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Adult Congenital Heart Disease Complexity Restratification by Computed Tomography and/or Cardiac Magnetic Resonance

Maria de Fatima Egas-Bejar1, Gabriela Meléndez-Ramirez2, Stephanie Teresa Angulo-Cruzado3

  • 1Cardiac Imaging Fellowship, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Echocardiography (Mount Kisco, N.Y.)
|November 4, 2025
PubMed

Insights

Echocardiography is comparable to CT/CMR for stratifying adult congenital heart disease (CHD) complexity. Restratification rates were low, suggesting echocardiography is reliable in specialized centers.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Congenital Heart Disease

Background:

  • Accurate stratification of congenital heart disease (CHD) complexity is crucial for guiding treatment in adults.
  • Echocardiography is the primary imaging modality for CHD assessment.
  • The additional value of computed tomography (CT) and cardiac magnetic resonance (CMR) for reclassifying CHD complexity requires further investigation.

Purpose of the Study:

  • To determine the percentage of adult patients with CHD who are restratified by complexity using CT and/or CMR after initial echocardiography.
  • To assess the added value of advanced imaging modalities in refining CHD complexity classification.

Main Methods:

  • A cross-sectional study included 889 adult CHD patients from a specialized cardiology hospital (2021-2024).
  • Patients were classified according to European Society of Cardiology (ESC) guidelines.
  • Initial echocardiographic findings were compared with CT and/or CMR results using kappa-statistic for agreement.

Main Results:

  • The most common CHDs included aortic valve disease, bicuspid aorta, atrial septal defect, and tetralogy of Fallot.
  • Complexity distribution: mild (20.2%), moderate (59.9%), and severe (19.9%).
  • Only 1% of patients (10/889) were restratified; 9 from mild to moderate, 1 from moderate to mild. Echocardiography and CT/CMR showed strong agreement (Kappa: 0.979).

Conclusions:

  • Restratification of adult CHD complexity using CT/CMR after echocardiography occurs infrequently.
  • Echocardiographic findings demonstrated high comparability with CT and/or CMR findings in specialized centers.
  • Echocardiography appears to be a reliable primary tool for assessing CHD complexity in adults within expert settings.
Abstract

Keywords:
cardiac computed tomographycardiac magnetic resonanceclassification of congenital heart disease complexitycongenital heart diseaseechocardiography

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