title: Ability of noninvasive criteria to predict hemodynamically significant aortic obstruction in adults with coarctation of the aorta.
abstract: OBJECTIVE
  Coarctation of the aorta (CoA) is a common condition. Adult patients with newly diagnosed CoA and patients with recurring or residual CoA require evaluation of the severity of aortic obstruction. Cardiac catheterization is considered the gold standard for the evaluation of hemodynamically significant CoA. The European Society of Cardiology (ESC) Guidelines for the management of grown-up congenital heart disease (GUCH) include noninvasive criteria for identifying significant CoA. Our aim was to investigate the ability of the Class I and Class IIa ESC recommendations to identify significant CoA at cardiac catheterization.
  
  
  METHODS
  Sixty-six adult patients with native or recurrent CoA underwent diagnostic cardiac catheterization at the GUCH unit at the Sahlgrenska University Hospital in Gothenburg from October 1998 to November 2013. Clinical and imaging data, as well as data about cardiac catheterization were retrospectively collected from patient records.
  
  
  RESULTS
  The Class I ESC recommendations predicted significant CoA with a sensitivity of 0.57, a specificity of 0.63, a positive predictive value of 0.67, and a negative predictive value of 0.53. The combination of Class I and Class IIa recommendations predicted significant CoA with a sensitivity of 0.75, a specificity of 0.42, a positive predictive value of 0.66 and a negative predictive value of 0.52.
  
  
  CONCLUSIONS
  the noninvasive criteria proposed by the ESC guidelines to identify subjects with significant CoA performed poorly in our dataset. Further research is needed to develop more accurate, noninvasive criteria to evaluate CoA severity and thereby reduce the number of unnecessary cardiac catheterizations.
authors: Grown-Up Congenital Heart Disease (GUCH) unit, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Marco
authors: M
authors: Astengo
authors: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Caroline
authors: C
authors: Berntsson
authors: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Åse A
authors: ÅA
authors: Johnsson
authors: Grown-Up Congenital Heart Disease (GUCH) unit, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Peter
authors: P
authors: Eriksson
authors: Grown-Up Congenital Heart Disease (GUCH) unit, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Mikael
authors: M
authors: Dellborg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006328:Cardiac Catheterization; D000072226:Computed Tomography Angiography; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden; D055815:Young Adult
keywords: cardiac catheterization; coarctation of the aorta; congenital heart defects; decision support techniques; patient selection; practice guideline