A Noninvasive Prediction Model With Simple Echocardiographic Variables for Shunts Closure Possibility in Patients...

As right heart catheterization (RHC) is invasive and not always accessible, this study developed a noninvasive model (P-echo) to predict shunt closure feasibility in adult congenital heart disease (ACHD) patients with post-tricuspid valve shunt defects (PTD), specifically isolated ventricular septal defects (VSD) and patent ductus arteriosus (PDA).

A retrospective analysis of 1474 VSD or PDA patients from 2012 to 2022 was conducted. Echocardiographic parameters were assessed, and key variables identified via LASSO regression. The P-echo model incorporated left to right velocity (LRv), right to left velocity (RLv), tricuspid regurgitation (TR), pulmonary artery diameter (PA), and RV/LV ratio. Its predictive performance was evaluated using ROC curve analysis.

The P-echo model demonstrated excellent predictive performance with AUC values of 0.975 (95% CI: 0.965-0.984) in the derivation set, 0.963 (95% CI: 0.937-0.989) in the validation set, and high accuracy in both PDA (AUC 0.975, 95% CI: 0.965-0.984) and VSD (AUC 0.958, 95% CI: 0.936-0.980) subsets. In the derivation set, the model categorized patients into low (9.1% closure rate), medium (70.9% closure rate), and high-risk groups (99.7% closure rate) for shunt closure feasibility. Calibration plots confirmed the model's accuracy. Decision curve analysis showed a higher net benefit across a range of threshold probabilities, indicating the clinical usefulness of the model.

The P-echo model is a robust and reliable tool for predicting the feasibility of shunt closure in patients with PTD, offering a noninvasive alternative to RHC. This model can guide clinical decision-making and support individualized treatment strategies in ACHD management.