Gestational Age-Specific Markers Associated with Postnatal Intervention in Fetal Suspicion of Coarctation of the Aorta

Abstract

Objective Fetal diagnosis of coarctation of the aorta (CoA) is currently associated with a high false-positive rate. Many predictive markers may be gestational age (GA)-specific. We sought to establish GA-specific traditional and speckle-tracking fetal echocardiography (STE) markers predictive of true CoA in neonates with prenatal suspicion.

Study Design This is a retrospective case–control study. We compared the fetal ventricular and arch dimensions, as well as the deformation parameters by STE, of infants who required a postnatal intervention for their CoA with those who did not. Cohort was stratified based on GA before or after 30 weeks. Data extractors were masked to the outcome. The first fetal echocardiogram available was used.

Results Seventy-five newborns with a fetal echocardiography performed between October 2013 and May 2022 for an antenatal suspicion of CoA were included, of which 59 (79%) had an aortic arch with nonsignificant obstruction upon ductal closure, and 16 (21%) underwent a neonatal intervention for a confirmed CoA. Before 30 weeks' GA, the right ventricular to left ventricular (RV/LV) end-diastolic width and end-diastolic area (EDA) ratios were most associated with postnatal CoA confirmation (area under the curve [AUCs] = 0.96 and 0.92). After 30 weeks' GA, the RV/LV end-diastolic width ratio (AUC = 0.95), the Z-score for the ascending aorta (AUC = 0.93), and the LV end-diastolic width Z-score (AUC = 0.91) performed the best. A decreased RV peak longitudinal strain was observed in those who developed true CoA and performed well by receiver operating characteristic analysis after 30 weeks (AUC = 0.85). In the overall cohort, the RV/LV EDA ratio was the most sensitive predictor of CoA and identified all cases with CoA. Indeed, a cutoff > 1.24 had a specificity of 69.5% and a sensitivity of 100% (receiver operating characteristic curve with an AUC of 0.88).

Conclusion We outlined sensitive and specific fetal markers associated with postnatal CoA based on GA at suspicion.

Key Points

• Fetal ventricular disproportion predicts postnatal coarctation.

• A decreased right ventircular contraction was observed in those with coarctation.

• Fetal markers differ based on gestational age at fetal evaluation.

Keywords

coarctation of the aorta - fetal echocardiography - STE - strain - congenital heart defect - ventricular disproportion

Data Availability Statement

Derived data generated will be shared on reasonable request to the corresponding author.

Note

Findings were presented at the University of Montreal's Maternal-Fetal Medicine research conference (October 2022), the McGill University Health Center's Child Health and Human Development research day (November 2022) and were presented at the Pediatric Academic Society (PAS) 2023 conference.

Authors' Contributions

S.A. contributed to conceptualizing and designing the study, collected the data, analyzed the data, and drafted the initial and revised manuscript. S.S.M. contributed to conceptualizing and designing the study, collected the data, and critically reviewed the manuscript. A.O. contributed to conceptualizing and designing the study, collected the data, and critically reviewed the manuscript. P.W. contributed to conceptualizing and designing the study, collected the data, and critically reviewed the manuscript. D.V.M. contributed to the coordination of the study, the interpretation of the findings, and critically reviewed the manuscript. J.S. collected the data, contributed to the coordination of the study, and critically reviewed the manuscript. C.R. contributed to conceptualizing and designing the study, contributed to the interpretation of the findings, and critically reviewed the manuscript. G.A. conceptualized and designed the study, supervised data collection, supervised data analysis, contributed to the interpretation of the findings, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 28 May 2023

Accepted: 25 March 2024

Accepted Manuscript online:
03 April 2024

Article published online:
23 April 2024

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