Study On The Prenatal Diagnosis Of Coarctation Of Aorta By Combination Of Multiple Indexes

ObjectiveEchocardiography is the preferred imaging method for diagnosing fetal aortic coarctation(COA).Due to the unique hemodynamic characteristics of fetuses,the differences of postnatal blood circulation and diverse fetal physiological and pathological characteristics,there are still great difficulties in prenatal diagnosis of aortic coarctation.The purpose of this study is to analyze the diagnostic value of various echocardiographic parameters,explore the sensitivity and specificity of different ultrasound parameters in diagnosing aortic coarctation,and the value of combining multiple indexes for prenatal diagnosis of fetal aortic coarctation.This study aims to provide more accurate evaluation index for prenatal diagnosis of aortic coarctation.MethodsThe general condition and ultrasound data of 108 fetuses suspected of aortic coarctation from January 2018 to December 2022 were retrospectively analyzed.All fetuses suspected of"coarctation of aorta"were divided into case group(confirmed by surgery or echocardiography after birth)and false positive group(confirmed by echocardiography after birth as normal aortic arch)according to the postnatal follow-up results.At the same time,105 normal fetuses with matched the gestation age were selected as the normal control group.Each parameter was measured three times and took the average.Subsequently,summarize the image information stored in the workstation accordingly.Calculate the right ventricle(RV)/left ventricle(LV)ratio,pulmonary valve annulus(PA)/aortic valve annulus(AO)ratio,diastolic velocity-time integral(VTI_D)/systolic velocity-time integral(VTI_S)ratio,VTI_D/(VTI_D+VTI_S)ratio,systolic maximum peak velocity(SP_V)/end diastolic velocity(ED_V)ratio,resistance index(RI)[SP_V/(EV_D+SP_V)ratio],and convert the above inner diameter parameters into Z scores based on the fetal femur length(FL).All subjects were followed up to the surgical intervention or 6 months old.Comprehensively analyze the ultrasound parameters of the three groups of fetuses,filter the most relevant indicators and combinations for diagnosis,and analyze the diagnostic value of each parameter for fetal aortic coarctation.Results1.In the normal control group,the various fetal heart diameters had a good linear relationship with gestational age and femur length diameter.VTI_D,while parameters such as VTI_S,VTI_D/VTI_Sratio,RV/LV ratio,PA/AO ratio,Isthmus of aorta(AOI)z-score did not have a linear correlation with gestational age and femur length.2.The single factor Receiver operating characteristic(ROC)curve analysis results showed that VTI_D/VTI_Sratio>0.62 and AOI z-score<-4.1 were reliable indicators for diagnosing fetal aortic coarctation,with the area under the receiver operating characteristic curve(AUC)of 0.91 and 0.78,respectively.ED_Vhad the highest sensitivity of 93.48%,while the specificity of RV/LV ratio was the highest(96.77%).3.The backward LR stepwise regression method was used to screen variables.Four variables were obtained,namely VTI_D/VTI_Sratio,RV/LV ratio,PA/AO ratio and AOI z-score,for final logistic regression modeling,and then performed binary multi-factor logistic regression.The AUC of multi-index combination was 0.96,with the sensitivity of 93.48%and the specificity of 83.87%,the diagnostic efficiency of which was greater than that of any single parameter.ConclusionsVTI_D/VTI_Sratio and AOI z-score are reliable indicators for the diagnosis of fetal aortic coarctation.The combination of VTI_D/VTI_Sratio,RV/LV ratio,PA/AO ratio and AOI z-score has the highest diagnostic efficacy,with a sensitivity of 93.48%and a specificity of 83.87%,which is superior to any single parameter.The combined application of Doppler data improves the diagnostic accuracy of COA compared to a single two-dimensional ultrasound measurement,which reinforces the importance of combined diagnosis with multiple COA indices in fetuses.