Congenital Heart DiseaseDevelopment and Validation of an Echocardiographic Model for Predicting Progression of Discrete Subaortic Stenosis in Children
Section snippets
Study Design:
The study included 100 patients from 2 institutions and was performed in 2 stages. In phase I, a multiple logistic regression prediction model was developed based on multiple clinical and echocardiographic variables of 52 patients with DSS from Texas Children’s Hospital. In phase II, the prediction model was applied to 48 patients with DSS from Children’s Hospital in Boston to examine its diagnostic accuracy in an independent study sample.
Phase I Study:
All patients diagnosed by echocardiography as having DSS
Patients:
One hundred patients with DSS who met inclusion criteria were included in the study: 52 patients from Texas Children’s Hospital participated in phase I and 48 patients from Children’s Hospital, Boston, were included in phase II. Based on the defined criteria, 33 patients were classified as having nonprogressive DSS, 50 as having progressive stenosis, and the remaining 17 patients formed the intermediate progression group. The demographic and clinical characteristics of the groups are summarized
Discussion
This study identified 3 echocardiographic features that were independently predictive of progressive DSS in children: (1) the distance of subaortic obstruction from the aortic valve, (2) involvement of the anterior mitral leaflet by the subaortic membrane, and (3) initial Doppler gradient. These 3 variables can be applied using a prediction equation to discriminate between nonprogressive and progressive subaortic stenosis.
Early studies based largely on cardiac catheterization data from patients
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