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Gestational age-specific scoring systems for the prediction of coarctation of the aorta
Enery Gómez-Montes1, Ignacio Herraiz, Paula Isabel Gómez-Arriaga
1Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Universitario '12 de Octubre', Madrid, Spain.
Insights
Predicting coarctation of the aorta (CoAo) prenatally is improved by gestational age-specific scoring systems. These systems combine cardiac parameters to enhance diagnostic accuracy in fetal echocardiography.
Area of Science:
- Fetal cardiology
- Prenatal diagnosis
- Congenital heart defects
Background:
- Coarctation of the aorta (CoAo) is a serious congenital heart defect.
- Accurate prenatal prediction of CoAo is crucial for timely intervention and improved outcomes.
- Current methods for prenatal CoAo detection have limitations.
Purpose of the Study:
- To identify the optimal combination of cardiac parameters for predicting CoAo during fetal development.
- To develop gestational age-specific scoring systems to improve diagnostic accuracy.
Main Methods:
- Analysis of 115 fetuses with prenatally diagnosed simple cardiac asymmetry.
- Logistic regression to identify key predictors of CoAo.
- Development and evaluation of gestational age-specific scoring systems using pairwise parameter combinations.
Main Results:
- CoAo was confirmed in 45% of the study population.
- In early diagnosis (≤28 weeks), ascending aorta (AAo) and aortic isthmus z-scores showed high accuracy (AUC 0.98).
- In late diagnosis (>28 weeks), the tricuspid valve/mitral valve and main pulmonary artery/AAo ratios provided the best prediction (AUC 0.84).
Conclusions:
- Gestational age-specific scoring systems combining cardiac size parameters enhance prenatal CoAo risk stratification.
- These objective and simple scoring systems can be readily implemented in fetal cardiology settings.
- Improved prenatal detection of CoAo can lead to better management and outcomes for affected neonates.
Objectives:
To determine which combination of cardiac parameters provides the best prenatal prediction of coarctation of aorta (CoAo).
Methods:
We selected all cases of simple cardiac asymmetry prenatally diagnosed in 2003-2013. Logistic regression was used to select the best predictors of CoAo.
Results:
The study population included 115 fetuses. CoAo was confirmed in 52 neonates (45%). The sample was divided in two groups according to the gestational age (GA) at diagnosis: early group (EG) ≤28 weeks (n = 57), and late group (LG) >28 weeks (n = 58). CoAo was confirmed in 75% and 16% of cases, respectively. GA-specific scoring systems with maximum two parameters were made, and the pairwise combination with the best diagnostic performance for each group was selected. In EG, the z-score of ascending aorta (AAo) and aortic isthmus (three vessels and trachea view) showed the best diagnostic accuracy [area under receiver-operating curve (AUC) 0.98, 95% confidence interval (CI) 0.94-1.00]. In the LG, the best results were provided by the tricuspid valve/mitral valve ratio with the main pulmonary artery/AAo ratio (AUC 0.84, 95% CI 0.67-1.00).
Conclusions:
Gestational age-specific scoring systems combining size-based cardiac parameters may improve the accuracy of fetal echocardiography to stratify the risk of CoAo. The objectivity and simplicity of its components may facilitate its implementation in fetal cardiology units.
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