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<p>To investigate the ascending aorta (AAO)–descending aorta (DAO) outer/internal distance index (AAO–DAO ODI/IDI) prediction value for fetal complete transposition of the great arteries (D-TGA). Selected D-TGA fetuses between January 2019 and June 2024 as the D-TGA group and an equal number of normal fetuses (gestational age (GA) matched ± 1&#xa0;week) as the control group. The AAO–DAO outer/internal distance (AAO–DAO OD/ID) and DAO diameter were measured in the aortic arch long-axis view, and the AAO–DAO ODI/IDI were calculated, which are the ratios of AAO–DAO OD/ID to DAO. The relationship between AAO–DAO OD/ID and AAO–DAO ODI/IDI and GA of the normal group was analyzed. The differences in AAO–DAO ODI/IDI between the D-TGA and the normal fetuses were compared, and the difference between the D-TGA with intact ventricular septum (D-TGA-IVS) and the D-TGA with ventricular septal defects (D-TGA-VSD) was compared. The sensitivity and specificity of the receiver operating characteristic (ROC) curve were applied to analyze the discrimination ability of AAO–DAO ODI/IDI for D-TGA and normal fetuses and D-TGA-IVS and D-TGA-VSD. In the normal control group, the DOA ICC was 0.972 (95% CI 0.958–0.982), the AAO–DAO OD ICC was 0.988 (95% CI 0.983–0.992), and the AAO–DAO ID ICC was 0.978 (95% CI 0.967–0.985); in the D-TDA group, the DAO ICC was 0.975 (95% CI 0.956–0.989), the AAO–DAO OD ICC was 0.994 (95% CI 0.991–0.996), and the AAO–DAO ID ICC was 0.991 (95% CI 0.987–0.994). The AAO–DAO OD (<i>r</i> = 0.811, <i>P</i> &lt; 0.001) and AAO–DAO ID (<i>r</i> = 0.707, <i>P</i> &lt; 0.001) increased with increasing GA. The linear regression equations are AAO–DAO OD = 0.087*GA-0.474 (<i>R</i><sup>2</sup> = 0.758, <i>N</i> = 69), and AAO–DAO ID = 0.052*GA-0.319 (<i>R</i><sup>2</sup> = 0.626, <i>N</i> = 69) respectively. The AAO–DAO ODI (<i>r</i> = 0.080, <i>P</i> = 0.511) and AAO–DAO IDI (<i>r</i> = 0.096, <i>P</i> = 0.433) did not significantly correlate with GA. In the D-TGA group, the AAO–DAO ODI/IDI were greater than the normal group (6.35 ± 0.43 vs 4.65 ± 0.35, <i>t</i> = −&#xa0;25.385, <i>P</i> &lt; 0.001) and (4.30 ± 0.42 vs 2.69 ± 0.30, <i>t</i> = −&#xa0;26.050, <i>P</i> &lt; 0.001). In the D-TGA-IVS group, the AAO–DAO ODI/IDI was greater than the D-TGA-VSD group (6.55 ± 0.32 vs 6.09 ± 0.43, <i>t</i> = 5.118, <i>P</i> &lt; 0.001) and (4.50 ± 0.32 vs 4.04 ± 0.39, <i>t</i> = 5.425, <i>P</i> &lt; 0.001). The AAO–DAO ODI AUC was 0.998 (95% CI 0.995–1), and the AAO–DAO IDI AUC was 0.999 (95% CI 0.996–1) for differentiating D-TGA from normal fetuses (twofold cross-validation). When the AAO–DAO ODI cutoff value was 5.34, the sensitivity was 98.6%, the specificity was 97.1%, the positive predictive value (PPV) was 97.1%, and the negative predictive value (NPV) was 98.5%, the positive likelihood ratio (PLR) was 34, and the negative likelihood ratio (NLR) was 0.015; when the AAO–DAO IDI cutoff value was 3.46, the sensitivity was 97.1%, the specificity was 100%, the PPV was 100%, the NPV was 97.2%, and the NLR was 0.029. The AAO–DAO ODI AUC was 0.807 (95% CI 0.696–918), and the AAO–DAO IDI AUC was 0.814 (95% CI 0.712–917) for differentiating D-TGA-IVS from D-TGA-VSD. When the AAO–DAO ODI cutoff value was 6.27, the sensitivity was 87.2%, the specificity was 70.0%, the PPV was 79.1%, the NPV was 80.8%, the PLR was 3.78, and the NLR was 0.24; when the AAO–DAO IDI cutoff value was 4.27, the sensitivity was 82.1%, the specificity was 73.3%, the PPV was 80.0%, the NPV was 75.9%, the PLR was 4, and the NLR was 0.32. AAO–DAO ODI/IDI is a sensitive predictive indicator for fetal D-TGA.</p>

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Ascending Aorta–Descending Aorta Outer/Internal Distance Index as a Potential Novel Method for Predicting Fetal Complete Transposition of the Great Arteries: A Pilot Study

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Qi Yang,
  • Yanping Ruan,
  • Xiaoyan Gu,
  • Ye Zhang,
  • Xiaowei Liu,
  • Lin Sun,
  • Ying Zhao,
  • Yihua He,
  • Jiancheng Han

摘要

To investigate the ascending aorta (AAO)–descending aorta (DAO) outer/internal distance index (AAO–DAO ODI/IDI) prediction value for fetal complete transposition of the great arteries (D-TGA). Selected D-TGA fetuses between January 2019 and June 2024 as the D-TGA group and an equal number of normal fetuses (gestational age (GA) matched ± 1 week) as the control group. The AAO–DAO outer/internal distance (AAO–DAO OD/ID) and DAO diameter were measured in the aortic arch long-axis view, and the AAO–DAO ODI/IDI were calculated, which are the ratios of AAO–DAO OD/ID to DAO. The relationship between AAO–DAO OD/ID and AAO–DAO ODI/IDI and GA of the normal group was analyzed. The differences in AAO–DAO ODI/IDI between the D-TGA and the normal fetuses were compared, and the difference between the D-TGA with intact ventricular septum (D-TGA-IVS) and the D-TGA with ventricular septal defects (D-TGA-VSD) was compared. The sensitivity and specificity of the receiver operating characteristic (ROC) curve were applied to analyze the discrimination ability of AAO–DAO ODI/IDI for D-TGA and normal fetuses and D-TGA-IVS and D-TGA-VSD. In the normal control group, the DOA ICC was 0.972 (95% CI 0.958–0.982), the AAO–DAO OD ICC was 0.988 (95% CI 0.983–0.992), and the AAO–DAO ID ICC was 0.978 (95% CI 0.967–0.985); in the D-TDA group, the DAO ICC was 0.975 (95% CI 0.956–0.989), the AAO–DAO OD ICC was 0.994 (95% CI 0.991–0.996), and the AAO–DAO ID ICC was 0.991 (95% CI 0.987–0.994). The AAO–DAO OD (r = 0.811, P < 0.001) and AAO–DAO ID (r = 0.707, P < 0.001) increased with increasing GA. The linear regression equations are AAO–DAO OD = 0.087*GA-0.474 (R2 = 0.758, N = 69), and AAO–DAO ID = 0.052*GA-0.319 (R2 = 0.626, N = 69) respectively. The AAO–DAO ODI (r = 0.080, P = 0.511) and AAO–DAO IDI (r = 0.096, P = 0.433) did not significantly correlate with GA. In the D-TGA group, the AAO–DAO ODI/IDI were greater than the normal group (6.35 ± 0.43 vs 4.65 ± 0.35, t = − 25.385, P < 0.001) and (4.30 ± 0.42 vs 2.69 ± 0.30, t = − 26.050, P < 0.001). In the D-TGA-IVS group, the AAO–DAO ODI/IDI was greater than the D-TGA-VSD group (6.55 ± 0.32 vs 6.09 ± 0.43, t = 5.118, P < 0.001) and (4.50 ± 0.32 vs 4.04 ± 0.39, t = 5.425, P < 0.001). The AAO–DAO ODI AUC was 0.998 (95% CI 0.995–1), and the AAO–DAO IDI AUC was 0.999 (95% CI 0.996–1) for differentiating D-TGA from normal fetuses (twofold cross-validation). When the AAO–DAO ODI cutoff value was 5.34, the sensitivity was 98.6%, the specificity was 97.1%, the positive predictive value (PPV) was 97.1%, and the negative predictive value (NPV) was 98.5%, the positive likelihood ratio (PLR) was 34, and the negative likelihood ratio (NLR) was 0.015; when the AAO–DAO IDI cutoff value was 3.46, the sensitivity was 97.1%, the specificity was 100%, the PPV was 100%, the NPV was 97.2%, and the NLR was 0.029. The AAO–DAO ODI AUC was 0.807 (95% CI 0.696–918), and the AAO–DAO IDI AUC was 0.814 (95% CI 0.712–917) for differentiating D-TGA-IVS from D-TGA-VSD. When the AAO–DAO ODI cutoff value was 6.27, the sensitivity was 87.2%, the specificity was 70.0%, the PPV was 79.1%, the NPV was 80.8%, the PLR was 3.78, and the NLR was 0.24; when the AAO–DAO IDI cutoff value was 4.27, the sensitivity was 82.1%, the specificity was 73.3%, the PPV was 80.0%, the NPV was 75.9%, the PLR was 4, and the NLR was 0.32. AAO–DAO ODI/IDI is a sensitive predictive indicator for fetal D-TGA.