Echocardiographic parameters for evaluating coarctation of the aorta before and after birth: A meta-analysis

Objective To investigate the diagnostic value and correlation strength of echocardiographic parameters in evaluating and predicting fetal coarctation of the aorta (CoA). Methods PubMed, Web of Science, GeenMedical, The Cochrane Library, CMB, CNKI, Wanfang, and VIP were searched to obtain all data on the echocardiographic diagnosis of aortic coarctation collected from the database to December 1, 2023. Related literature. The quality of the included literature was evaluated using the QUADAS-2 risk assessment standard provided by Revman 5.3 statistical software. The majority of the parameters were analyzed by the Z-score and the corresponding ratio. The results were analyzed using Stata15.1 software, which combined sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) for the data that were pooled. The diagnostic odds ratio (DOR) and publication bias analysis were performed for all included studies. Results A total of 17 studies were included containing a total of 1,373 patients. The mean mitral valve diameter Z score, ascending aorta Z score, ascending aorta diameter, aortic isthmus mean diameter Z score ( Three-vessel tracheal section), and ductus arteriosus/aortic isthmus diameter (P < 0.05) of the fetuses with aortic coarctation were lower compared with those of the normal fetuses (P = 0.007, P = 0.032, P = 0.006, P = 0.011, P = 0.019, respectively). The aortic isthmus/ductus arteriosus (diameter, mm), mean pulmonary valve diameter Z score, right ventricle/left ventricle (diameter), and right ventricle/left ventricle (area) were higher than those noted in normal fetuses (P = 0.455, P = 0.557, P = 0.408, P = 0.522, respectively). The echocardiographic parameter of neonates and infants was the carotid-subclavian artery index. Following combination of the data, the following results were obtained: Sensitivity: 0.90 (95% CI: 0.72–0.97), specificity: 0.97 (95% CI: 0.92–0.99), positive likelihood ratio: 26.7 (95% CI: 10.7–66.5), negative likelihood ratio: 0.10 (95%CI: 0.03–0.32), diagnostic odds ratio: 262 (95% CI: 37-1875), subject area under the operating characteristic curve (AUC): 0.98. Conclusion For fetuses at risk, the cardiac parameters of the aforementioned ultrasound signs can be more accurately evaluated and can predict the occurrence of CoA before and after birth.