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Xiao S, Cao H, Liu J, Hong L, Ma J, Zhu Y, Xie Y, Zhang Z, Shi J, Cui L, Zhang Y, Xie M, Zhang L. A novel diagnostic model for fetal coarctation of the aorta with ventricular septal defect. Int J Cardiol 2025; 422:132927. [PMID: 39725069 DOI: 10.1016/j.ijcard.2024.132927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 11/08/2024] [Accepted: 12/20/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND Our study aimed to develop a novel diagnostic model for fetal coarctation of the aorta with ventricular septal defect(CoA/VSD). METHODS AND RESULTS We respectively included 70 fetuses with suspected CoA/VSD(January 2017-June 2023). After birth, 26 fetuses (26/47, 55.3 %) were confirmed to be true-positive CoA/VSD (TP-CoA/VSD), 21 cases had only VSDs without CoA, namely false-positive CoA/VSD (FP-CoA/VSD), and the remaining 23 fetuses were excluded due to additional major malformations, multiple pregnancies or other reasons. Large VSDs and doubly committed subarterial VSDs were more prevalent in true coarctation fetuses(all p < 0.05). Among morphological parameters of echocardiography, the aortic isthmus (AoI)/VSD ratio had the highest area under the curve (AUC) of 0.81 (95 % CI: 0.68-0.94, p < 0.001) and cutoff value of ≤0.67. Three new diagnostic models were constructed by adding different functional variables, namely left ventricular longitudinal strain(LVLS), LV ejection fraction, and LV fractional area of change to the morphological variable AoI/VSD ratio. The diagnostic model of AoI/VSD ratio and LVLS had the highest AUC of 0.96 (95 % CI: 0.86-1.00; p < 0.001). In addition, risk stratification revealed a high risk of prenatal CoA/VSD when the risk probability was greater than 0.80, which required early medical counseling and intervention. CONCLUSIONS In fetuses suspected with having CoA/VSD, myocardial strains of both ventricles were lower in true CoA group. Additionally, a diagnostic model of new morphological parameter AoI/VSD ratio and functional variable LVLS, was highly valuable in diagnosing fetal CoA/VSD.
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Affiliation(s)
- Sushan Xiao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Juanjuan Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Liu Hong
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Ma
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ye Zhu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuji Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zisang Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiawei Shi
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Cui
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yi Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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Akam-Venkata J, Thankavel PP, Hussain T, Sharma K, Balakrishnan PL, Ikemba CM. Can we diagnose aortic arch obstruction in a fetus with an atrioventricular septal defect? Cardiol Young 2024; 34:2182-2188. [PMID: 39676641 DOI: 10.1017/s1047951124025642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
BACKGROUND Aortic arch obstruction and/or coarctation of aorta is uncommon (5-20%) in balanced atrioventricular septal defects. Although technically challenging, prenatal diagnosis of aortic arch obstruction in atrioventricular septal defect is critical for delivery planning and improves prenatal counselling regarding the timing of cardiac surgery. We sought to identify prenatal predictors of coarctation of aorta in atrioventricular septal defect. METHODS Retrospective review of patients prenatally diagnosed with atrioventricular septal defect at two institutions. RESULTS Ninety-five fetuses with atrioventricular septal defect were identified and sufficient outcome data and diagnostic acoustic windows were available in 62. Six patients (10%) had coarctation of aorta after birth. Among the 38 patients with Trisomy 21, four (11%) had coarctation of aorta. On multivariable analysis, the proximal transverse aortic arch z score and ratio of left:right atrioventricular valve were independent predictors of coarctation of aorta with good interobserver reproducibility. Either proximal transverse aortic arch z score < -2, or ratio of left:right atrioventricular valve <0.7, predicted aortic arch obstruction with 100% sensitivity and 89% specificity. CONCLUSION Proximal transverse aortic arch z score and lower ratio of left:right atrioventricular valve diameter are independent predictors of postnatal coarctation of aorta in fetal patients with atrioventricular septal defect. The next step is the prospective application of these parameters to create an algorithm directing fetal counselling in terms of delivery location, and expected timing of surgical interventions.
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Affiliation(s)
- Jyothsna Akam-Venkata
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
- The Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, FL, USA
| | - Poonam P Thankavel
- Department of Pediatrics, Division of Pediatric Cardiology, Medical City Children's Hospital, Dallas, TX, USA
| | - Tarique Hussain
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kavita Sharma
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Preetha L Balakrishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | - Catherine M Ikemba
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
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Silva J, Azevedo T, Ginja M, Oliveira PA, Duarte JA, Faustino-Rocha AI. Realistic Aspects of Cardiac Ultrasound in Rats: Practical Tips for Improved Examination. J Imaging 2024; 10:219. [PMID: 39330439 PMCID: PMC11433567 DOI: 10.3390/jimaging10090219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 09/02/2024] [Indexed: 09/28/2024] Open
Abstract
Echocardiography is a reliable and non-invasive method for assessing cardiac structure and function in both clinical and experimental settings, offering valuable insights into disease progression and treatment efficacy. The successful application of echocardiography in murine models of disease has enabled the evaluation of disease severity, drug testing, and continuous monitoring of cardiac function in these animals. However, there is insufficient standardization of echocardiographic measurements for smaller animals. This article aims to address this gap by providing a guide and practical tips for the appropriate acquisition and analysis of echocardiographic parameters in adult rats, which may also be applicable in other small rodents used for scientific purposes, like mice. With advancements in technology, such as ultrahigh-frequency ultrasonic transducers, echocardiography has become a highly sophisticated imaging modality, offering high temporal and spatial resolution imaging, thereby allowing for real-time monitoring of cardiac function throughout the lifespan of small animals. Moreover, it allows the assessment of cardiac complications associated with aging, cancer, diabetes, and obesity, as well as the monitoring of cardiotoxicity induced by therapeutic interventions in preclinical models, providing important information for translational research. Finally, this paper discusses the future directions of cardiac preclinical ultrasound, highlighting the need for continued standardization to advance research and improve clinical outcomes to facilitate early disease detection and the translation of findings into clinical practice.
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Affiliation(s)
- Jessica Silva
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (J.S.); (T.A.); (M.G.); (P.A.O.)
| | - Tiago Azevedo
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (J.S.); (T.A.); (M.G.); (P.A.O.)
- Animal and Veterinary Research Centre (CECAV), Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- Centro de Investigação de Montanha (CIMO), Laboratório Associado para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, Campus de Santa Apolónia, 5300-253 Bragança, Portugal
| | - Mário Ginja
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (J.S.); (T.A.); (M.G.); (P.A.O.)
- Animal and Veterinary Research Centre (CECAV), Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - Paula A. Oliveira
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (J.S.); (T.A.); (M.G.); (P.A.O.)
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - José Alberto Duarte
- Associate Laboratory i4HB, Institute for Health and Bioeconomy, University Institute of Health Sciences (IUCS), Advanced Polytechnic and University Cooperative (CESPU), 4585-116 Gandra, Portugal;
- UCIBIO—Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory (1H-TOXRUN), University Institute of Health Sciences (IUCS), Advanced Polytechnic and University Cooperative (CESPU), 4585-116 Gandra, Portugal
| | - Ana I. Faustino-Rocha
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production (Inov4Agro), University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (J.S.); (T.A.); (M.G.); (P.A.O.)
- Department of Zootechnics, School of Sciences and Technology, University of Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, 7004-516 Évora, Portugal
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Chen G, Wang P, Zhang Y, Li N, Fu L, Chen Y, Geng X, Han Y, Qin L, Gao B, Yu T, Mi J. Ultrasound parameters of arteries and heart in normal fetuses. Cardiovasc Ultrasound 2024; 22:9. [PMID: 39075466 PMCID: PMC11285228 DOI: 10.1186/s12947-024-00328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Currently, no normal ultrasound data of the fetuses during the 20-40 gestation have been obtained for references of fetal growth and development. If such ultrasound data existed for prenatal diagnosis of possible diseases and abnormalities, neonates would be able to get timely treatment immediately after birth. This study was thus performed to obtain ultrasound parameters of normal fetuses during the 20-40 week gestation and the distribution of ultrasound parameters with the gestational age for references of detecting potential fetal diseases and abnormalities. METHODS Normal fetuses without any abnormalities were enrolled, and the ultrasound parameters of the general biology, arteries, and aorta were measured and analyzed. RESULTS 417 normal fetuses were enrolled. A significant (P < 0.05) negative correlation with the gestational age was detected in the peak systolic velocity/peak diastolic velocity (S/D), pulsatility index (PI) and resistance index (RI) of the umbilical artery (UA). A relatively stable relationship with the gestational age was detected in the fetal weight%, S/D, PI and RI of the middle cerebral artery (MCA), peak systolic velocity (PSV) and velocity time integral (VTI) of the intra-abdominal UA, fetal heart to chest ratio, mitral valve (MV)- and tricuspid valve (TV)-E/A peak flow velocity, aortic isthmic Z-score and displacement, distance between the brachiocephalic artery-left common carotid artery (BA-LCCA) and LCCA-left subclavian artery (LSA), Z-score of aorta, ascending aorta (AAO), pulmonary artery (PA), main pulmonary artery (MPA), and descending aorta (DAO). A significant (P < 0.05) positive correlation with the gestational age was detected in the fetal biological data, MCA PSV and VTI, free-UA PSV and VTI and cardio-thoracic ratio, cardiac parameters, ductus arteriosus (DA) and isthmus diameter, aortic parameters, PA and MPA diameter, MPA PSV and VTI, isthmus flow volume and velocity and PA flow volume, DA and BA parameters, and LCCA and LSA parameters (flow volume, PSV, and VTI). CONCLUSION A certain correlation and distribution trend is detected in the ultrasound parameters of normal fetuses, and the ratios among different parameters remain relative stable. These findings can be used for determination of abnormal growth of the fetuses in prenatal ultrasound scan.
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Affiliation(s)
- Guihong Chen
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Pin Wang
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Yanhong Zhang
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Na Li
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Liman Fu
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Yu Chen
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Xuna Geng
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Yongfeng Han
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Lu Qin
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China
| | - Bulang Gao
- Cardiology Department, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Shijiazhuang, 050000, Hebei Province, China
| | - Tianxiao Yu
- Department of Medical Ultrasound, Research Center for Clinical Medicine Sciences, The Fourth Hospital of Shijiazhuang, No.16 Tangu North Street, Shijiazhuang, 050000, Hebei Province, China.
| | - Jie Mi
- Cardiology Department, Shijiazhuang People's Hospital, No. 365, Jianhua South Street, Shijiazhuang, 050000, Hebei Province, China.
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Wu YC, Chen CH, Lu HT, Lee YL, Chen PY, Wu TY, Tien MH, Wu CH, Huang JYJ, Hsiao CH, Chu WC. Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging. Bioengineering (Basel) 2024; 11:378. [PMID: 38671799 PMCID: PMC11048424 DOI: 10.3390/bioengineering11040378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. METHODS A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. RESULTS Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). CONCLUSIONS Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.
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Affiliation(s)
- Yi-Cheng Wu
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ching-Hsuan Chen
- Department of Obstetrics and Gynecology, Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan; (C.-H.C.); (Y.-L.L.)
| | - Hsin-Tzu Lu
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
| | - Yu-Li Lee
- Department of Obstetrics and Gynecology, Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan; (C.-H.C.); (Y.-L.L.)
| | - Pi-Yu Chen
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ting-Yu Wu
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ming-Hsun Tien
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
| | - Chiung-Hui Wu
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
| | - Jack Yu-Jen Huang
- Department of Obstetrics and Gynecology, Ton Yen General Hospital, Hsinchu 302048, Taiwan; (M.-H.T.); (C.-H.W.); (J.Y.-J.H.)
- Taiwan IVF Group Center for Reproductive Medicine & Infertility, Hsinchu 302053, Taiwan; (P.-Y.C.); (T.-Y.W.)
| | - Ching-Hua Hsiao
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
- Department of Obstetrics and Gynecology, Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan; (C.-H.C.); (Y.-L.L.)
| | - Woei-Chyn Chu
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan; (Y.-C.W.); (H.-T.L.)
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Phillips AA, Punn R, Algaze C, Blumenfeld YJ, Chock VY, Kwiatkowski DM, Quirin A, Tacy TA, Thorson K, Maskatia SA. Left Ventricular Strain, Arch Angulation, and Velocity-Time Integral Ratio Improve Performance of a Clinical Pathway for Fetal Diagnosis of Neonatal Coarctation of the Aorta. Fetal Diagn Ther 2024; 51:320-334. [PMID: 38621375 PMCID: PMC11318582 DOI: 10.1159/000538550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION 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.
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Affiliation(s)
- Aaron Anthony Phillips
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Rajesh Punn
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Fetal and Pregnancy Health Program, Stanford Children’s Health, Stanford, CA, USA
| | - Claudia Algaze
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yair J. Blumenfeld
- Fetal and Pregnancy Health Program, Stanford Children’s Health, Stanford, CA, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie Y. Chock
- Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David M. Kwiatkowski
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy Quirin
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Theresa A. Tacy
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Fetal and Pregnancy Health Program, Stanford Children’s Health, Stanford, CA, USA
| | - Kelly Thorson
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Shiraz A. Maskatia
- Divisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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Villalaín C, D'Antonio F, Flacco ME, Gómez-Montes E, Herraiz I, Deiros-Bronte L, Maskatia SA, Phillips AA, Contro E, Fricke K, Bhawna A, Beattie MJ, Moon-Grady AJ, Durand I, Slodki M, Respondek-Liberska M, Patel C, Kawamura H, Rizzo G, Pagani G, Galindo A. Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:446-456. [PMID: 38197327 DOI: 10.1002/uog.27576] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA). METHODS An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model. RESULTS The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio < 0.7, hypoplastic aortic arch (all P < 0.001), aortic isthmus diameter Z-score of < -2 in the sagittal (P = 0.003) and three-vessel-and-trachea (P < 0.001) views, pulmonary artery/ascending aorta diameter ratio > 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield. CONCLUSIONS Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Villalaín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - F D'Antonio
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - M E Flacco
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - E Gómez-Montes
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - I Herraiz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - L Deiros-Bronte
- Department of Pediatric Cardiology, La Paz Children's Hospital, Madrid, Spain
| | - S A Maskatia
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - A A Phillips
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - E Contro
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, S. Orsola University Hospital, Bologna, Italy
| | - K Fricke
- Department of Clinical Sciences Lund, Pediatric Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - A Bhawna
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - M J Beattie
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - I Durand
- Department of Pediatrics, Rouen University Hospital, Rouen, France
| | - M Slodki
- Medicine Faculty, Mazovian University in Plock, Plock, Poland
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute in Lodz, Lodz, Poland
| | - M Respondek-Liberska
- Department for Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz, Lodz, Poland
- Fetal Cardiology Department Polish Mother's Memorial Hospital, Lodz, Poland
| | - C Patel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Kawamura
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - G Pagani
- Department of Obstetrics and Gynecology, ASST-Papa Giovanni XXIII, Maternal Fetal Medicine Unit, Bergamo, Italy
| | - A Galindo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Complutense University, Madrid, Spain
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
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Piura E, Engel O, Doctory N, Arbib N, Biron-Shental T, Kovo M, Arnon S, Markovitch O. Velocity Time Integral: A Novel Method for Assessing Fetal Anemia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1090. [PMID: 37508587 PMCID: PMC10377850 DOI: 10.3390/children10071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/04/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
The velocity time integral (VTI) is a clinical Doppler ultrasound measurement of blood flow, measured by the area under the wave curve and equivalent to the distance traveled by the blood. This retrospective study assessed the middle cerebral artery (MCA) VTI of fetuses in pregnancies complicated by maternal alloimmunization. Doppler indices of the MCA were retrieved from electronic medical records. Systolic deceleration-diastolic time, systolic acceleration time, VTI, and peak systolic velocity (PSV) were measured at 16-40 weeks gestation. Cases with PSV indicating fetal anemia (cutoff 1.5 MoM) and normal PSV were compared. The study included 255 Doppler ultrasound examinations. Of these, 41 were at 16-24 weeks (group A), 100 were at 25-32 weeks (group B), and 114 were at 33-40 weeks (group C). VTI increased throughout gestation (5.5 cm, 8.6 cm, and 12.1 cm in groups A, B, and C, respectively, p = 0.003). VTI was higher in waveforms calculated to have MCA-PSV ≥ 1.5 MoM compared to those with MCA-PSV < 1.5 MoM (9.1 cm vs. 14.1 cm, respectively, p < 0.001), as was VTI/s (22.04 cm/s vs. 33.75 cm/s, respectively; p < 0.001). The results indicate that the MCA VTI increases significantly among fetuses with suspected anemia, indicating higher perfusion of hemodiluted blood to the brain. This feasible measurement might provide a novel additional marker for the development of fetal anemia.
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Affiliation(s)
- Ettie Piura
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Offra Engel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Neta Doctory
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nisim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shmuel Arnon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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9
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Hermida U, van Poppel MPM, Lloyd DFA, Steinweg JK, Vigneswaran TV, Simpson JM, Razavi R, De Vecchi A, Pushparajah K, Lamata P. Learning the Hidden Signature of Fetal Arch Anatomy: a Three-Dimensional Shape Analysis in Suspected Coarctation of the Aorta. J Cardiovasc Transl Res 2023; 16:738-747. [PMID: 36301513 PMCID: PMC10299929 DOI: 10.1007/s12265-022-10335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
Abstract
Neonatal coarctation of the aorta (CoA) is a common congenital heart defect. Its antenatal diagnosis remains challenging, and its pathophysiology is poorly understood. We present a novel statistical shape modeling (SSM) pipeline to study the role and predictive value of arch shape in CoA in utero. Cardiac magnetic resonance imaging (CMR) data of 112 fetuses with suspected CoA was acquired and motion-corrected to three-dimensional volumes. Centerlines from fetal arches were extracted and used to build a statistical shape model capturing relevant anatomical variations. A linear discriminant analysis was used to find the optimal axis between CoA and false positive cases. The CoA shape risk score classified cases with an area under the curve of 0.907. We demonstrate the feasibility of applying a SSM pipeline to three-dimensional fetal CMR data while providing novel insights into the anatomical determinants of CoA and the relevance of in utero arch anatomy for antenatal diagnosis of CoA.
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Affiliation(s)
- Uxio Hermida
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 5Th Floor Becket House, 1 Lambeth Palace Road, London, SE1 7EH, UK
| | - Milou P M van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - David F A Lloyd
- Department of Perinatal Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Johannes K Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Adelaide De Vecchi
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 5Th Floor Becket House, 1 Lambeth Palace Road, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Pablo Lamata
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, 5Th Floor Becket House, 1 Lambeth Palace Road, London, SE1 7EH, UK.
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Sun J, Starc J, Stevens RM. Challenges of prenatal diagnosis of fetal hypoplastic aortic arch and predication of the need for intervention. J Card Surg 2022; 37:3711-3712. [PMID: 36047368 DOI: 10.1111/jocs.16837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Prenatal diagnosis of hypoplastic aortic arch and coarctation of aorta is still challenging and remains one of the most difficult cardiac defects to diagnose. The results reveal a significant improvement of prenatal diagnosis of hypoplastic arch and coarctation of aorta. The data also shows the significant overlapping of fetal aortic isthmus z score between the infants who need the arch procedure and those who do not.
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Affiliation(s)
- Jie Sun
- St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - James Starc
- St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Randy M Stevens
- St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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11
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Liu J, Cao H, Zhang L, Hong L, Cui L, Song X, Ma J, Shi J, Zhang Y, Li Y, Wang J, Xie M. Incremental value of myocardial deformation in predicting postnatal coarctation of the aorta: establishment of a novel diagnostic model. J Am Soc Echocardiogr 2022; 35:1298-1310. [PMID: 35863545 DOI: 10.1016/j.echo.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/12/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prenatal detection of coarctation of the aorta (CoA) still suffers from high false-positive and false-negative rates. The objective of this study was to develop a novel model to improve the diagnostic accuracy of fetal CoA. METHODS A retrospective study was conducted in 122 fetuses with suspected CoA who also had postnatal follow-ups. Fetuses with confirmed diagnosis of CoA after birth were defined as CoA group, and Non-CoA group were those false-positives. Conventional fetal echocardiographic measurements, including great arterial dimensions and flow characteristics were obtained. Left ventricular (LV) functional parameters were determined using two-dimensional speckle tracking echocardiography. A novel multi-parametric diagnostic model, including gestational age (GA) at diagnosis, aortic isthmus (AOI) Z-score and LV longitudinal strain (LVLS), was developed by univariate and multivariate logistic regression analyses. The model was validated prospectively by a validation cohort of 48 fetuses. RESULTS CoA was confirmed in 62/122 (50.8%) cases after birth. Fetuses with postnatal CoA were diagnosed significantly earlier than false-positives (median (interquartile range), 24.5 (23.3-26.4) vs 27.8 (24.5-30.4) weeks; P < .001). The Z-scores of aortic dimensions (aortic valve annulus, ascending aorta, transverse aortic arch and AOI) were significantly smaller (all P < .001), while the Z-scores of pulmonary dimensions (pulmonary valve annulus and main pulmonary artery) were significantly greater (all P < .05), in cases of confirmed CoA than false-positives. Compared with Non-CoA group, CoA group displayed lower LV ejection fraction (P = .005), LV fractional area change (P < .001) and LVLS (P < .001). A multivariate logistic regression model incorporating GA (odds ratio (OR): 0.74, 95% confidence interval (CI): 0.60-0.88; P = .001), AOI Z-score (OR: 0.20, 95% CI: 0.08-0.41; P < .001) and LVLS (OR: 1.79, 95% CI: 1.41-2.42; P < .001) was established to diagnose CoA more accurately (Akaike information criterion: 81.77, C-statistics: 0.945). The performance of this model was confirmed prospectively in the validation cohort. CONCLUSIONS In fetuses with suspected CoA, speckle tracking analysis of LVLS may have an incremental value in predicting postnatal CoA. Our diagnostic model, including GA, AOI Z-score and LVLS, may provide a good tool for the stratification of the risk in fetal CoA and contribute to patient-specific perinatal management.
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Affiliation(s)
- Juanjuan Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China; Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
| | - Liu Hong
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Cui
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoyan Song
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Ma
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jiawei Shi
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yi Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China; Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China; Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China.
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12
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Arya B, Maskatia SA. Coarctation of the aorta: Prenatal assessment, postnatal management and neonatal outcomes. Semin Perinatol 2022; 46:151584. [PMID: 35422354 DOI: 10.1016/j.semperi.2022.151584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coarctation of the aorta (Coa) is a potentially life threatening diagnosis. It occurs in 0.3 per 1000 live births and accounts for 6-8% of all infants with congenital heart defects. Neonates with severe Coa may be completely asymptomatic at birth, as the ductus arteriosus can provide flow to the lower body. Those who are not diagnosed prenatally may be diagnosed only after constriction of the ductus arteriosus, when they present in cardiogenic shock. This group has a higher risk for mortality and morbidity relative to those diagnosed prenatally. Despite the increasing practice of universal pulse oximetry screening, many cases with significant coarctation of the aorta still go undiagnosed in the newborn period. In this article, we present the pathophysiology, diagnosis, presentation, treatment and outcomes of Coa.
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Affiliation(s)
- Bhawna Arya
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, United States.
| | - Shiraz A Maskatia
- Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, United States
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13
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Chen Y, Li H, Huang D, Liu J, Zhang R, Lei W, Liang Y, Cui Y, Gu Y, Shentu W, Wang H. Echocardiographic findings for improved prenatal diagnosis of aortic coarctation with ventricular septal defect. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:825-832. [PMID: 34931278 DOI: 10.1007/s10554-021-02476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Accurate prenatal diagnosis of coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) remains challenging. The objective of the study was to identify which Doppler and/or two-dimensional sonographic findings are most useful for predicting fetal CoA/VSD. A retrospective cohort study identified 35 fetuses with suspected CoA/VSD. Prenatal imaging characteristics included the right ventricular/left ventricular, pulmonary artery (PA)/aorta ratio, aortic isthmus (AOI) Z score, diastolic velocity-time integral (VTID), and systolic velocity-time integral (VTIS) at the AOI. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated. Significant differences in the PA/AO, VTID, VTID/VTIS, VTID/VTIS, VTID/(VTID + VTIS), and AOI Z score between the true CoA group and false positives were found. When associated with VSD, the VTID/VTIS and VTID/(VTID + VTIS) had the highest AUC (0.97, 95% confidence interval: 0.84-1.00), with 88.46% sensitivity and 100.00% specificity for predicting the true CoA. The AOI Z score had the highest sensitivity (92.31%). Adding the VTID/VTIS to the AOI Z score significantly improved the performance (IDI, 50%; NRI, 82%; P < 0.05), with an improvement in specificity (77.78% vs. 55.56%; non-Event P = 0.008) without sacrificing sensitivity (96.15% vs. 92.31%; Event P = 0.564). In fetuses with suspected CoA associated with VSD, the quantitative spectral Doppler metric aided accurate detection of the fetal CoA, with reduced false positives. The conventional AOI Z score plus spectral Doppler metric may improve the overall diagnostic accuracy of CoA/VSD.
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Affiliation(s)
- Yunyu Chen
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China
| | - Huixian Li
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Danping Huang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China
| | - Jinrong Liu
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China
| | - Rui Zhang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China
| | - Wenjia Lei
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China
| | - Yongen Liang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China
| | - Yanqin Cui
- Cardiac Intensive Care Unit, the Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, China
| | - Yuanyuan Gu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, China
| | - Weihui Shentu
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China.
| | - Hongying Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, NO.9 of Jinsui Road, Guangzhou, 510623, China.
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Colquitt JL, Loar RW, Bolin EH, Ezon DS, Heinle JS, Morris SA. Left heart hypoplasia in the fetus: echocardiographic predictors of outcome. Prenat Diagn 2022; 42:447-460. [PMID: 35040508 DOI: 10.1002/pd.6101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Fetal left heart hypoplasia (LHH) with an apex-forming left ventricle may require neonatal intervention but it is difficult to predict. METHODS We performed a retrospective study of fetuses with LHH defined as normal segmental anatomy, apex-/near-apex forming left ventricle, and ≥1 left-sided Z-score <-2 between 1997-2014. Fetuses with mitral or aortic atresia, critical aortic stenosis, extracardiac anomalies, or fetal intervention were excluded. Classification and regression tree analyses (CART) were performed to construct algorithms to predict postnatal circulation: no surgery versus biventricular surgery versus single ventricle (SV) palliation. RESULTS Among 138 included fetuses, 52 (37%) underwent neonatal surgery, with 10 (7%) undergoing SV palliation. The strongest single outcome discriminator was exclusively left-to-right flow foramen ovale (FO) flow >32 weeks gestational age (seen in 0% with no surgery, 22% with biventricular surgery, 88% with SV palliation). On CART analysis >32 weeks GA, fetuses with right-to-left FO flow and aortopulmonary ratio >0.76 had 0% probability of neonatal surgery, while those with left-to-right FO flow and mitral valve Z-score <-3.6 had a 70% probability of SV palliation. CONCLUSION SV palliation is an uncommon outcome of fetal LHH. Fetal FO flow and other echocardiographic measures can help determine risk and type of postnatal intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- John L Colquitt
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | - Robert W Loar
- Pediatric Cardiology, Cook Children's Medical Center, Fort Worth, TX
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas
| | - David S Ezon
- Icahn School of Medicine at Mount Sinai, Department of Pediatric Cardiology, Children's Heart Center, Mt. Sinai Hospital, New York, NY
| | - Jeffrey S Heinle
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Shaine A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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Gómez-Montes E, Herraiz García I, Escribano Abad D, Rodríguez Calvo J, Villalaín González C, Galindo Izquierdo A. Application of a Global Multiparameter Scoring System for the Prenatal Prediction of Coarctation of the Aorta. J Clin Med 2021; 10:jcm10163690. [PMID: 34441986 PMCID: PMC8397204 DOI: 10.3390/jcm10163690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/01/2022] Open
Abstract
To assess prospectively the capability of our previously reported global multiparameter scoring system to predict coarctation of the aorta (CoAo) in fetuses with cardiac asymmetry, we applied and analyzed the performance of our scoring system in predicting postnatal CoAo in fetuses undergoing prenatal echocardiographic assessment because of cardiac asymmetry between 2011 and 2021, and we determined the cut-off points of the score with the best balance between specificity and sensitivity, and of maximum sensitivity and specificity. CoAo was confirmed in 39/179 newborns (21.8%). We found a significantly higher probability of CoAo in fetuses with CoAo than in cases without CoAo (84.2 ± 18.2% vs. 26.0 ± 28.6%, p < 0.001). The AUC of the ROC of the score was 0.93 (95% CI 0.89–0.97). The cut-off value with the best balance between specificity and sensitivity was a predicted risk of ≥53% (sensitivity 92.3% and specificity 80.0%). The cut-off point of maximum sensitivity was ≥35% (sensitivity 100% and specificity 72.9%), and that of maximum specificity was ≥96% (sensitivity 43.6% and specificity 96.4%). In none of the fetuses with a probability of CoAo < 35% was this condition confirmed after birth. This occurred in 102 fetuses in the whole study population (57%) and in 84 of the 111 in whom CoAo was suspected beyond 28 weeks (75.7%). This multiparameter score allows an adequate discrimination between fetuses without CoAo and those with CoAo, reducing the false positive diagnoses in cardiac asymmetry.
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Affiliation(s)
- Lisa K Hornberger
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Lois Hole Hospital for Women, Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Luke G Eckersley
- Fetal and Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Lois Hole Hospital for Women, Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
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DeVore GR, Haxel C, Satou G, Sklansky M, Pelka MJ, Jone PN, Cuneo BF. Improved detection of coarctation of the aorta using speckle-tracking analysis of fetal heart on last examination prior to delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:282-291. [PMID: 32022339 DOI: 10.1002/uog.21989] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The false-positive rate for prenatal diagnosis of coarctation of the aorta (FP-CoA) commonly exceeds 50%, with an accurate detection rate of < 50%. This study was conducted to determine if the sensitivity for prenatal detection of true CoA and the FP-CoA rate could be improved by evaluating the fetal epicardial size and shape in the four-chamber view (4CV) and the endocardial right (RV) and left (LV) ventricular size, shape and contractility. METHODS We analyzed retrospectively Digital Imaging and Communications in Medicine (DICOM) clips of the 4CV from the last examination prior to delivery in a series of 108 fetuses with CoA suspected prenatally by pediatric cardiologists using traditional diagnostic criteria. Postnatal evaluation distinguished those fetuses which subsequently required CoA surgery (true positives; true CoA) from those that were FP-CoA. Postnatal cardiac abnormalities were identified for each group. For the prenatal evaluation, we measured the 4CV end-diastolic epicardial area, circumference, length, width and global sphericity index. Speckle-tracking analysis was used to compute the endocardial RV and LV end-diastolic area, length, 24-segment sphericity index, 24-segment transverse width and the following functional parameters: fractional area change; global longitudinal, free-wall and septal-wall strain; basal-apical-length, basal free-wall and basal septal-wall fractional shortening; septal-wall annular plane systolic excursion; 24-segment transverse-width fractional shortening; and LV end-diastolic and end-systolic volumes, stroke volume, cardiac output and ejection fraction. In addition, the RV/LV end-diastolic area ratio was computed. Using a control group of 200 normal fetuses, the mean and SD for each of the above cardiac measurements was used to compute the Z-scores for each measurement in each of the 108 study fetuses. Logistic regression analysis was then performed on the Z-score values to identify variables that separated the true CoA group from the FP-CoA group. RESULTS Of the 108 study fetuses, 54 were confirmed postnatally to have true CoA and 54 were FP-CoA. Right/left area disproportion > 90th centile was present in 80% (n = 43) of the true-CoA fetuses and 76% (n = 41) of the FP-CoA fetuses. Fetuses with true CoA had a significantly greater number of associated cardiac abnormalities (93%, n = 50) compared with the FP-CoA fetuses (61%, n = 33) (P < 0.001). The most common associated malformations were bicuspid aortic valve (true CoA, 46% (n = 25) vs FP-CoA, 22% (n = 12); P < 0.01), aortic arch hypoplasia (true CoA, 31% (n = 17) vs FP-CoA, 11% (n = 6); P < 0.01), ventricular septal defect (true CoA, 33% (n = 18) vs FP-CoA, 11% (n = 6); P < 0.05) and mitral valve abnormality (true CoA, 30% (n = 16) vs FP-CoA, 4% (n = 2); P < 0.01). Logistic regression analysis identified 28 variables that correctly identified 96% (52/54) of the fetuses with true CoA, with a false-positive rate of 4% (2/54) and a false-negative rate of 4% (2/54). These variables included the epicardial size in the 4CV, size and shape of RV and LV, and abnormal contractility of RV and LV. The area under the receiver-operating-characteristics curve was 0.98 (SE, 0.023; 95% CI, 0.84-1). There was no significant difference in the percent of fetuses with RV/LV area disproportion between those with CoA and those that were FP-CoA. CONCLUSIONS Speckle-tracking analysis of multiple ventricular measurements may be helpful to refine the diagnosis in fetuses that are suspected to have CoA prenatally. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - C Haxel
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - G Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M J Pelka
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - P N Jone
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - B F Cuneo
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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Liang X, Fang J, Li H, Yang X, Ni D, Zeng F, Chen Z. CR-Unet-Based Ultrasonic Follicle Monitoring to Reduce Diameter Variability and Generate Area Automatically as a Novel Biomarker for Follicular Maturity. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3125-3134. [PMID: 32839052 DOI: 10.1016/j.ultrasmedbio.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Follicle size is closely related to ovarian function and is an important biomarker in transvaginal ultrasound examinations for assessing follicular maturity during an assisted reproduction cycle. However, manual measurement is time consuming and subject to high inter- and intra- observer variability. Based on the deep learning model CR-Unet described in our previous study, the aim of our present study was to investigate further the feasibility of using this model in clinical practice by validating its performance in reducing the inter- and intra-observer variability of follicle diameter measurement. This study also investigated whether follicular area is a better biomarker than diameter in assessing follicular maturity. Data on 106 ovaries and 230 follicles collected from 80 cases of single follicular cycles and 26 cases of multiple follicular cycles constituted the validation set. Intra-observer variability was 0.973 and 0.982 for the senior sonographer and junior sonographer in single follicular cycles and 0.979 (0.971, 0.985) and 0.920 (0.892, 0.943) in multiple follicular cycles, respectively, while CR-Unet had no intra-group variation. Bland-Altman plot analysis indicated that the 95% limits of agreement between senior sonographer and CR-Unet (-2.1 to 1.1 mm, -2.02 to 0.75 mm) were smaller than those between senior sonographer and junior sonographer (-1.51 to 1.15 mm, -2.1 to 1.56 mm) in single and multiple follicular cycles. The average operating times of diameter measurement taken by the junior sonographer, senior sonographer and CR-Unet were 7.54 ± 1.8, 4.87 ± 0.84 and 1.66 ± 0.76 s, respectively (p < 0.001). Correlation analysis indicated that both manual and automated follicular area correlated better with follicular volume than diameter. The deep learning algorithm and the new biomarker of follicular area hold potential for clinical application of ultrasonic follicular monitoring.
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Affiliation(s)
- Xiaowen Liang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinghui Fang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haoming Li
- Medical Ultrasound Image Computing (MUSIC) Lab, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xin Yang
- Department of Computer Science and Engineering, Chinese University of Hong Kong, Hong Kong, China
| | - Dong Ni
- Medical Ultrasound Image Computing (MUSIC) Lab, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Fengyi Zeng
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Nyrnes SA, Fadnes S, Wigen MS, Mertens L, Lovstakken L. Blood Speckle-Tracking Based on High-Frame Rate Ultrasound Imaging in Pediatric Cardiology. J Am Soc Echocardiogr 2020; 33:493-503.e5. [PMID: 31987749 DOI: 10.1016/j.echo.2019.11.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Flow properties play an important role in cardiac function, remodeling, and morphogenesis but cannot be displayed in detail with today's echocardiographic techniques. The authors hypothesized that blood speckle-tracking (BST) could visualize and quantify flow patterns. The aim of this study was to determine the feasibility, accuracy, and potential clinical applications of BST in pediatric cardiology. METHODS BST is based on high-frame rate ultrasound, using a combination of plane-wave imaging and parallel receive beamforming. Pattern-matching techniques are used to quantify blood speckle motion. Accuracy of BST velocity measurements was validated using a rotating phantom and by comparing BST-derived inflow velocities with pulsed-wave Doppler obtained in the left ventricles of healthy control subjects. To test clinical feasibility, 102 subjects (21 weeks to 11.5 years of age) were prospectively enrolled, including healthy fetuses (n = 4), healthy control subjects (n = 51), and patients with different cardiac diseases (n = 47). RESULTS The phantom data showed a good correlation (r = 0.95, with a tracking quality threshold of 0.4) between estimated BST velocities and reference velocities down to a depth of 8 cm. There was a good correlation (r = 0.76) between left ventricular inflow velocity measured using BST and pulsed-wave Doppler. BST displayed lower velocities (mean ± SD, 0.59 ± 0.14 vs 0.82 ± 0.21 m/sec for pulsed-wave Doppler). However, the velocity amplitude in BST increases with reduced smoothing. The clinical feasibility of BST was high, as flow patterns in the area of interest could be visualized in all but one case (>99%). CONCLUSIONS BST is highly feasible in fetal and pediatric echocardiography and provides a novel approach for visualizing blood flow patterns. BST provides accurate velocity measurements down to 8 cm, but compared with pulsed-wave Doppler, BST displays lower velocities. Studying blood flow properties may provide novel insights into the pathophysiology of pediatric heart disease and could become an important diagnostic tool.
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Affiliation(s)
- Siri A Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Smedsrud Wigen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lasse Lovstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Wang Y, Li J, Liu S, Mu L, Li G, Yu H, Yang J, Ma C. Value of exercise stress electrocardiography for stratification of exercise capacity and left ventricular systolic and diastolic function on coronary slow flow: case-control study. BMC Cardiovasc Disord 2019; 19:288. [PMID: 31830922 PMCID: PMC6909497 DOI: 10.1186/s12872-019-01291-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Coronary slow flow phenomenon (CSFP) is an angiographic entity characterized by delayed coronary opacification in absence of evident obstructive lesion in the epicardial coronary artery. However, whether patients with CSFP exhibit differing responses to exercise is still not known. This study aimed to evaluate results of exercise stress electrocardiography (ExECG) and left ventricular (LV) function during exercise, and study the value of ExECG for stratification of exercise capacity and LV function in patients with CSFP. Methods Thirty patients with CSFP and 24 controls were enrolled in the study. Diagnosis of CSFP was made by Thrombolysis in Myocardial Infarction frame count. ExECG and LV function measured by echocardiography at rest, during exercise and recovery phase were evaluated. Results Negative ExECG was found in 24 (80%) patients with CSFP. At rest, LV global longitudinal strain (GLS) decreased and mitral average E/e’ increased in patients with CSFP compared with controls; however, there were no differences in these parameters between CSFP patients with negative ExECG and patients with positive ExECG. During exercise, CSFP patients with negative ExECG and controls had significantly increased LV GLS and decreased mitral average E/e’, but CSFP patients with positive ExECG had significantly decreased LV GLS and increased mitral average E/e’. Conclusions About 80% patients with CSFP exhibited negative ExECG. CSFP patients with negative ExECG exhibited improved LV function but CSFP patients with positive ExECG exhibited impaired LV function during exercise. ExECG may aid in the stratification of exercise capacity and LV function in patients with CSFP.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Jinyang Li
- Department of Cardiology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Lixin Mu
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Guangyuan Li
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Hang Yu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China.
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