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Risk Factors for Coarctation of the Aorta on Prenatal Ultrasound: A Systematic Review and Meta-Analysis.

Familiari, A; Morlando, M; Khalil, A; Sonesson, S-E; Scala, C; Rizzo, G; Del Sordo, G; Vassallo, C; Elena Flacco, M; Manzoli, L; et al. Familiari, A; Morlando, M; Khalil, A; Sonesson, S-E; Scala, C; Rizzo, G; Del Sordo, G; Vassallo, C; Elena Flacco, M; Manzoli, L; Lanzone, A; Scambia, G; Acharya, G; D'Antonio, F (2017) Risk Factors for Coarctation of the Aorta on Prenatal Ultrasound: A Systematic Review and Meta-Analysis. Circulation, 135 (8). pp. 772-785. ISSN 1524-4539 https://doi.org/10.1161/CIRCULATIONAHA.116.024068
SGUL Authors: Khalil, Asma

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Abstract

BACKGROUND: Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain the strength of association and to quantify the diagnostic accuracy of different ultrasound signs in predicting CoA prenatally. METHODS: Medline, Embase, CINAHL, and Cochrane databases were searched. Random-effects and hierarchical summary receiver operating characteristic model meta-analyses were used to analyze the data. RESULTS: Seven hundred ninety-four articles were identified, and 12 (922 fetuses at risk for CoA) articles were included. Mean mitral valve diameter z score was lower (P<0.001) and the mean tricuspid valve diameter z score was higher in fetuses with CoA than in those without CoA (P=0.01). Mean aortic valve diameter z score was lower in fetuses with CoA than in healthy fetuses (P≤0.001), but the ascending aorta diameter, expressed as z score or millimeters, was similar between groups (P=0.07 and 0.47, respectively). Mean aortic isthmus diameter z scores measured either in sagittal (P=0.02) or in 3-vessel trachea view (P<0.001) were lower in fetuses with CoA. Conversely, the mean pulmonary artery diameter z score, the right/left ventricular and pulmonary artery/ascending aorta diameter ratios were higher (P<0.001, P=0.02, and P=0.02, respectively) in fetuses with CoA in comparison with controls, although aortic isthmus/arterial duct diameter ratio was lower in fetuses with CoA than in those without CoA (P<0.001). The presence of coarctation shelf and aortic arch hypoplasia were more common in fetuses with CoA than in controls (odds ratio, 26.0; 95% confidence interval, 4.42-153; P<0.001 and odds ratio, 38.2; 95% confidence interval, 3.01-486; P=0.005), whereas persistent left superior vena cava (P=0.85), ventricular septal defect (P=0.12), and bicuspid aortic valve (P=0.14) did not carry an increased risk for this anomaly. Multiparametric diagnostic models integrating different ultrasound signs for the detection of CoA were associated with an increased detection rate. CONCLUSIONS: The detection rate of CoA may improve when a multiple-criteria prediction model is adopted. Further large multicenter studies sharing the same imaging protocols are needed to develop objective models for risk assessment in these fetuses.

Item Type: Article
Additional Information: This is a non-final version of an article published in final form in Familiari, A; Morlando, M; Khalil, A; Sonesson, S-E; Scala, C; Rizzo, G; Del Sordo, G; Vassallo, C; Elena Flacco, M; Manzoli, L; Lanzone, A; Scambia, G; Acharya, G; D'Antonio, F. (2017) Risk Factors for Coarctation of the Aorta on Prenatal Ultrasound: A Systematic Review and Meta-Analysis. Circulation, 135 (8). pp. 772-785.
Keywords: aortic coarctation, fetal echocardiography, heart defects, congenital, prenatal diagnosis, Cardiovascular System & Hematology, 1103 Clinical Sciences, 1102 Cardiovascular Medicine And Haematology, 1117 Public Health And Health Services
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Circulation
ISSN: 1524-4539
Language: eng
Dates:
DateEvent
21 February 2017Published
29 December 2016Published Online
14 December 2016Accepted
Publisher License: Publisher's own licence
PubMed ID: 28034902
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108606
Publisher's version: https://doi.org/10.1161/CIRCULATIONAHA.116.024068

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