Application of a Global Multiparameter Scoring System for the Prenatal Prediction of Coarctation of the Aorta

Abstract

To assess prospectively the capability of our previously reported global multiparameter scoring system to predict coarctation of the aorta (CoAo) in fetuses with cardiac asymmetry, we applied and analyzed the performance of our scoring system in predicting postnatal CoAo in fetuses undergoing prenatal echocardiographic assessment because of cardiac asymmetry between 2011 and 2021, and we determined the cut-off points of the score with the best balance between specificity and sensitivity, and of maximum sensitivity and specificity. CoAo was confirmed in 39/179 newborns (21.8%). We found a significantly higher probability of CoAo in fetuses with CoAo than in cases without CoAo (84.2 ± 18.2% vs. 26.0 ± 28.6%, p < 0.001). The AUC of the ROC of the score was 0.93 (95% CI 0.89–0.97). The cut-off value with the best balance between specificity and sensitivity was a predicted risk of ≥53% (sensitivity 92.3% and specificity 80.0%). The cut-off point of maximum sensitivity was ≥35% (sensitivity 100% and specificity 72.9%), and that of maximum specificity was ≥96% (sensitivity 43.6% and specificity 96.4%). In none of the fetuses with a probability of CoAo < 35% was this condition confirmed after birth. This occurred in 102 fetuses in the whole study population (57%) and in 84 of the 111 in whom CoAo was suspected beyond 28 weeks (75.7%). This multiparameter score allows an adequate discrimination between fetuses without CoAo and those with CoAo, reducing the false positive diagnoses in cardiac asymmetry.

Accurate Prenatal Diagnosis of Coarctation of the Aorta by Three-step Echocardiographic Diagnostic Model

“…The two indices used together would balance any false negative and false positive rates. Gómez-Montes [7] proposed the cutoff value of the Z-score of the isthmus to be ≤ -2 when measured in 3VT view, which is larger than our data. In our study, the measurement of the isthmus had to be taken at the insertion of the PDA in the sagittal and coronary views or proximal to the ori ce of the LSA in the long axis view, and the cut-off value was ≤ -7.5.…”

“…It was measured by two straight lines, where one line was drawn proximal (from the take-off of the second head vessel) to distal (to the end of the third head vessel) along the internal boundary of the transverse arch, and the second line was drawn proximal (just prior to the isthmus) to distal (to the end of the isthmus) along the internal boundary of the isthmus (Fig. 1) [3,7].…”

Challenges of prenatal diagnosis of fetal hypoplastic aortic arch and predication of the need for intervention

“…Their findings further demonstrate the anatomic and pathophysiological complexity of ductus arteriosus and aortic isthmus region in patients with coarctation of aorta and dynamic change following the transition from fetal to neonatal circulation, and the need to adopt multiparametric diagnostic model and multicriteria prediction model 6–9 . Many investigators have been working to explore the application of three‐dimensional fetal echocardiography and cardiac magnetic resonance imaging in fetal aortic arch anomalies to increase the accuracy of the diagnosis of coarctation of aorta and the prediction for postnatal intervention 10–12 …”

Retos en el diagnóstico prenatal de coartación de aorta: actualización y perspectiva actual

“…Otro parámetro Doppler asociado con la CoAo es el aumento de la velocidad máxima transaórtica en aquellos fetos en los que se confirma posnatalmente la CoAo y requieren ser intervenidos 44 . Sin embargo, la utilidad de los parámetros ecocardiográficos funcionales para el diagnóstico de CoAo es controvertida, y no se ha demostrado de manera inequívoca su rentabilidad diagnóstica 39,43,45,46 En la tabla 1 se resumen los principales signos prenatales de coartación de aorta.…”