Diagnostic accuracy of CTA-based quantitative hemodynamics for functional assessment in coarctation of aorta

To evaluate the diagnostic performance of a 3D computational fluid dynamics method for patient-specific peak systolic pressure gradient estimation method based on CTA (PSPG_CTA) in non-invasively estimating peak systolic pressure gradients (PG) for patients with suspected coarctation of the aorta (CoA) on a larger scale.

This retrospective study included 115 patients with clinically suspected CoA. A patient-specific PSPG_CTA model was constructed for each patient by integrating anatomical data from CTA, cuff blood pressure measurements, and blood velocity data from echocardiography into hemodynamic simulations. The model was used to compute blood flow status and estimate peak systolic PGs across the coarctation. Diagnostic performance of PSPG_CTA-derived PGs was assessed against invasive catheter-based measurements (gold standard). Diagnostic accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated to evaluate diagnostic performance, and intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate the agreement.

In overall analysis, the PSPG_CTA showed higher specificity (86.5% vs. 51.4%, p < 0.001) and accuracy (89.6% vs. 77.4%, p < 0.001) compared with echocardiography. Receiver operating characteristic (ROC) analysis revealed that the AUC improved from 0.82 (95% CI: 0.72-0.91) with echocardiography to 0.96 (95% CI: 0.93-0.99, p = 0.0014) with PSPG_CTA. These superior diagnostic capabilities were consistent across subgroups stratified by age and the presence of associated congenital anomalies. Furthermore, PSPG_CTA-derived PGs showed excellent agreement with invasive measurements (ICC = 0.92, 95% CI: 0.88-0.94).

Non-invasive PSPG_CTA provided accurate functional assessment of CoA, with higher diagnostic performance than echocardiography. PSPG_CTA may serve as a reliable tool for hemodynamic functional assessment in patients with early suspected CoA to guide clinical considerations of invasive catheterization.