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In the setting of coarctation of the aorta (CoA), clinical symtoms and signs, exercise testing and imaging techniques help identify patients in need of intervention. Nonetheless, cardiac catheterization is still regarded as the gold standard for the evaluation of haemodynamically significant CoA. According to the European Society of Cardiology Guidelines (ESC), all patients with a non-invasive pressure difference >20 mmHg between upper and lower limbs with arterial hypertension, pathological blood pressure response during exercise, or left ventricular hypertrophy (LVH) should have intervention (class I recommendation, level of evidence C), while hypertensive patients with ≥50% aortic narrowing relative to the aortic diameter at the diaphragm level on imaging, should be considered for intervention (class IIa recommendation, level of evidence C).
Clinical, imaging and catheterization data of 42 consecutive subjects with CoA suspected to be haemodynamically significant and undergoing cardiac catheterization from October 1998 to November 2011 with complete clinical and catheterization data were reviewed retrospectively. The ability of Class I and IIa recommendations in identifying patients with a peak-to-peak pressure gradient ≥ 20 mmHg at catheterization was tested.
42 cases were analysed, 31 were male (74%); mean age at cath 35.1 ± 4.8 years; 26 (62%) had native CoA; 26 (62%) bicuspid aortic valve; 3 (7%) left ventricular ejection fraction < 55%; 33 (79%) hypertension; 22 (52%) had LVH; and 23 patients (54.8%) had a peak-to-peak pressure gradient ≥ 20 mmHg. Combination of class IC and IIaC recommendations predicted a significant pressure gradient with a sensitivity of 0.87, specificity of 0.37, positive predictive value of 0.62 and a negative predictive value of 0.70. Overall diagnostic accuracy was 0.64.
Current ESCguideline critera to identify patients with CoA needing intervention performed poorly in predicting a significant pressure gradient at catheterisation. Further efforts are needed to develop a reliable noninvasive method to classify patients with CoA, thereby safely reducing the number of diagnostic catheterizations
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Adult Congenital Heart Disease
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1292-133
- 2013 American College of Cardiology Foundation