학술논문
Accuracy of Transthoracic Echocardiography in Assessing Retro-aortic Rim prior to Device Closure of Atrial Septal Defects.
Document Type
Academic Journal
Author
O'Byrne ML; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.; Glatz AC; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.; Goldberg DJ; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.; Shinohara R; The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.; Dori Y; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.; Rome JJ; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.; Gillespie MJ; Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA.; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA.
Source
Publisher: Tech Science Press Country of Publication: United States NLM ID: 101256510 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1747-0803 (Electronic) Linking ISSN: 1747079X NLM ISO Abbreviation: Congenit Heart Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: Deficient retro-aortic rim has been identified as a risk factor for device erosion following trans-catheter closure of atrial septal defects (ASDs). Transthoracic echocardiography (TTE) is the primary screening method for subjects for possible device closure of ASD, but its reliability in measuring retro-aortic rim size has not been assessed previously.
Design: A single-institution cross-sectional analysis of children and adults referred for trans-catheter device closure of single ostium secundum ASD from January 1, 2005 to April 1, 2012 with reviewable TTE and trans-esophageal echocardiogram images was performed. Inter-rater reliability of measurements was tested in a 24% sample. Accuracy of TTE measurement of retro-aortic rim was assessed using a Bland-Altman plot with trans-esophageal echocardiogram measurement as the gold standard. Test characteristics of TTE detection of deficient retro-aortic rim were calculated. Risk factors for misclassification of deficient retro-aortic rim were assessed using receiver operator characteristic curves. Risk factors for measurement error were assessed through multivariate linear regression.
Results: In total, 163 subjects of median age 5 years (range: 0.3-46 years) were included. Trans-thoracic echocardiography had 90% sensitivity, 84% specificity, 90% positive predictive value, and 83% negative predictive value to detect deficient retro-aortic rim. Bland-Altman plot demonstrated no fixed bias (P = .23), but errors in measurement increased on average as the aortic rim increased in size (P < .001). Prespecified patient level risk factors did not affect receiver operator characteristic curve area under the curve, nor were any patient-level risk factors independently associated with increased measurement error on TTE.
Conclusions: TTE is a sensitive and specific screening test for deficient retro-aortic rim across a range of patient ages and sizes.
(© 2014 Wiley Periodicals, Inc.)
Design: A single-institution cross-sectional analysis of children and adults referred for trans-catheter device closure of single ostium secundum ASD from January 1, 2005 to April 1, 2012 with reviewable TTE and trans-esophageal echocardiogram images was performed. Inter-rater reliability of measurements was tested in a 24% sample. Accuracy of TTE measurement of retro-aortic rim was assessed using a Bland-Altman plot with trans-esophageal echocardiogram measurement as the gold standard. Test characteristics of TTE detection of deficient retro-aortic rim were calculated. Risk factors for misclassification of deficient retro-aortic rim were assessed using receiver operator characteristic curves. Risk factors for measurement error were assessed through multivariate linear regression.
Results: In total, 163 subjects of median age 5 years (range: 0.3-46 years) were included. Trans-thoracic echocardiography had 90% sensitivity, 84% specificity, 90% positive predictive value, and 83% negative predictive value to detect deficient retro-aortic rim. Bland-Altman plot demonstrated no fixed bias (P = .23), but errors in measurement increased on average as the aortic rim increased in size (P < .001). Prespecified patient level risk factors did not affect receiver operator characteristic curve area under the curve, nor were any patient-level risk factors independently associated with increased measurement error on TTE.
Conclusions: TTE is a sensitive and specific screening test for deficient retro-aortic rim across a range of patient ages and sizes.
(© 2014 Wiley Periodicals, Inc.)