Abstract 9008: Echocardiographic Markers in Early Postnatal Life to Predict Intervention in Coarctation of Aorta
Bibliographic record
Abstract
Background: Coarctation of the aorta (CoA) is challenging to diagnose in the early neonatal life due to the patent ductus arteriosus (PDA). We aimed to describe the resource utilization, early post-natal cardiac profile and predictors for need of cardiac surgery. Methods: Retrospective study of infants with an antenatal suspicion of CoA, without major associated cardiac anomalies, born at ≥37 weeks during 2014 to 2020. The analyzed echocardiography (ECHO) was performed within 48 hours after birth. Those not requiring post-natal intervention (normal group) were compared to those that required post-natal cardiac surgery (CoA). Strain was measured using speckle-tracking ECHO (STE). Results: A total of 51 newborns were included, of which 40 (78%) were normal and 11 (22%) underwent intervention. In the normal group, median hospitalization was 4 [2-6] days, 6 (15%) were exposed to prostaglandin E (PGE) infusion, 38 (95%) were on intravenous fluids, 9 (23%) required gavage and age at full feeds was 3 days (IQR: 2-5). Ductus was patent in all newborns and aortic arch measurements were significantly smaller in the CoA (ascending [p=0.01], proximal, distal, isthmus [ p <0.001]). Right ventricular (RV) predominance was higher in the CoA group, as demonstrated by the left ventricular (LV) end-systolic eccentricity index (EI) (1.60 [0.28] vs 2.16 [0.45]; p <0.001) and by a larger end-diastolic area (EDA) of the RV in apical 4 chamber (A4C) relative to the LV-EDA - with a ratio of 1.02 [0.2] vs 1.56 [0.23]; p <0.001. Isthmus and EI were predictive for intervention (OR 26, 95%CI (-42 to -9); p =0.002, OR 4.5, 95%CI (1.5-7.5); p =0.003). A RV to LV EDA ratio in A4C greater than 1.3 demonstrated a high probability for intervention (AUC = 0.97). CoA newborns had a lower RV deformation by STE (peak systolic strain rate (SR); -0.98 [0.17] vs -0.83 [0.2]; p =0.02, early diastolic SR; 1.05 [0.2] vs 0.85 [0.26]; p =0.01). Conclusions: Most infants with antenatal suspicion of CoA did not require intervention but were high consumers of resources. Despite PDA patency, isthmus and RV predominance on first post-natal ECHO were predictors for surgery. The novel markers of strain by STE and ventricular EDA ratio in A4C may help predicting those with true CoA requiring intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".