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January 1, 2024Fetal Diagnosis and TherapyOpen Access

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

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Authors

APAaron Anthony PhillipsRPRajesh PunnLucile Packard Children's HospitalCAClaudia AlgazeLucile Packard Children's Hospital

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Implication

Retrospective cohort study reveals novel echocardiographic markers accurately predict neonatal aortic coarctation in fetuses, indicating improved risk stratification.

Key Points

  • To determine whether novel fetal echocardiographic metrics—including velocity-time integral ratios, aortic arch angles, and left ventricular longitudinal strain—improve diagnostic specificity for neonatal coarctation of the aorta.
  • Retrospective cohort study of fetuses managed under a prospective clinical pathway and classified as mild, moderate, or high risk for coarctation of the aorta based on standard echocardiographic measures.
  • Blinded retrospective measurement of novel metrics, including diastolic-to-systolic aortic isthmus velocity-time integral ratio (VTId:VTIs), ascending-to-descending aorta angle, transverse-to-descending aorta angle, and left ventricular strain.
  • All novel metrics (VTId:VTIs, ascending-to-descending angle, transverse-to-descending angle, and left ventricular strain) differed significantly between surgical and non-surgical cases (p < 0.01 for all).
  • Among moderate- and high-risk fetuses where standard high-risk criteria failed to discriminate surgical cases, the novel metrics demonstrated superior discrimination, achieving 100% specificity and a positive predictive value of 78% to 100%.

Cite This Study

Phillips et al. (2024) studied this question.

synapsesocial.com/papers/6a71a0da87f9210571284b5ahttps://doi.org/10.1159/000538550
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Also Consider

Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Utility of novel fetal echocardiographic morphometric measures of the aortic arch in the diagnosis of neonatal coarctation of the aorta2015 · 80 citations
  2. 2Temporal and spatial performance of vector velocity imaging in the human fetal heart2010 · 111 citations
  3. 3Importance of Relationship between Ductus and Isthmus in Fetal Diagnosis of Coarctation of Aorta2015 · 46 citations