Prenatal Diagnosis of Aortic Coarctation: Prediction Algorithm according to Gestational Age

Objectives: The aim of the study was first to quantify the diagnostic accuracy of predictive anatomical factors of aortic coarctation (CoA) and second to design a postnatal CoA probability algorithm according to gestational age (GA) in prenatal period. Methods: Global and according to GA diagnostic performance of cardiac anatomical variables using the ROC curve were evaluated in a retrospective cohort of fetuses with suspicion of CoA (2004-2020). A serial testing strategy to predict postnatal CoA by fetal echocardiography was designed. Results: 114 fetuses were included. Isthmus-to-ductal (I/D) ratio provided the best discrimination between healthy fetuses and those with CoA (AUC 0.91, 95% CI: 0.86-0.96, I/D < 0.74 sensitivity 96.3%, I/D < 0.6, specificity 92.5%) with good classification capacity in both the second and third trimesters of gestation. Isthmus z-score and pulmonary/aortic valve ratio increased accuracy in fetuses >28 and tricuspid/mitral valve ratio (TV/MV) in fetuses <= 28 weeks. Study of I/D plus TV/MV ratio in fetuses <= 28 and I/D ratio plus isthmus z-scores in fetuses >28 weeks allowed to correctly classify 91.8% of fetuses as high or low probability of postnatal CoA. Conclusions: Diagnostic discrimination of anatomic predictive factors for CoA varies according to GA. Specific algorithms according to GA increase accuracy in CoA's prenatal prediction.

Automated summary

The study aimed to quantify the diagnostic accuracy of predictive anatomical factors of aortic coarctation (CoA) and design a postnatal CoA probability algorithm according to gestational age (GA) in prenatal period. The I/D ratio provided the best discrimination between healthy fetuses and those with CoA, with specific algorithms according to GA improving prenatal prediction accuracy for CoA. Using a serial testing strategy, the study achieved a high classification capacity for high or low probability of postnatal CoA.