Open AccessAccuracy of Transthoracic Echocardiography in Assessing Retro‐aortic Rim prior to Device Closure of Atrial Septal Defects
Author(s) -
O'Byrne Michael L.,
Glatz Andrew C.,
Goldberg David J.,
Shinohara Russell,
Dori Yoav,
Rome Jonathan J.,
Gillespie Matthew J.
Publication year - 2014
Publication title -
congenital heart disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.828
H-Index - 42
eISSN - 1747-0803
pISSN - 1747-079X
DOI - 10.1111/chd.12226
Subject(s) - medicine , receiver operating characteristic , cardiology , gold standard (test) , bland–altman plot , nuclear medicine , limits of agreement
Objective Deficient retro‐aortic rim has been identified as a risk factor for device erosion following trans‐catheter closure of atrial septal defects ( ASD s). 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 J anuary 1, 2005 to A pril 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 B land– A ltman 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. B land– A ltman 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.