A New Method Using the Four-Chamber View to Identify Fetuses With Subsequently Confirmed Postnatal Aortic Coarctation

Area of Science:

• Cardiology
• Fetal Medicine
• Medical Imaging

Background:

• Prenatal diagnosis of coarctation of the aorta (CoA) is crucial for timely intervention.
• Traditional methods for prenatal CoA detection have limitations in sensitivity and specificity.
• Four-chamber view (4CV) measurements offer a potential non-invasive approach to assess fetal cardiac morphology.

Purpose of the Study:

• To evaluate the diagnostic performance of fetal heart size and shape measurements from the 4CV for detecting coarctation of the aorta (CoA).
• To determine the sensitivity, specificity, and false-positive rate of this imaging-based method in high-risk fetuses.

Main Methods:

• Retrospective analysis of 108 fetuses at risk for CoA.
• Calculation of global sphericity index (GSI), ventricular area ratios, and sphericity indices using speckle tracking.
• Development and validation of a logistic regression model using these cardiac measurements.

Main Results:

• The logistic regression model, incorporating 4CV GSI, RV area/heart area, LV base SI, and RV base SI, demonstrated high diagnostic accuracy.
• In the validation group, the model achieved 98.15% sensitivity and 98.15% specificity for detecting CoA, with a 1.85% false-positive rate.
• The model identified 90% of fetuses with isolated CoA in the validation group.

Conclusions:

• Fetal cardiac measurements derived from the 4CV, including length, width, and area ratios, are effective in detecting coarctation of the aorta (CoA).
• This quantitative imaging approach provides high sensitivity and specificity for identifying fetuses at risk of CoA, with a low false-positive rate.