@Article{chd.12637,
AUTHOR = {Adam B. Christopher, Abraham Apfel, Tao Sun, Jackie Kreutzer, David S. Ezon},
TITLE = {Diastolic velocity half time is associated with aortic coarctation  gradient at catheterization independent of echocardiographic  and clinical blood pressure gradients},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {5},
PAGES = {713--720},
URL = {http://www.techscience.com/schd/v13n5/39050},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> The most accurate noninvasive parameter to predict whether a patient
with aortic coarctation will meet interventional criteria at catheterization remains
elusive. We aim to determine the best independent echocardiographic predictors of
a coarctation peak‐to‐peak pressure gradient ≥20 mm Hg at catheterization, the ac‐
cepted threshold for intervention.<br/>
<b>Design:</b> Retrospective query of our catheterization database from 1/2007 to 7/2016
for the diagnostic code of aortic coarctation was performed. Multiple echocardio‐
graphic measurements and blood pressure gradients prior to cardiac catheterization
were collected. Univariate correlation of variables with the continuous catheteriza‐
tion peak were calculated using Spearman’s rho. Univariate association with peak‐to‐
peak gradient at catheterization ≥20 mm Hg was tested using Mann‐Whitney U test
and the Pearson chi‐square test or Fisher’s exact test. Multivariable logistic regres‐
sion assessed the independent association of the clinically relevant metrics with gra‐
dient at catheterization ≥20 mm Hg.<br/>
<b>Results:</b> Sixty‐eight patients met study criteria (median age 9.25 years), of whom
84% underwent intervention at catheterization. Echocardiographic peak and mean
coarctation velocity, indexed systolic and diastolic velocity half times (SVHTi, DVHTi),
and blood pressure gradient all had moderate correlation (Spearman’s
rho = 0.529‐0.617, P < .001) with the continuous catheterization gradient and were
significantly associated with the binary outcome of catheterization peak ≥20 mm Hg
(P < .001). Logistic regression found echocardiographic mean systolic gradient (OR
1.213 [95% CI 1.041‐1.414]) and DVHTi (OR 1.039 [95% CI 1.004‐1.074]) indepen‐
dently associate with catheterization peak ≥20 mm Hg after controlling for blood
pressure gradient (OR 1.066 [0.987‐1.150]).<br/>
<b>Conclusions:</b> Most echocardiographic estimates show moderate correlation with
arch gradient at catheterization. Noninvasive four extremity blood pressure gradient
is significantly associated with peak‐to‐peak gradient ≥20 mm Hg. DVHTi may pro‐
vide a unique independently associated echocardiographic estimate of coarctation
severity. Further study of these variables with larger cohorts may allow for develop‐
ment of predictive models to direct catheterization.},
DOI = {10.1111/chd.12637}
}