Model for screening adult congenital heart disease surgery eligibility with echocardiography parameters
Yang Zi-Yang1, Li Hezhi2, Xie Nanshan1
1Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China.
Insights
A new scoring system predicts adult congenital heart disease (CHD) surgical eligibility using echocardiography, avoiding invasive right heart catheterization (RHC). This tool enhances pre-screening convenience and flexibility for CHD patients needing surgery.
Area of Science:
- Cardiology
- Medical Imaging
- Congenital Heart Disease
Background:
- Adult congenital heart disease (CHD) management requires assessing pulmonary to systemic flow (Qp/Qs) and vascular resistance (Rp/Rs) ratios.
- Right heart catheterization (RHC) is the standard for measuring these ratios but is invasive and impractical for frequent follow-ups.
Purpose of the Study:
- To develop and validate a non-invasive scoring system using echocardiography to predict surgical eligibility in adult CHD patients.
- To identify echocardiographic parameters that can reliably estimate Qp/Qs and Rp/Rs ratios.
Main Methods:
- A cohort of 1,785 adult CHD patients was divided into derivation (974 patients) and validation groups.
- Binary logistic regression identified independent echocardiographic predictors of surgical eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3).
- A predictive scoring system was developed and validated using receiver operating characteristic (ROC) analysis.
Main Results:
- Key predictors identified include estimated pulmonary artery systolic pressure, pulmonary valve velocity, and left/right atrial diameters.
- The scoring system demonstrated strong predictive value in the validation group, with an area under the ROC curve of 0.87 (p < 0.01).
- Performance remained high in subgroups based on tricuspid valve malformation (0.86 and 0.85).
Conclusions:
- The developed echocardiography-based scoring system offers a convenient and flexible method for pre-screening adult CHD patients for surgical eligibility.
- This non-invasive approach can reduce the need for repeated RHC procedures, improving patient safety and care efficiency.
Objectives:
This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters.
Methods:
A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis.
Results:
Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84-0.90, p < 0.01), 0.86 (95% CI: 0.82-0.91, p < 0.01), and 0.85 (95% CI: 0.79-0.90, p < 0.01), respectively.
Conclusions:
This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC.
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