CTA-Based Non-invasive Estimation of Pressure Gradients Across a CoA: a Validation Against Cardiac Catheterisation

Non-invasive estimation of pressure gradients across a coarctation of the aorta (CoA) can reduce the need for diagnostic cardiac catheterisation. We aimed to validate two novel computational strategies-target-value approaching (TVA) and target-value fixing (TVF)-together with unrefined Doppler estimates, and to compare their diagnostic performance in identifying critical pressure drops for 40 patients. Compared to catheterisation, no statistically significant difference was demonstrated with TVA (P = 0.086), in contrast to TVF (P = 0.005) and unrefined Doppler echocardiography (P < 0.001). TVA manifested the strongest correlation with catheterisation (r = 0.93), compared to TVF (r = 0.83) and echocardiography (r = 0.67) (all P < 0.001). In discriminating pressure gradients greater than 20 mmHg, TVA, TVF, and echocardiography had respective sensitivities of 0.92, 0.88, and 0.80; specificities of 0.93, 0.80, and 0.73; and AUCs of 0.96, 0.89, and 0.80. The TVA strategy may serve as an effective and easily implemented approach to be used in clinical management of patients with CoA. Graphical Central illustration. Pressure gradients estimated using Doppler echocardiography and two novel computational strategies (TVA and TVF) were compared with cardiac catheterisation for 40 patients. TVA and TVF utilised the CTA images to obtain the CoA anatomy and Doppler echocardiography velocimetry to obtain velocity data for the assignment of CFD boundary conditions

Automated summary

This study validated two novel computational strategies, TVA and TVF, for estimating pressure gradients in patients with aortic coarctation. Compared to unrefined Doppler echocardiography, TVA showed stronger correlation, higher sensitivity, and specificity in identifying critical pressure drops.