Application Of Z-score Combined With Cardiovascular Diameter Ratio In Fetal Coarctation Of The Aorta

Objective Our aim was to establish Z-score reference ranges and diameter ratio for cardiovascular dimensions using two dimensional echocardiography,to compare cardiovascular parameters between Coarctation of the Aorta(Co A)and normal fetuses,to evaluate these cardiovascular perameters in the prenatal diagnosis of Co A.Methods Eight hundred normal fetuses and fifty fetuses with Co A were conducted in this study.Nine cardiovascular dimensions were measured with two dimensional echocardiography for Co A and normal fetuses,including: LAID?LVID?RAID?RVID?MPA?AAO?AAI?DA?DAO.The following ratios were calculated in two groups: RAID/LAID?RVID/LVID?MPA/AAO?DA/AAI?DAO/AAI?AAO/AAI?AAO/DAO.Then,the nine cardiovascular dimensions Z-Score formulas were calculated based on gestational age(GA)of the normal fetuses.the parameters of normal group and Co A group were compared.Results 1.The RAID?RVID?MPA?DA mean Z-Scores,RAID/LAID?RVID/LVID?MPA/AAO?DA/AAI?DAO/AAI?AAO/AAI ratios of Co A group were great than normal group;the LVID?AAO Z-Score?AAI mean Z-Scores and AAO/DAO ratio of Co A group were less than normal group(P<0.05).2.In the scatter diagram,AAO?AAO?AAI Z-scores and MPA / AAO?DA / AAI?DAO / AAI?AAO /DAO ratios of the Co A group were obviously separated from those in the normal group(P<0.05).3.ROC curve shows the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,youden's index,area under the curve,cut-off points,and the order is from high to low according to the diagnosis efficiency:AAI Z-Score(90%,94.9%,52.3%,99.3%,17.65,0.1,0.849,0.992,-2);DAO/AAI(100%,90.4%,39.4%,100%,10.41,0,0.904,0.996,1.7);DA/AAI(100%,89.3%,37%,100%,9.35,0,0.893.0.998,1.5);MPA/AAO(90%,89.8%,35.4%,99.3%,8.82,0.11,0.798,0.954,1.6);AAO Z-Score(98%,88.3%,34.3%,99.9%,8.38,0.02,0.863,0.992,-2);AAO/DAO(82%,89.3%,32.3%,98.8%,7.7,0.2,0.713,0.96,0.8).Conclusion 1.The cardiovascular Z-score formulas we developed can provide a quantitative basis for the prenatal diagnosis.2.AAI Z-score <-2,AAO Z-score <-2 and DA/AAI ratio increase,DAO/AAI ratio increase,MPA/AAO ratio increase,and AAO/DAO ratio decrease can be used as the basis for prenatal ultrasound detection of Co A.