Echocardiographic findings for improved prenatal diagnosis of aortic coarctation with ventricular septal defect

Yunyu Chen; Huixian Li; Danping Huang; Jinrong Liu; Rui Zhang; Wenjia Lei; Yongen Liang; Yanqin Cui; Yuanyuan Gu; Weihui Shentu; Hongying Wang

doi:10.1007/s10554-021-02476-w

Echocardiographic findings for improved prenatal diagnosis of aortic coarctation with ventricular septal defect

Int J Cardiovasc Imaging. 2022 Apr;38(4):825-832. doi: 10.1007/s10554-021-02476-w. Epub 2021 Dec 21.

Authors

Yunyu Chen¹, Huixian Li², Danping Huang¹, Jinrong Liu¹, Rui Zhang¹, Wenjia Lei¹, Yongen Liang¹, Yanqin Cui³, Yuanyuan Gu⁴, Weihui Shentu⁵, Hongying Wang⁶

Affiliations

¹ Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China.
² Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Cardiac Intensive Care Unit, the Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, China.
⁴ Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, China.
⁵ Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China. stwh2007@sina.cn.
⁶ Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China. why0118@163.com.

PMID: 34931278
DOI: 10.1007/s10554-021-02476-w

Abstract

Accurate prenatal diagnosis of coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) remains challenging. The objective of the study was to identify which Doppler and/or two-dimensional sonographic findings are most useful for predicting fetal CoA/VSD. A retrospective cohort study identified 35 fetuses with suspected CoA/VSD. Prenatal imaging characteristics included the right ventricular/left ventricular, pulmonary artery (PA)/aorta ratio, aortic isthmus (AOI) Z score, diastolic velocity-time integral (VTI_D), and systolic velocity-time integral (VTI_S) at the AOI. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated. Significant differences in the PA/AO, VTI_D, VTI_D/VTI_S, VTI_D/VTI_S, VTI_D/(VTI_D + VTI_S), and AOI Z score between the true CoA group and false positives were found. When associated with VSD, the VTI_D/VTI_S and VTI_D/(VTI_D + VTI_S) had the highest AUC (0.97, 95% confidence interval: 0.84-1.00), with 88.46% sensitivity and 100.00% specificity for predicting the true CoA. The AOI Z score had the highest sensitivity (92.31%). Adding the VTI_D/VTI_S to the AOI Z score significantly improved the performance (IDI, 50%; NRI, 82%; P < 0.05), with an improvement in specificity (77.78% vs. 55.56%; non-Event P = 0.008) without sacrificing sensitivity (96.15% vs. 92.31%; Event P = 0.564). In fetuses with suspected CoA associated with VSD, the quantitative spectral Doppler metric aided accurate detection of the fetal CoA, with reduced false positives. The conventional AOI Z score plus spectral Doppler metric may improve the overall diagnostic accuracy of CoA/VSD.

Keywords: Aortic coarctation; Fetal echocardiography; Prenatal diagnosis; Ventricular septal defect.