Abstract 2603: Predictors of Coronary Artery Visualization in Kawasaki Disease in the Pediatric Heart Network (PHN) Multi-Center Study
Background: Echocardiography is the imaging modality of choice for evaluation of coronary artery (CA) abnormalities in Kawasaki disease (KD). Single center series have established high specificity and sensitivity for abnormality detection.
Objective: To determine visualization rates of CAs across clinical centers and factors associated with success.
Methods: Subjects enrolled in an 8 center PHN prospective, randomized trial of pulse steroids in primary treatment of KD underwent standardized echo evaluation at diagnosis and at 1 and 5 weeks later. All studies were interpreted by local centers and at a core laboratory (lab) which provided training and feedback over the study period. Imaging rates were calculated for each tertile of study time (9 month blocks). We explored univariate and multivariate predictors of CA visualization.
Results: The core lab evaluated 587 echoes from 199 patients over 27 months. Left main, proximal/distal left anterior descending (LAD) and proximal right CAs were verified as visualized by the core lab in 91–98% of studies, but less often for the distal right (65%), circumflex (86%) and posterior descending (PD) (54%) CA segments. Visualization rates for 2 of the 3 less successfully imaged segments improved with time (p<.05). Weight and BSA did not impact success. In multivariate analysis, local center, CA segment and time from study start to echo were independent predictors of visualization (all p<.001). For CA segments for which % visualization varied by center, higher % visualization was associated with larger center volume (p=.001). Use of routine sedation was also associated with higher % visualization: distal LAD odds ratio (OR) 2.32 (95% CI 1.2, 4.49; p = 0.13), distal right OR 9.09 (95% CI 5.38, 15.35; p<.001), circumflex OR 2.94 (95% CI 1.61, 5.38; p<.001), PD OR 2.77 (95% CI 1.7, 4.53; p<.001). Moderate agreement between local and core lab readings (ICC 0.55– 0.70) was present for all CA segments except the PD (ICC 0.38).
Conclusion: Successful visualization of CAs in KD is associated with the specific CA 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 multi-center trials.