Evidence map›Paper›PMID 38621375›Full record

ArticleFetal diagnosis and therapy2024

Left Ventricular Strain, Arch Angulation, and Velocity-Time Integral Ratio Improve Performance of a Clinical Pathway for Fetal Diagnosis of Neonatal Coarctation of the Aorta.

Aaron Anthony Phillips, Rajesh Punn, Claudia Algaze, Yair J Blumenfeld, Valerie Y Chock, David M Kwiatkowski, Amy Quirin, Theresa A Tacy, Kelly Thorson, Shiraz A Maskatia

Abstract read
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In one paragraph

Article in Fetal diagnosis and therapy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Aaron Anthony PhillipsDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Rajesh PunnDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Claudia AlgazeDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Yair J BlumenfeldFetal and Pregnancy Health Program, Stanford Children's Health, Stanford, California, USA.
Valerie Y ChockNeonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
David M KwiatkowskiDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Amy QuirinDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Theresa A TacyDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Kelly ThorsonDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Shiraz A MaskatiaDivisions of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionNeonatal presentation of coarctation of the aorta (CoA) is a potentially life-threatening condition that is difficult to diagnose in fetal life. We therefore sought to validate and compare novel metrics that may add diagnostic value for fetal CoA, including the diastolic to systolic aortic isthmus VTI ratio (VTId:VTIs), ascending aorta to descending aorta angle (AAo-DAo), transverse aorta to descending aorta angle (TAo-DAo), and LV longitudinal strain (LVS), then to evaluate whether these novel metrics improve specificity to identify fetuses at the highest risk for postnatal CoA without compromising sensitivity.

methodsRetrospective cohort study of fetuses followed a prospective clinical pathway and previously classified as mild, moderate, or high-risk for CoA based on standard fetal echo metrics. Novel metrics were retrospectively measured in a blinded manner.

resultsAmong fetuses with prenatal concern for CoA, VTId:VTIs, AAo-DAo angle, TAo-DAo angle, and LVS were significantly different between surgical and non-surgical cases (p < 0.01 for all variables). In the subgroup of moderate- and high-risk fetuses, the standard high-risk criteria (flow reversal at the foramen ovale or aortic arch) did not discriminate effectively between surgical and non-surgical cases. VTId:VTIs, AAo-Dao angle, Tao-DAo angle, and LVS all demonstrated greater discrimination than standard high-risk criteria, with specificity of 100% and PPV (positive predictive value) of 78-100%.

conclusionsThe incorporation of novel metrics added diagnostic value to our clinical pathway for fetal CoA with higher specificity than the previous high-risk criteria. The incorporation of these metrics into the evaluation of fetuses at moderate- or high-risk for surgical CoA may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation.

Indexed as

Aortic CoarctationUltrasonography, PrenatalAorta, ThoracicCritical PathwaysFemaleHeart VentriclesHumansInfant, NewbornPregnancyRetrospective StudiesCardiac surgeryCoarctationCongenital heart diseaseFetal echocardiographyMyocardial strain

Identifiers

PMID38621375
PMCPMC11318582

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.