Echocardiographic score to predict neonatal surgery for aortic coarctation in newborns with prenatal suspicion and patent ductus arteriosus

Figures & data

Figure 1. Sites of measurements of the aortic Arch.

Table 1. Prenatal and birth characteristics.

	No CoA (n = 43)	CoA (n = 44)	p
Gender (male), n (%)	26 (60)	23 (52)	.441
Birth weight (kg), mean ± SD	3.17 ± 0.47	3.10 ± 0.58	.5712
Birth length (cm), mean ± SD	49.3 ± 2.2	48.8 ± 2.4	.442
Weight Pc, mean ± SD	49.7 ± 28.7	44.8 ± 32.2	.4626
Length Pc, mean ± SD	48.6 ± 30.0	45.4 ± 29.5	.6133
BSA Haycock, mean ± SD	0.206 ± 0.038	0.208 ± 0.025	.8051
CHD family history, n (%)	4 (9)	3 (7)	.646
Gestational age (days), mean ± SD	272.6 ± 11.5	272.0 ± 11.5	.8037
Maternal diabetes, n (%)	7 (16)	5 (11)	.514
Maternal hypertension, n (%)	1 (2)	2 (5)	.599
Maternal age (years), mean ± SD	33.9 ± 5.8	32.6 ± 5.8	.2898
Paternal age (years), mean ± SD	37.4 ± 6.2	35.7 ± 7.0	.2464
Parental disease, n (%)	9 (20)	4 (9)	.100
Infection in pregnancy, n (%)	1 (2)	3 (7)	.353
AHR in pregnancy, n (%)	3 (7)	0 (0)	.056

AHR: Assisted Human Reproduction; BSA: Body Surface Area; CHD: Congenital Heart Disease; Pc: Percentile.

Table 2. Echographic aortic parameters.

Aorta	No CoA (n = 43)	CoA (n = 44)	p
Bovine arch, n (%)	14 (32.5)	4 (9)	.007
Bicuspid aortic valve, n (%)	5 (11.6)	24 (55)	<.001
Aoric anulus (mm), mean ± SD	5.6 ± 0.7	5.5 ± 0.6	.3704
Aortic anulus z-score, mean ± SD	–4.8 ± 0.2	–4.8 ± 0.2	.8173
Sinuses (mm), mean ± SD	8.5 ± 0.8	8.4 ± 0.8	.4353
Sinuses z-score, mean ± SD	–0.55 ± 0.34	–0.58 ± 0.41	.7352
STJ (mm), mean ± SD	5.98 ± 0.75	5.71 ± 0.77	.1118
STJ z-score, mean ± SD	–0.70 ± 0.37	–0.81 ± 0.48	.2649
Ascending aorta(mm), mean ± SD	7.15 ± 0.79	7.02 ± 0.92	.4420
Ascending aorta z-score, mean ± SD	–0.74 ± 0.36	–0.78 ± 0.42	.6509
D1(mm), mean ± SD	6.39 ± 0.64	6.06 ± 0.98	.0653
D2(mm), mean ± SD	5.12 ± 0.92	4.65 ± 1.07	.0454
D2 z-score, mean ± SD	–0.95 ± 0.52	–1.22 ± 0.73	.0743
D3(mm), mean ± SD	4.18 ± 0.68	3.58 ± 0.61	<.001
D3 z-score, mean ± SD	–0.96 ± 0.42	–1.39 ± 0.49	<.001
D4(mm), mean ± SD	3.39 ± 0.56	2.56 ± 0.56	<.001
D4 z-score, mean ± SD	–0.76 ± 0.49	–1.49 ± 0.56	<.001
LCA- LSA distance(mm), mean ± SD	4.36 ± 1.99	6.24 ± 2.52	.0002
Abdominal aorta (mm), mean ± SD	5.81 ± 0.73	5.46 ± 0.69	.0237
Abdominal aorta z-score, mean ± SD	0.48 ± 0.34	0.34 ± 0.36	.0784
IA(mm), mean ± SD	4.16 ± 0.63	4.28 ± 0.75	.4257
LCA(mm), mean ± SD	3.43 ± 0.41	3.37 ± 0.49	.5412
LSA(mm), mean ± SD	3.51 ± 0.50	3.28 ± 0.60	.0573

IA: Innominate Artery; LCA: Left Common Carotid Artery; LSA: Left Subclavian Artery; STJ: Sinotubular Junction; D1, D2, D3, D4 diameters as reported in Figure 1. Bold values denote statistical significance at the p < .05 level.

Table 3. Derived parameters for aortic arch evaluation.

	No CoA (n = 43)	CoA (n = 44)	p
D2/D1(%), mean ± SD	79.13 ± 13.00	76.79 ± 15.49	.4905
D3/D1 (%), mean ± SD	65.72 ± 10.40	60.49 ± 13.67	.0485
D3/D1 > 70%, n (%)	11 (26)	7 (16)	.265
D3/D1 > 60%, n (%)	26 (60.5)	21 (47.7)	.233
D4/D1(%), mean ± SD	53.53 ± 9.54	43.54 ± 12.83	.0001
D4/D1 > 50%, n (%)	27 (62.7)	10 (22.7)	<.001
CSAi, mean ± SD	1.17 ± 0.56	0.70 ± 0.46	<.001
CSAi <0.8, n (%)	12 (27.9)	36 (81.8)	<.001
D4/Abdominal aorta, mean ± SD	0.59 ± 0.11	0.52 ± 0.29	.1372
LCA/D3, mean ± SD	0.84 ± 0.16	0.96 ± 0.19	.0017
D1/Sinuses, mean ± SD	0.76 ± 0.09	0.73 ± 0.12	.2323
D3/Sinuses, mean ± SD	0.49 ± 0.09	0.43 ± 0.07	.0007
D4/Sinuses, mean ± SD	0.39 ± 0.08	0.31 ± 0.08	<.001
D1/Weight, mean ± SD	2.04 ± 0.32	2.02 ± 0.54	.8052
D3/Weight, mean ± SD	1.34 ± 0.24	1.19 ± 0.28	.0109
D4/Weight, mean ± SD	1.09 ± 0.23	0.85 ± 0.23	<.001
D4/Weight > 1, n (%)	28 (65)	10 (23)	<.001
D3/BSA, mean ± SD	19.95 ± 3.15	17.42 ± 3.24	.0004
D4/BSA, mean ± SD	16.17 ± 2.97	12.43 ± 2.89	<.001

BSA: Body Surface Area; CSAi: Carotid – Subclavian Artery index; LCA: Left Common Carotid Artery; LSA: Left Subclavian Artery; D1, D2, D3, D4 diameters as reported in Figure 1. Bold values denote statistical significance at the p < .05 level.

Table 4. Univariate regression Analysis for CoA.

	OR	95% CI	p	AUC
Bicuspid AV	9.12	3.019−27.541	<.0001	0.7146
VSD	7.6	2.519−22.921	<.001	0.6919
D3	0.212	0.091−0.496	<.001	0.7497
D4	0.06	0.0185−0.1954	<.001	0.8753
D4/Sinuses	0.856	0.793−0.926	<.001	0.8030
D4/D1 > 50%	0.174	0.0682−0.445	<.001	0.7003
D3/Weight	0.107	0.017−0.664	.016	0.6637
D4/Weight	0.009	0.001−0.103	<.001	0.8009
D4/Weight >1	0.1575	0.061−0.404	<.001	0.7119
D3/BSA	0.745	0.648–0.903	.002	0.7013
D4/BSA	0.625	0.502–0.779	<.001	0.8528
LCA-LSA distance	1.485	1.178−1.872	.001	0.7228
CSAi	0.128	0.041−0.404	<.001	0.7944
LCA/D3	57.646	3.790−876.712	0.004	0.6773

AUC: Area Under Curve; AV: Aortic Valve; CI: Confidence Interval; CSAi: Carotid – Subclavian Artery Index; LCA: Left Common Carotid Artery; LSA: Left Subclavian Artery; OR: Odds Ratio; VSD: Ventricular Septal Defect. D1, D2, D3, D4 diameters as reported in Figure 1.

Figure 2. Area under ROC curve for CoMOD.

Table 5. Multivariable logistic model estimating the probability to develop CoA.

	OR	95% CI	p
Bicuspid AV	4.259	1.008−17.998	.049
VSD	6.713	1.449−31.077	.015
D3	4.259	0.069−0.769	.016
D4	0.961	0.026−0.354	<.001
LCA-LSA Distance	1.443	1.058−1.969	.021

AV: Aortic Valve; CI: Confidence Interval; LCA: Left Common Carotid Artery; LSA: Left Subclavian Artery; OR: Odds Ratio; VSD: Ventricular Septal Defect. D3, D4 diameters as reported in Figure 1.

Figure 3. Box Plot of CoA and No CoA patients distribution according to CoMOD.

Table 6. Diagnostic accuracy of CoA with CoMOD >0.

CoMOD > 0:
Sensitivity	90.9%
Specificity	86.05%
PPV	86.9%
NPV	90.2%
Correctly classified	88.5%