Prenatal diagnosis of CHDs: a simple ultrasound prediction model to estimate the probability of the need for neonatal cardiac invasive therapy.
OBJECTIVE
To develop a prediction model based on echocardiographic findings to estimate the probability of the need for neonatal cardiac invasive therapy, including cardiac surgery or catheter-based therapy, in foetuses with CHD.


METHODS
Retrospective cohort study: a prediction model was developed based on echocardiographic findings on the examination of the four-chamber, the three-vessel, and the three-vessel and tracheal views. We assessed performance using the area under the curve of the receiver operating characteristic.


RESULTS
Among 291 patients with prenatal diagnosis of CHD and complete follow-up, 175 (60.1%) required neonatal cardiac invasive therapy. The variables "functionally single ventricle", "great artery reverse flow", and "congenital heart block" had a discrimination value of 100% and were excluded from the model. In univariate and multivariate analysis, "non-visualisation of a great vessel", "asymmetry of the great vessels", "visualisation of one atrioventricular valve", and "ventricular asymmetry" were significantly associated with the need for neonatal cardiac invasive therapy. The area under the receiver operating characteristic curve was 0.9324 (95% CI 0.92-0.97).


CONCLUSIONS
A prediction model based on echocardiographic findings in foetuses with CHD, even without a definite diagnosis, allows an accurate estimation of the probability of requiring neonatal cardiac invasive therapy. This can modify patient care, especially in regions where a Foetal Medicine Specialist or a Paediatric Cardiologist is not available and referral may be extremely difficult due to social and economic barriers.
1Foetal Medicine Unit,Hospital Italiano de Buenos Aires,Beuno Aires,Argentina.
Pablo
P
Marantz
1Foetal Medicine Unit,Hospital Italiano de Buenos Aires,Beuno Aires,Argentina.
Sofía
S
Grinenco
2Department of Pediatric Cardiology,Hospital Italiano de Buenos Aires,Beuno Aires,Argentina.
Fabio
F
Pestchanker
1Foetal Medicine Unit,Hospital Italiano de Buenos Aires,Beuno Aires,Argentina.
César H
CH
Meller
1Foetal Medicine Unit,Hospital Italiano de Buenos Aires,Beuno Aires,Argentina.
Gustavo
G
Izbizky
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*
CHD; Foetal heart; echocardiography; prediction model; prenatal diagnosis