Atrioventricular depolarization differences identify coronary artery anomalies in Kawasaki disease.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Atrioventricular depolarization differences, measured by the spatial or two dimensional PR angle differentiate KD patients with CAA versus those without.
Children's Hospital Colorado, Aurora, CO, USA.|University of Colorado School of Medicine, Aurora, CO, USA.|Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Daniel
D
Cortez
Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Nandita
N
Sharma
Children's Hospital Colorado, Aurora, CO, USA.|University of Colorado School of Medicine, Aurora, CO, USA.
Pei-Ni
PN
Jone
D016022:Case-Control Studies; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000503:physiopathology*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016037:Single-Blind Method
Kawasaki; PR angle; coronary artery anomalies; vectorcardiography
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