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Evaluating the severity of aortic coarctation in infants using anatomic features measured on CTA

  • Cardiac
  • Published:
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Abstract

Objectives

A machine learning model was developed to evaluate the severity of aortic coarctation (CoA) in infants based on anatomical features measured on CTA.

Methods

In total, 239 infant patients undergoing both thorax CTA and echocardiography were retrospectively reviewed. The patients were assigned to either mild or severe CoA group based on their pressure gradient on echocardiography. They were further divided into patent ductus arteriosus (PDA) and non-PDA groups. The anatomical features were measured on double-oblique multiplanar reconstructed CTA images. Then, the optimal features were identified by using the Boruta algorithm. Subsequently, the coarctation severity was classified using linear discriminant analysis (LDA). We further investigated the relationship between the anatomical features and re-coarctation using Cox regression.

Results

Four anatomical features showed significant differences between the mild and severe CoA groups, including the smallest aortic cross-sectional area indexed to body surface area (p < 0.001), the narrowest aortic diameter (CoA diameter) indexed to height (p < 0.001), the diameter of the descending aorta at the diaphragmatic level (p < 0.001) and weight (p = 0.005). With these features, accuracy of 88.6% and 90.2%, sensitivity of 65.0% and 72.1%, and specificity of 92.9% and 100% were obtained for classifying the CoA severity in the non-PDA and PDA groups, respectively. Moreover, CoA diameter indexed to weight was associated with the risk of re-coarctation.

Conclusions

CoA severity can be evaluated by using LDA with anatomical features. When quantifying the severity of CoA and risk of re-coarctation, both anatomical alternations at the CoA site and the growth of the patients need to be considered.

Key Points

• CTA is routinely ordered for infants with coarctation of the aorta; however, whether anatomical variations observed with CTA could be used to assess the severity of CoA remains unknown.

• Using the diameter and area of the coarctation site adjusted to body growth as features, the LDA model achieved an accuracy of 88.6% and 90.2% in differentiating between the mild and severe CoA patients in the non-PDA group and PDA group, respectively.

• The narrowest aortic diameter (CoA diameter) indexed to weight has a hazard ratio of 10.29 for re-coarctation.

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Abbreviations

AUC:

Area under the receiver operator characteristic curve

BSA:

Body surface area

CoA:

Aortic coarctation

CoA diameter:

The narrowest aortic diameter

CoA diameter/age:

CoA diameter indexed to age

CoA diameter/height:

CoA diameter indexed to height

CoA diameter/weight:

CoA diameter indexed to weight

CoA/DAo ratio:

CoA diameter indexed to the diameter of the descending aorta at the diaphragmatic level

Coarctation area/BSA:

The smallest aortic cross-sectional area indexed to body surface area

CTA:

Computed tomography angiography

LDA:

Linear discriminant analysis

PDA:

Patent ductus arteriosus

PH:

Pulmonary hypertension

VSD:

Ventricular septal defect

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Funding

This study has received funding from the National Key Research and Development Program of China (Grant No. 2017YFA0205202), and partially funded by the National Natural Science Foundation of China (Grant No. U1401255), and Science and Technology Planning Project of Guangdong Province No.2014A020212228.

Author information

Author notes

  1. Yiming Yu and Yubo Wang contributed equally to this work.

Authors and Affiliations

  1. School of Life Science and Technology, Xidian University, No. 2 Taibainan Road, Xi’an, 710071, Shaanxi, China

    Yiming Yu, Yubo Wang, Maoqing Yang, Jun Li & Liyu Huang

  2. Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong General Hospital), Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China

    Meiping Huang & Qianjun Jia

  3. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong General Hospital), Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China

    Jian Zhuang

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  1. Yiming Yu
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Corresponding author

Correspondence to Liyu Huang.

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Guarantor

The scientific guarantor of this publication is Liyu Huang, Xidian University.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

This study was approved by the ethics committee of Guangdong General Hospital (Guangdong General Hospital No. GDREC2014109H).

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Yu, Y., Wang, Y., Yang, M. et al. Evaluating the severity of aortic coarctation in infants using anatomic features measured on CTA. Eur Radiol 31, 1216–1226 (2021). https://doi.org/10.1007/s00330-020-07238-1

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  • DOI: https://doi.org/10.1007/s00330-020-07238-1

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