Factors influencing diagnostic discrepancy between preoperative transthoracic echocardiography and cardiovascular angiography in patent ductus arteriosus intervention: a multicenter retrospective study

TL;DR

This study finds that nearly half of pediatric patients with patent ductus arteriosus show differences between two imaging methods, which can affect treatment outcomes.

Contribution

The study identifies specific patient and anatomical factors that predict discrepancies between TTE and angiocardiography measurements in PDA.

Findings

45.4% of patients showed a significant discrepancy between TTE and angiocardiography measurements.

Tubular PDA morphology, small PDA size, and preterm birth were strong predictors of measurement discrepancy.

Funnel-type and larger PDAs showed the highest agreement between imaging methods.

Abstract

Discrepancies between transthoracic echocardiography (TTE) and angiocardiography in assessing patent ductus arteriosus (PDA) dimensions may impact transcatheter closure outcomes.

This multicenter retrospective study included 216 pediatric patients who underwent PDA closure, aiming to evaluate the prevalence and predictors of TTE-angiocardiography measurement discrepancy (defined as ≥0.5 mm difference).

45.4% of patients exhibited significant discrepancy. Multivariate analysis identified tubular PDA morphology (OR = 2.71, P = 0.004), small PDA size (<2.5 mm, OR = 3.42, p < 0.001), preterm birth (OR = 2.87, p = 0.003), growth retardation (OR = 2.19, p = 0.022), and abnormal ECG, chest x-ray, or cardiac enzymes (ORs: 1.96–2.05, all p < 0.05) as independent predictors. Measurement agreement was highest for funnel-type and larger PDAs.

Nearly half of pediatric PDA cases show clinically relevant TTE-angiography discordance, particularly in patients with tubular morphology, small size, prematurity, or systemic abnormalities. These factors should prompt cautious interpretation of TTE and consideration of intraoperative angiographic confirmation to optimize device selection and procedural success.