Diagnostic value of an ROC curve of the size of the antepartum foramen ovale in the prediction of puerperal atrial septal defect

Liu, Lin; He, Yihua; Li, Zhian; Zhang, Ye; Gu, Xiaoyan; Han, Jiancheng; Chen, Jiaoyang

doi:10.3892/etm.2013.1012

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…On the other hand, increased FO diameter has been associated with atrial septal defect (ASD) in postnatal life. Li et al, using ROC analysis, have reported that large FO diameters and FO/ Aorta ratios can be used to predict development of secundum ASD in the postnatal period [29]. Although there was no significant difference between the FO diameters in the two groups in our study, the DV-D and DV-a velocities were significantly increased in the study group, which is interpreted as an increased preload.…”

Section: Discussioncontrasting

confidence: 47%

Can abnormal ductus venosus peak velocity index for veins in normal fetuses predictfailure of functional closure of the foramen ovale in the postnatal period?

Yozgat

Avci²,

Kilic

et al. 2015

Med Ultrason

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Aim: To investigate whether ductus venosus (DV) wave velocities and/or DV peak velocity index for veins (DV-PVIV) can predict failure of functional closure of the foramen ovale in the postnatal period. Material and methods: Fetal echocardiography was performed in 455 healthy women with uneventful pregnancies between the 20-24 th gestational weeks. DV blood flow and DV-PVIV data were collected prospectively. Echocardiography was repeated in healthy subjects on the 30 th postnatal day. Four hundred patients met the study criteria. Newborns with clearly visible foraminal flaps, interatrial septal defects smaller than 5 mm and right-to-left shunting through the defect were accepted as patent foramen ovale (PFO) (n=91). Newborns without PFO (n=309) comprised the control group. Results: A statistically significant difference was detected between the groups with and without PFO in terms of mean DV-PVIV values, DV-D and DV-a wave velocities (p<0.05 for all). ROC analysis showed that increased DV-PVIV values were related to and predictive of PFO (AUC=0.75; p<0.001) and that a threshold value of 0.62, had a sensitivity of 86.8% (95% CI 78.1-93.0%) and a specificity of 51.7% (95% CI 46.1-57.5%). Conclusion: DV-PVIV values above 0.62 at the time of fetal echocardiographic examination can predict failure of functional closure of the foramen ovale in the postnatal period.

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Section: Discussioncontrasting

confidence: 47%

Can abnormal ductus venosus peak velocity index for veins in normal fetuses predictfailure of functional closure of the foramen ovale in the postnatal period?

Yozgat

Avci²,

Kilic

et al. 2015

Med Ultrason

View full text Add to dashboard Cite

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Outcomes of patent foramen ovale greater than 3 mm at birth in extremely low birthweight infants

et al. 2023

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Background Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. Methods Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. Results Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months – 3 years). One infant had presumptive resolution because of the presence of flap valve. Conclusion No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up.

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Use of ROC curve analysis for prediction gives fallacious results: Use predictivity-based indices

Indrayan,

Malhotra,

Pawar

2024

Journal of Postgraduate Medicine

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The area under the ROC curve is frequently used for assessing the predictive efficacy of a model, and the Youden index is commonly used to provide the optimal cut-off. Both are misleading tools for predictions. A ROC curve is drawn for the sensitivity of a quantitative test against its (1 – specificity) at different values of the test. Both sensitivity and specificity are retrospective in nature as these are indicators of correct classification of already known conditions. They are not indicators of future events and are not valid for predictions. Predictivity intimately depends on the prevalence which may be ignored by sensitivity and specificity. We explain this fallacy in detail and illustrate with several examples that the actual predictivity could differ greatly from the ROC curve-based predictivity reported by many authors. The predictive efficacy of a test or a model is best assessed by the percentage correctly predicted in a prospective framework. We propose predictivity-based ROC curves as tools for providing predictivities at varying prevalence in different populations. For optimal cut-off for prediction, in place of the Youden index, we propose a P-index where the sum of positive and negative predictivities is maximum after subtracting 1. To conclude, for correctly assessing adequacy of a prediction models, predictivity-based ROC curves should be used instead of the usual sensitivity-specificity-based ROC curves and the P-index should replace the Youden index.

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Diagnostic value of an ROC curve of the size of the antepartum foramen ovale in the prediction of puerperal atrial septal defect

Cited by 3 publications

References 14 publications

Can abnormal ductus venosus peak velocity index for veins in normal fetuses predictfailure of functional closure of the foramen ovale in the postnatal period?

Can abnormal ductus venosus peak velocity index for veins in normal fetuses predictfailure of functional closure of the foramen ovale in the postnatal period?

Outcomes of patent foramen ovale greater than 3 mm at birth in extremely low birthweight infants

Use of ROC curve analysis for prediction gives fallacious results: Use predictivity-based indices

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