Objectives: The carotid intima-media thickness (CIMT) is a reliable screening method for vascular alterations even in a pediatric cohort; however, reference values of CIMT established recently by LMS methods for childhood and adolescence are limited when comparing patients after Kawasaki disease (KD) and controls. We tested the hypothesis that there are significant differences between the values of CIMT expressed as absolute values and z-scores in children and adolescents after KD and controls.
Methods: We reviewed 12 published articles regarding CIMT on patients after KD and controls. Absolute values (Ab) of the mean±1 SD of CIMT in patients after KD and controls were transformed to z-scores (Zs) using age-specific reference values established by Jourdan et al. (J: 247 Caucasian subjects aged 10-20 years) and our own data (O: 175 Asian subjects aged 6-20 years), and the results were compared between the two references. In this study, the mean age of the study population derived from each article was designated the representative age for transformation.
Results: In either reference (J) or (O), there was no significant sex difference in CIMT at any given age. The mean CIMT of (Ab) and (Zs) transformed by (J) or (O) were significantly different between patients after KD and controls, at 41.6% (Ab), 66.6% (Zs) by (J), and 83.3% (Zs) by (O) among 12 articles, respectively. Therefore, patients after KD had significantly higher (Zs) by (O) than those of controls (0.66±0.71 vs. 0.03±0.68, p=0.006, respectively). Compared with reference values, the controls of (O) were within the normal range. However, there were no significant differences in (Zs) by (J) between the two groups (1.72±0.77 vs. 1.23±0.83, p=0.116, respectively). When we assessed 9 articles dealing with Asian subjects, the difference of (Zs) between the two groups remained significant only by (O) (p=0.015). In contrast, when we assessed 3 articles dealing with mainly Caucasian subjects, there was no significant difference in (Zs) between the two groups with both (J) and (O).
Conclusions: These results indicate that age and race-specific reference values for CIMT are mandatory for performing an accurate assessment of the vascular status in healthy children and adolescents and particularly in those after KD.