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A new scoring system for spontaneous closure prediction of perimembranous ventricular septal defects in children
Jing Sun1, Kun Sun1, Sun Chen1
1Pediatric Heart Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.
Insights
A new scoring system accurately predicts spontaneous closure (SC) probability in perimembranous ventricular septal defect (PMVSD) patients. This tool aids in forecasting closure likelihood for congenital heart defects.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Defects
- Cardiac Surgery
Background:
- Perimembranous ventricular septal defect (PMVSD) is a common congenital heart anomaly.
- While some PMVSDs close spontaneously (SC), others require surgical or device closure.
- Predicting SC is crucial for optimal patient management.
Purpose of the Study:
- To develop and validate a predictive scoring system for spontaneous closure (SC) in perimembranous ventricular septal defect (PMVSD) patients.
- To identify key clinical factors associated with SC in PMVSD.
- To improve the forecasting of SC probability for informed clinical decisions.
Main Methods:
- A Cox regression model was established using data from 1873 PMVSD patients (derivative cohort).
- Factors analyzed included age at contact, VSD diameter, shunt flow, aneurysmal tissue of the ventricular membranous septum (ATVMS), complications, and left ventricular end-diastolic dimension (LVDD).
- The derived scoring system was validated in an independent cohort of 382 PMVSD patients.
Main Results:
- Multivariate analysis identified age, defect size, shunt flow, ATVMS, complications, and LVDD as significant predictors of SC.
- The predictive scoring system demonstrated high accuracy in both derivative (ROC AUC 0.831) and validation (ROC AUC 0.863) cohorts.
- The model effectively predicted the probability of spontaneous closure in PMVSD.
Conclusions:
- A novel scoring system effectively predicts the probability of spontaneous closure in PMVSD.
- This tool can assist clinicians in managing PMVSD by forecasting SC likelihood.
- Further research may refine predictive models for congenital heart defects.
Background:
Perimembranous ventricular septal defect (PMVSD) is a congenital heart aberration, which is surgically treated by patch or device closure, but also can heal without operation as spontaneous closure (SC).
Methods:
We analyzed data from 1873 PMVSD patients admitted to our hospital during September 2001 and December 2009, in order to establish a Cox regression model for PMVSD SC probability prediction (derivative cohort). Initial contact age, ventricular septal defect (VSD) diameter, shunt flow, aneurysmal tissue of the ventricular membranous septum (ATVMS) development, associated complications, and left ventricular end-diastolic dimension (LVDD) were analyzed for correlations with SC. The derived scoring system based on the coefficients of the model was developed and applied to another cohort with 382 PMVSD patients to evaluate the validity for SC probability forecast (validation cohort).
Results:
Multivariate Cox regression analysis revealed that SC of PMVSD was associated with age at first contact, defect size, diffuse shunt flow, ATVMS formation, associated complication, as well as increased LVDD, which were used to establish a new scoring system. The area under the receiver operating characteristic (ROC) curve of our predictive scaling was 0.831 (95% CI 0.804-0.858, p<0.001) in the derivative cohort. The scoring system also accurately predicted SC with an area under the ROC curve of 0.863 (95% CI 0.785-0.941, p<0.001) in the validation cohort.
Conclusion:
Our scoring system using factors affecting SC can predict the probability of SC in PMVSD patients.
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