Abstract：
BACKGROUND: Neonatal presentation of coarctation of the aorta (CoA) is a potentially life-threatening condition that is difficult to diagnose in fetal life. We therefore sought to validate and compare novel metrics that may add diagnostic value for fetal CoA, including the diastolic to systolic aortic isthmus VTI ratio (VTId:VTIs), ascending aorta to descending aorta angle (AAo-DAo), transverse aorta to descending aorta angle (TAo-DAo), and LV longitudinal strain (LVS), then to evaluate whether these novel metrics improve specificity to identify fetuses at the highest risk for postnatal CoA without compromising sensitivity.
METHODS: Retrospective cohort study of fetuses followed a prospective clinical pathway and previously classified as mild, moderate, or high-risk for CoA based on standard fetal echo metrics. Novel metrics were retrospectively measured in a blinded manner.
RESULTS: Among fetuses with prenatal concern for CoA, VTId:VTIs, AAo-DAo angle, TAo-DAo angle, and LVS were significantly different between surgical and non-surgical cases (p < 0.01 for all variables). In the subgroup of moderate- and high-risk fetuses, the standard high-risk criteria (flow reversal at the foramen ovale or aortic arch) did not discriminate effectively between surgical and non-surgical cases. VTId:VTIs, AAo-Dao angle, Tao-DAo angle, and LVS all demonstrated greater discrimination than standard high-risk criteria, with specificity of 100% and PPV (positive predictive value) of 78-100%.
CONCLUSIONS: The incorporation of novel metrics added diagnostic value to our clinical pathway for fetal CoA with higher specificity than the previous high-risk criteria. The incorporation of these metrics into the evaluation of fetuses at moderate- or high-risk for surgical CoA may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation.
METHODS: Retrospective cohort study of fetuses followed a prospective clinical pathway and previously classified as mild, moderate, or high-risk for CoA based on standard fetal echo metrics. Novel metrics were retrospectively measured in a blinded manner.
RESULTS: Among fetuses with prenatal concern for CoA, VTId:VTIs, AAo-DAo angle, TAo-DAo angle, and LVS were significantly different between surgical and non-surgical cases (p < 0.01 for all variables). In the subgroup of moderate- and high-risk fetuses, the standard high-risk criteria (flow reversal at the foramen ovale or aortic arch) did not discriminate effectively between surgical and non-surgical cases. VTId:VTIs, AAo-Dao angle, Tao-DAo angle, and LVS all demonstrated greater discrimination than standard high-risk criteria, with specificity of 100% and PPV (positive predictive value) of 78-100%.
CONCLUSIONS: The incorporation of novel metrics added diagnostic value to our clinical pathway for fetal CoA with higher specificity than the previous high-risk criteria. The incorporation of these metrics into the evaluation of fetuses at moderate- or high-risk for surgical CoA may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation.
摘要：
背景：新生儿主动脉缩窄（CoA）是一种潜在的危及生命的疾病，在胎儿时期难以诊断。因此，我们试图验证和比较可能增加胎儿主动脉缩窄诊断价值的新指标。包括舒张和收缩主动脉峡部VTI比率（VTID：VTI），升主动脉到降主动脉的角度（AAo-DAo），横主动脉到降主动脉的角度（TAo-DAo），和LV纵向应变（LVS）。然后评估这些新指标是否提高了特异性，以识别产后主动脉缩窄（CoA）风险最高的胎儿而不影响敏感性。
方法：胎儿的回顾性队列研究遵循前瞻性临床路径，先前分类为轻度，中度,或基于标准胎儿回声指标的CoA高风险。以盲法的方式回顾性地测量了新的指标。
结果：在产前关注主动脉缩窄的胎儿中，VTid:VTI,AAo-DAo角度,TAo-DAo角度,和LVS在手术和非手术病例之间存在显着差异（所有变量p<0.01）。在中危和高危胎儿亚组中，标准高风险标准(卵圆孔或主动脉弓的血流逆转)不能有效区分手术和非手术病例.VTid:VTI,青岛角,陶道角,和LVS都表现出比标准高风险标准更大的歧视，特异性为100％，PPV（阳性预测值）为78-100％。
结论：新指标的结合增加了我们对胎儿CoA临床路径的诊断价值，其特异性高于先前的高风险标准。将这些指标纳入对中度或高危胎儿进行手术CoA的评估可能会改善产前咨询，允许更一致的手术计划，最终优化医院资源配置。
方法：胎儿的回顾性队列研究遵循前瞻性临床路径，先前分类为轻度，中度,或基于标准胎儿回声指标的CoA高风险。以盲法的方式回顾性地测量了新的指标。
结果：在产前关注主动脉缩窄的胎儿中，VTid:VTI,AAo-DAo角度,TAo-DAo角度,和LVS在手术和非手术病例之间存在显着差异（所有变量p<0.01）。在中危和高危胎儿亚组中，标准高风险标准(卵圆孔或主动脉弓的血流逆转)不能有效区分手术和非手术病例.VTid:VTI,青岛角,陶道角,和LVS都表现出比标准高风险标准更大的歧视，特异性为100％，PPV（阳性预测值）为78-100％。
结论：新指标的结合增加了我们对胎儿CoA临床路径的诊断价值，其特异性高于先前的高风险标准。将这些指标纳入对中度或高危胎儿进行手术CoA的评估可能会改善产前咨询，允许更一致的手术计划，最终优化医院资源配置。
