Model for screening adult congenital heart disease surgery eligibility with echocardiography parameters

https://doi.org/10.1016/j.healun.2022.08.016Get rights and content
Under a Creative Commons license
open access

Objectives

This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters.

Methods

A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis.

Results

Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84−0.90, p < 0.01), 0.86 (95% CI: 0.82−0.91, p < 0.01), and 0.85 (95% CI: 0.79−0.90, p < 0.01), respectively.

Conclusions

This scoring system could augment flexibility and convenience for pre-screening CHD patients’ eligibility for surgery, before RHC.

KEYWORDS

congenital heart disease
echocardiogram
pulmonary artery hypertension
pulmonary to systemic flow ratio
pulmonary to systemic vascular resistance ratio

Abbreviations

CHD
congenital heart disease
CI
confidence interval
ePASP
estimated pulmonary artery systolic pressure
LA
left atria anterior-posterior diameters
OR
odds ratio
PAH
pulmonary artery hypertension
PV
highest blood flow velocity through pulmonary valve
Qp/Qs
pulmonary to systemic flow ratio
RA
Right atrial diameter
RHC
right heart catheterization
Rp/Rs
pulmonary to systemic vascular resistance ratio
ROC
receiver operating characteristic

Cited by (0)

#

These authors contributed equally to this work.