based on their drinking behavior: heavy drinking (>175 g/week in the last 2 years, n = 70), moderate drinking (>42 to ≤175 g/week in the last 2 years, n = 53), and nondrinking (lifetime alcohol consumption of <98 g, n = 79). The diameters of the left and right coronary arteries were compared among the three groups. Results No significant differences in the diameters of the left and right coronary arteries were observed among the three groups. Conclusions Alcohol consumption may not affect the diameter of the coronary arteries.

Percutaneous coronary intervention in four month old infant for acute myocardial ischemia after repaired ALCAPA

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare, but life-threatening condition. The treatment of choice in patients with ALCAPA is the establishment of a dual coronary artery system with surgical reimplantation of the left coronary artery in the left coronary sinus. Percutaneous coronary intervention is infrequent in the pediatric population but can be a life-saving by promptly restoring flow to an obstructed coronary artery. It is a highly demanding and high-risk procedure in infants due to the technical difficulties and the small coronary artery diameter in infants.

Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

ObjectiveWe aimed to compare the severity of coronary artery abnormalities in Kawasaki disease between infants and older children.MethodsWe retrospectively reviewed and compared coronary artery dilation and aneurysm severity in infants <1 year of age with Kawasaki disease at our centre over a 10-year period with that observed in children ≥1 year of age in the Pediatric Heart Network Trial of Pulse Steroid Therapy in Kawasaki Disease. Coronary artery abnormalities were defined by z-scores according to American Heart Association guidelines.ResultsOf the 93 infants identified during the study period, 80 were treated with intravenous gamma globulin within the first 10 days of illness and were included for comparison to 170 children ≥1 year of age treated in the same time frame from the Pediatric Heart Network public database. The mean maximum z-score was significantly higher in infants compared with older children (3.37 vs 2.07, p<0.001). A higher incidence of medium and giant aneurysms was observed in infants compared with children ≥1 year of age (11% vs 3% for medium aneurysms, p=0.015; 8% vs <1% for giant aneurysms, p=0.005).ConclusionsInfants with Kawasaki disease have more severe coronary artery dilation compared with older children, and a higher prevalence of medium and giant aneurysms. Because adverse outcomes are closely linked to the maximal coronary artery diameter in Kawasaki disease, patients diagnosed as infants require very close long-term monitoring for cardiac complications.