Usefulness of Cardiovascular Magnetic Resonance Imaging to Predict the Need for Intervention in Patients With Coarctation of the Aorta

• Published in: The American journal of cardiology 2012-03, Vol.109 (6), p.861-865
• Main Authors: Muzzarelli, Stefano, MD, Meadows, Alison Knauth, MD, PhD, Ordovas, Karen Gomes, MD, Higgins, Charles Bernard, MD, Meadows, Jeffery Joshua, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aortic Coarctation - diagnosis; Aortic Coarctation - physiopathology; Aortic Coarctation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity; Cardiology. Vascular system; Cardiovascular; Catheters; Child; Child, Preschool; Clinical outcomes; Diagnosis, Differential; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Humans; Infant; Intervention; Magnetic Resonance Imaging, Cine - utilization; Male; Medical sciences; Medical treatment; Middle Aged; NMR; Nuclear magnetic resonance; Predictive Value of Tests; Regression analysis; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Young Adult
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.10.048

Cardiovascular magnetic resonance (CMR) imaging can predict hemodynamically significant coarctation of the aorta (CoA) with a high degree of discrimination. However, the ability of CMR to predict important clinical outcomes in this patient population is unknown. Therefore, we sought to define the ability of CMR to predict the need for surgical or transcatheter intervention in patients with CoA. We retrospectively reviewed the data from 133 consecutive patients who had undergone CMR for the evaluation of known or suspected CoA. The characteristics of the CMR-derived variables predicting the need for surgical or transcatheter intervention for CoA within 1 year were determined through logistic regression analysis. Therapeutic aortic intervention was performed in 41 (31%) of the 133 patients during the study period. The indexed minimum aortic cross-sectional area was the strongest predictor of subsequent intervention (area under the receiver operating characteristic curve 0.975) followed by heart rate-corrected deceleration time in the descending aorta (area under the receiver operating characteristic curve 0.951), and the percentage of flow increase (area under the receiver operating characteristic curve 0.867). The combination of the indexed minimum aortic cross-sectional area and rate-corrected deceleration time in the descending aorta provided the best predictive model (area under the receiver operating characteristic curve 0.986). In conclusion, CMR findings can predict the need for subsequent intervention in CoA. These findings reinforce the “gate-keeper role” of CMR to cardiac catheterization by providing valuable diagnostic and powerful prognostic information and could guide additional treatment of patients with CoA with the final intent of reducing the number of diagnostic catheterizations in such patients.