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Prenatal diagnosis of CHDs: a simple ultrasound prediction model to estimate the probability of the need for neonatal cardiac invasive therapy

Published online by Cambridge University Press:  27 April 2015

Pablo Marantz ,
Sofía Grinenco ,
Fabio Pestchanker ,
César H. Meller  and
Gustavo Izbizky
Pablo Marantz
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Fundación Hospitalaria, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
Sofía Grinenco*
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Fundación Hospitalaria, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
Fabio Pestchanker
Affiliation:
Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
César H. Meller
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
Gustavo Izbizky
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
*
Correspondence to: S. Grinenco, Hospital Italiano de Buenos Aires. Potosí 4135, (C1199ACI) Buenos Aires, Argentina. Tel: +5411 956 021 1530; Fax: +5411 49 590 200 1577; E-mail: [email protected]
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Abstract

Objectives

To develop a prediction model based on echocardiographic findings to estimate the probability of the need for neonatal cardiac invasive therapy, including cardiac surgery or catheter-based therapy, in foetuses with CHD.

Methods

Retrospective cohort study: a prediction model was developed based on echocardiographic findings on the examination of the four-chamber, the three-vessel, and the three-vessel and tracheal views. We assessed performance using the area under the curve of the receiver operating characteristic.

Results

Among 291 patients with prenatal diagnosis of CHD and complete follow-up, 175 (60.1%) required neonatal cardiac invasive therapy. The variables “functionally single ventricle”, “great artery reverse flow”, and “congenital heart block” had a discrimination value of 100% and were excluded from the model. In univariate and multivariate analysis, “non-visualisation of a great vessel”, “asymmetry of the great vessels”, “visualisation of one atrioventricular valve”, and “ventricular asymmetry” were significantly associated with the need for neonatal cardiac invasive therapy. The area under the receiver operating characteristic curve was 0.9324 (95% CI 0.92–0.97).

Conclusions

A prediction model based on echocardiographic findings in foetuses with CHD, even without a definite diagnosis, allows an accurate estimation of the probability of requiring neonatal cardiac invasive therapy. This can modify patient care, especially in regions where a Foetal Medicine Specialist or a Paediatric Cardiologist is not available and referral may be extremely difficult due to social and economic barriers.

Keywords

Foetal heartprenatal diagnosisprediction modelCHDechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 2 , February 2016 , pp. 347 - 353
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Copyright
© Cambridge University Press 2015 

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