Screening For Heart Disease Research Articles

Effects of coronary computer tomography angiography screening on smoking habits in asymptomatic individuals with family history of premature coronary heart disease

Background: The Screening for Asymptomatic Coronary Heart disease in the Siblings of young Myocardial Infarction patients study (SACHSMI) investigated the association between index myocardial infarction patient sibling(s) and obstructive coronary heart disease as detected by coronary computer tomography angiography (CCTA). The results of SACHSMI described a statistically significant association between smoking and prevalence of stenosis detected by CCTA. Data is lacking, however, regarding CCTA screening effects on smoking habits of young individuals. Methods: Fifty asymptomatic siblings of prospectively identified index myocardial infarction patients, aged 55 years or younger, were screened. These 50 sibling participants were shown and explained their CCTA results. The participants were followed using telephone call at 1 and 12 months after screening to assess any change in their smoking habits. The primary outcome of interest was to identify any change in smoking habit among the participants of the SACHSMI study undergoing CCTA 1 and 12 months post scanning. Results: Of the 50 participants, 20 (40%) had a history of smoking. One month post CCTA, 12 (60%; 95% confidence interval (CI): 36% to 81%) participants either stopped smoking (7/20 (35%; 95% CI: 15% to 59%)) or reduced (5/20 (25%; 95% CI: 9% to 49%)) the number of cigarettes smoked daily. At 12 months post CCTA, 11 (55%; 95% CI: 32% to 77%) participants either stopped smoking (6/20 (30%; 95% CI: 12% to 54%)) or reduced (5/20 (25%; 95% CI: 9% to 49%)) the number of cigarettes smoked daily. Conclusions: Screening individuals with family history of premature CHD via CCTA may have the additional benefit of reducing smoking in the short term.

False negative diagnoses of critical congenital heart disease with screening neonatal pulse oximetry.

False negative pulse oximeter results occur in new born infants with critical congenital heart disease who have an oximeter saturation ≥95%. Some of these infants have abnormal physical findings but others do not. To determine the causes of false negative results. Mathematical analysis of determinants of arterial oxygen saturation and discussion of oximeter bias. False negative oximeter results are not rare; the sensitivity of pulse oximetry screening for critical congenital heart disease is about 80%. The high saturation may be due to a very small right-to-left shunt at the time of study, a relatively high cardiac output and mixed venous saturation, or to positive bias in oximeter readings. It may also be due to some critical congenital heart lesions that do not show desaturation at the time of testing. A diagnosis of a normal heart based on a negative oximeter test is presumptive, and requires careful follow-up for 1-2 weeks after birth.

Echo workforce development in the Fiji Islands

Echocardiography has a wide scope of practice and requires many years of training and experience for one to be proficient; however, contextualised echo may be taught for the purpose of screening for rheumatic heart disease (RHD). In recent experience in the Fiji Islands, an echo workforce training programme was implemented with the intention of teaching general sonographers and physicians echo for the purpose of screening RHD with very positive results. This course was completed over three separate one week courses in a clinical setting.

Positive association between heart dosimetry parameters and a novel cardiac biomarker, solubleST-2, in thoracic cancer chest radiation.

BackgroundEarly screening and diagnosis of radiation‐induced heart disease (RIHD) is difficult in patients with chest radiation exposure. sST‐2 is involved in myocardial stress or injury. We evaluated the relationship between heart dose parameters and sST‐2 changes in chest malignant tumor patients who received chest radiation.MethodsWe prospectively collected thoracic malignancy cancer patients who had received chest radiotherapy. Heart dosimetry parameters were extracted from the treatment planning system. sST‐2 was measured at baseline, the middle stage, and after radiotherapy (recorded as pre‐ST‐2, mid‐ST‐2, and post‐ST‐2). sST‐2 change rate was calculated. Scatter plots showed the relationship between cardiac dose parameters and ST‐2 change rate. Multiple regression was used to analyze the relationship between cardiac dose parameters and ST‐2 change rate.ResultsTotally, 60 patients were enrolled. The mean V5, V10, V20, V30, V40, and MHD was 60.93 ± 27.79%, 51.43 ± 25.44%, 39.17 ± 21.75%, 28.07 ± 17.15%,18.66 ± 12.18%, and 18.60 ± 8.63 Gy, respectively. The median M‐LAD was 11.31 (IQR 3.33‐18.76) Gy. The mean pre‐ST‐2, mid‐ST‐2, and post‐ST‐2 was 5.1 ± 3.8, 6.4 ± 3.9, and 7.6 ± 4.4, respectively. sST‐2 was elevated with thoracic irradiation (P < .001). Multivariate linear regression analyses showed that V5, V10, V20, and MHD were independently and positively associated with ST‐2 change rate (β = .04, .04, .04, and .10, respectively, all P < .05).ConclusionSerum sST‐2 levels were elevated over time during radiotherapy. V5, V10, V20 and MHD were independently and positively associated with the elevated ST‐2 change rate.

Accurate Detection of Septal Defects With Fetal Ultrasonography Images Using Deep Learning-Based Multiclass Instance Segmentation

Accurate screening for septal defects is important for supporting radiologists' interpretative work. Some previous studies have proposed semantic segmentation and object detection approaches to carry out fetal heart detection; unfortunately, the models could not segment different objects of the same class. The semantic segmentation method segregates regions that only contain objects from the same class. In contrast, the fetal heart may contain multiple objects, such as the atria, ventricles, valves, and aorta. Besides, blurry boundaries (shadows) or a lack of consistency in the acquisition ultrasonography can cause wide variations. This study utilizes Mask-RCNN (MRCNN) to handle fetal ultrasonography images and employ it to detect and segment defects in heart walls with multiple objects. To our knowledge, this is the first study involving a medical application for septal defect detection using instance segmentation. The use of MRCNN architecture with ResNet50 as a backbone and a 0.0001 learning rate allows for two times faster training of the model on fetal heart images compared to other object detection methods, such as Faster-RCNN (FRCNN). We demonstrate a strong correlation between the predicted septal defects and ground truth as a mean average precision (mAP). As shown in the results, the proposed MRCNN model achieves good performance in multiclass detection of the heart chamber, with 97.59% for the right atrium, 99.67% for the left atrium, 86.17% for the left ventricle, 98.83% for the right ventricle, and 99.97% for the aorta. We also report competitive results for the defect detection of holes in the atria and ventricles via semantic and instance segmentation. The results show that the mAP for MRCNN is about 99.48% and 82% for FRCNN. We suggest that evaluation and prediction with our proposed model provide reliable detection of septal defects, including defects in the atria, ventricles, or both. These results suggest that the model used has a high potential to help cardiologists complete the initial screening for fetal congenital heart disease.

Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound: A National United States Survey.

Prenatal detection of congenital heart disease with obstetric screening remains at less than 50% in most population studies, far from what is thought to be achievable. We sought to identify barriers/facilitators for screening from the perspective of interpreting physicians and to understand how these barriers/facilitators may be associated with interpretation of screening images. Our mixed-methods studies included 4 focus groups in centers across the United States with obstetric, maternal-fetal medicine, and radiology providers who interpreted obstetric ultrasound studies. Themes around barriers/facilitators for fetal heart screening were coded from transcripts. A national Web-based survey was then conducted, which quantitatively measured reported barriers/facilitators and measured physicians' ability to interpret fetal heart-screening images. Multivariable generalized linear random-effect models assessed the association between barriers/facilitators and the accuracy of image interpretation at the image level. Three main themes were identified in the focus groups: intrinsic barriers (ie, comfort with screening), external barriers (ie, lack of feedback), and organizational barriers (ie, study volumes). Among 190 physician respondents, 104 interpreted ultrasound studies. Perceptions of barriers varied by practice setting, with nontertiary providers having lower self-efficacy and perceived usefulness of cardiac screening. Facilitators associated with the odds of accurate interpretation of screening images were knowledge (odds ratio, 2.54; P = .002) and the volume of scans per week (odds ratio, 1.01 for every additional scan; P = .04). Some of the main barriers to cardiac screening identified and prioritized by physicians across the United States were knowledge of screening and minimal volumes of scans. Targeting these barriers will aid in improving prenatal detection of congenital heart disease.

Assessment of the quality of fetal heart standard views using the FAST, STAR, and FINE four-dimensional ultrasound techniques in the screening of congenital heart diseases.

To compare the quality of standard fetal echocardiographic views obtained by four-dimensional ultrasound with those obtained by the simple targeted arterial rendering (STAR) technique, four-chamber view swing technique (FAST), and fetal intelligent navigation echocardiography (FINE/5D Heart® ) technique. This was a cross-sectional prospective study that included pregnant women between 22 and 34weeks of gestation, with normal fetuses. Fetal heart volumes were acquired using spatio-temporal image correlation (STIC) with the fetal spine between 2 and 9 o'clock. The FAST/STAR techniques consist of the manipulation of STIC volumes by drawing OmniView™ lines to obtain echocardiographic views. The FINE/5D Heart® technique uses intelligent navigation to automatically generate echocardiographic views. The quality of the images was classified as excellent, good, acceptable, and unacceptable. The analysis was performed using the Bonferroni multiple comparisons test. The study included 101 pregnant women aged between 16 and 44years. There was no mean difference in image quality between the techniques regarding fetal spine position in all echocardiographic views (P>.05). However, in the five-chamber, left ventricular outflow tract, right ventricular outflow tract, ductal arch, superior vena cava/inferior vena cava, and abdomen/stomach views, there was a statistically significant mean difference quality between the techniques, regardless of the spine position (P<.05). The best mean image quality was obtained by the FINE technique (P≤.016 for all fetal echocardiographic views). The quality of the echocardiographic views obtained using the FINE technique was superior to that of those generated by the FAST/STAR techniques in normal fetuses.

Pulse oximetry screening for critical congenital heart disease in term and late pre-term newborn

Pulse oximetry screening for critical congenital heart disease in term and late pre-term newborn

Preoperative Optimisation in Vascular Patients to Reduce Peri- and Postoperative Blood Transfusions and Postoperative Complications – A Proof of Concept Study

Introduction: Preoperative anaemia is associated with an increased risk of peri- and postoperative morbidity and mortality. Additionally, preoperative anaemia increases Red Blood Cell (RBC) transfusions associated with postoperative complications and an increase in the risk of perioperative myocardial damage. Perioperative myocardial damage is associated with increased morbidity and mortality. Preoperative screening of vascular patients for anaemia and structural heart disease facilitates optimisation of haemoglobin prior to surgery and enables, patient-tailored anaesthesia. This may increase perioperative oxygen delivery and reduce RBC transfusions. We aimed to investigate the effects of preoperative treatment of iron-deficiency anaemia on red blood cell (RBC) transfusions and postoperative myocardial damage, as well as the effect of preoperative screening for unknown heart disease with a focused cardiac ultrasound (FOCUS) in a vascular surgery patient cohort. Methods: This study was performed as an observational intervention study with a three-months observation period followed by a three-months intervention period. In the intervention period iron-deficient, anaemic patients received intravenous iron at the outpatient clinic, and all patients underwent a FOCUS scan in the outpatient clinic before surgery. Outcome measures included the incidence of preoperative anaemia, troponin rise after surgery, perioperative ECG changes consistent with ischaemia and the requirement for RBC transfusions. Results: In the observation period 24% of all patients were anaemic. The highest prevalence was observed in patients admitted for peripheral surgery (27%) compared to central open surgery (18%). Iron-deficiency anaemia was observed in 18% of peripheral surgery patients and in less than 10% in the remainder of the study cohort. All types of vascular surgeries caused an increase in troponin >20% indicating myocardial damage. This affected 70% of patients undergoing central open surgery and 40% of patients undergoing peripheral surgery and 55% of patients undergoing endovascular aortic repair. RBC transfusions were given in 70% of central open surgery, 16% of peripheral surgery patients and in 30% of endovascular aortic repairs. Total number of transfusions were higher in anaemic patients. The study is ongoing and will be completed in April 2019. Results for incidence of structural heart disease and the effects of intravenous iron treatment are pending. Conclusion: Vascular surgery patients have a high prevalence of anaemia. Myocardial injury and RBC transfusions are frequent during and after surgery. Data for the effects of intravenous iron treatment and FOCUS screening are awaited. Disclosure: Nothing to disclose

Carcinoid Heart Disease: A Guide for Clinicians.

Carcinoid heart disease is the collective term for all cardiac manifestations that develop in patients with carcinoid. The cardiac manifestations of carcinoid tumors are attributed to the paraneoplastic effects of vasoactive substances released by the malignant cells. The clinical manifestations of carcinoid heart disease include valvular destruction leading to valvular regurgitation and stenosis, right-sided heart failure, and metastatic carcinoid disease. A combination of biomarkers and cardiac imaging is used in screening and diagnosis of carcinoid heart disease in patients with carcinoid syndrome. The management of carcinoid heart disease involves medical and surgical treatment and requires a multidisciplinary approach for optimized care.

Classification of heart sound signals in congenital heart disease based on convolutional neural network

Cardiac auscultation is the basic way for primary diagnosis and screening of congenital heart disease(CHD). A new classification algorithm of CHD based on convolution neural network was proposed for analysis and classification of CHD heart sounds in this work. The algorithm was based on the clinically collected diagnosed CHD heart sound signal. Firstly the heart sound signal preprocessing algorithm was used to extract and organize the Mel Cepstral Coefficient (MFSC) of the heart sound signal in the one-dimensional time domain and turn it into a two-dimensional feature sample. Secondly, 1 000 feature samples were used to train and optimize the convolutional neural network, and the training results with the accuracy of 0.896 and the loss value of 0.25 were obtained by using the Adam optimizer. Finally, 200 samples were tested with convolution neural network, and the results showed that the accuracy was up to 0.895, the sensitivity was 0.910, and the specificity was 0.880. Compared with other algorithms, the proposed algorithm has improved accuracy and specificity. It proves that the proposed method effectively improves the robustness and accuracy of heart sound classification and is expected to be applied to machine-assisted auscultation.

P3129Rheumatic heart diseases screening in Bornean Malaysia: a pilot echocardiography study

Abstract Background Rheumatic heart disease is a major public health issue in developing countries including Malaysia. RHD is a preventable disease. Early detection and appropriate treatment may decrease the disease burden to the society. Rheumatic heart disease screening using portable echocardiography may improve early detection among school children in vulnerable community. This is a pilot study of rheumatic heart disease screening using Vscan among primary school students in the Bornean state of Sabah Malaysia. Purpose To evaluate the resources required for RHD screening, prevalence of RHD among school children and awareness among the parents and teachers. Methods A cohort of 211 students from a primary school were recruited in 2017–2018. Parental consents were obtained. Seven sessions were conducted at the school. Echocardiography was performed by 2–3 experienced ultrasonographers. Image interpretation as per the 2012 WHF RHD echocardiographic diagnostic criteria. Results Of the 211 students, 50% female, age range 7–12 year-old. Ethnic groups include Kadazandusun (87%), Rungus (2.4%), Lundayeh (2%), Chinese (2%). Overall, the average number of student scanned was 4.6 students/device/hour. There was a learning curve observed, whereby initial session only scanned 2 students/device/hour which improved to a maximum of 5.9 students/device/hour. Preliminary findings noted probable RHD among 36% (n=76) of screened subjects. Incidental diagnosis of congenital heart disease among 5 students. The suspected RHD cases were referred for formal echocardiography in the tertiary centre for confirmation. Thus far, 12 students were diagnosed with borderline RHD; the main diagnostic criteria in these cases were at least two morphological features of RHD of the MV without pathological MR or MS. Secondary prophylaxis with antibiotic, dental hygiene and patient education were given. Conclusion This is a pilot RHD screening using portable Vscan echocardiography among primary school students in Malaysia. Our study showed it is feasible to conduct RHD screening in the field using portable Vscan. The number of students screened improved with practice. Our preliminary finding suggest RHD is prevalent in this population in Sabah, Malaysia.

Pulsatile tubular cardiac tissues fabricated by wrapping human iPS cells-derived cardiomyocyte sheets.

The purpose of this study was to fabricate pulsatile tubular cardiac tissue using cell sheet based-tissue engineering. First, we fabricated human induced pluripotent stem cell (hiPSc)-derived cardiomyocyte sheets and normal human dermal fibroblast (NHDF) sheets which are harvested from temperature responsive culture dishes only by lowering the temperature. Then tubular cardiac tissues are formed by wrapping one hiPSc-derived cardiomyocyte sheet and three NHDF sheets around an octagonal column, and both ends of the tubular tissue were covered with fibrin and collagen gel. The octagonal column with the tubular tissue was connected to an in vitro circulation system in a culture box. After four-day culture, the cardiac tissue survived and pulsated spontaneously in the circulation system. Furthermore, the analysis with a Millar catheter inserted into the cardiac tubes revealed significant inner pressure changes generated by their beating. In addition, the tubular cardiac tissue pulsated in response to the electrical stimulation. Although histological analyses demonstrated that cardiac troponin T-positive cells stratified the inner surface of the tubular tissues, gene expression analyses showed an immature state of these cardiomyocytes. Thus, cell sheet-based tissue engineering realized human pulsatile tubular cardiac tissue fabrication and we believe that these tubular cardiac tissues should contribute to future drug screening and regenerative therapy for heart diseases.

P6153High risk plaque by coronary CTA predict cardiac events but not all-cause mortality: long term follow up

Abstract Background Ultra long-term (10 years) outcome data of coronary computed tomography angiography (CTA) for coronary heart disease (CHD) screening are lacking. Novel CTA imaging biomarkers (“high-risk-plaque”) may improve risk stratification. Aims To define CT-imaging predictors for long–term outcomes. Methods 1430 low-to-intermediate-risk patients (mean age 57.9 years; 44.4% females) were included into our prospective cohort study. Coronary Calcium Score (CCS) and CTA were performed. CTA was evaluated for: Stenosis severity (minimal&lt;25%; mild&lt;50%; moderate 50–70%; severe &gt;70%) (CADRADS 1–4), total mixed plaque burden (G-score), high–risk-plaque criteria: 1) low attenuation plaque 2) Napkin-ring (“lunar-eclipse” sign) 3) spotty calcification 4) remodeling index Primary endpoint was all-cause mortality, secondary endpoints cardiovascular mortality and composite (non-fatal and fatal) MACE. Results Over a follow-up of mean 10.55 years ±1.98 (range, 6.1–12.8), all-cause mortality rate was 106 (7.4%), cardiovascular mortality 25 (1.75%) and composite MACE 57 (4%). In patients with negative CTA, cardiovascular mortality was 0% and composite MACE rate 0.2%. Stenosis severity (CADRADS) was the strongest predictor for all 3 endpoints (p&lt;0.001) on multivariate analysis (unadjusted and adjusted for risk factors, p&lt;0.001) but calcium score &gt;100 AU only predicted mortality on the unadjusted multivariate analysis (p=0.045) but not on the adjusted. On multivariate analysis, G-score (p&lt;0.0001), LAP&lt;60HU and the Napkin-Ring predicted composite MACE (p&lt;0.001) but not all-cause mortality, before and after adjusting for risk factors (p=0.007 and 0.001 for LAP&lt;60HU and Napkin-Ring, respectively) while spotty calcification and remodeling index did not. 465 had calcium score zero and in 156 (33.5%) of those, noncalcified fibroatheroma were found (total rate, 11%), 4.9% had &gt;50% stenosis. However only 1 patient with calcium score zero died while there were 6 MACE. High risk plaque with “lunar eclipse” Conclusions Long-term prognosis is excellent if CTA is negative. Stenosis severity by CTA predicts all-cause and cardiovascular mortality, while calcium score predicts only mortality. Plaque burden and the high-risk plaque criteria LAP&lt;60 and Napkin-Ring (syn. “lunar eclipse”) are strong predictors of MACE, but not all–cause mortality. Coronary CTA outperforms calcium scoring for risk stratification.

OP15.03: Prenatal and newborn screening for congenital heart disease

To investigate the value of prenatal and postnatal echocardiogram in the diagnosis of congenital heart disease. Pregnant women who were born in the hospital from 2017.1 to 2017.12 were included in the study. The fetal structure was routinely screened during the second trimester. The newborns were screened for congenital heart disease by pulse oximetry and auscultation. The positive ones were examined by neonatal echocardiography. At 42 days postpartum, the returning infants underwent routine auscultationand those who were examined positive were further examined by echocardiography. A total of 13,849 pregnant women were collected during the study. 62 cases of congenital heart disease were found before birth, including 34 cases of severe congenital heart disease and 28 cases of mild congenital heart disease. In the neonatal period, 192 cases of congenital heart disease were found, including 6 cases of severe congenital heart disease and 186 cases of mild congenital heart disease. The incidence of congenital heart disease is 18.3%. The most common severe congenital heart disease is tetralogy of Fallot, a total of 17 cases. The cases of prenatal missed diagnosis were 3 cases of tetralogy of Fallot, 2 cases of total abnormal pulmonary venous drainage and 1 case of transposition of great arteries. The more common congenital heart diseases in the neonatal period were atrial septal defect and ventricular septal defect. Fetal echocardiography is more sensitive to the examination of severe congenital heart disease, and postpartum neonatal echocardiography can detect more mild congenital heart disease. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Echocardiographic screening for rheumatic heart disease in Turkish schoolchildren.

The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5-18 by using portable echocardiography in Ankara, Turkey. The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease. After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools. This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.

Point-of-care echocardiographic screening for left-sided valve heart disease: high yield and affordable cost in an elderly cohort recruited in primary practice

Background Data about the epidemiology of valvular heart disease (VHD) in the elderly is scarce. Hand-held ultrasound devices (HUDs) enable point-of-care ultrasound scanning (POCUS) but their use in an elderly population has not been reported for VHD screening in primary practice.Methods One hundred consecutive subjects aged >70 years without a VHD diagnosis had 2D and colour Doppler POCUS by an accredited sonographer, using a contemporary HUD (Vscan), in a primary practice setting. Patients with left-sided valve pathology identified by Vscan were referred for formal echo in the local tertiary cardiac centre.Results Mean age (s.d.) was 79.08 (3.74) years (72–92 years); 61 female. By Vscan, we found five patients with ≥moderate aortic stenosis (AS), eight with ≥moderate mitral regurgitation (MR) and none with ≥moderate aortic regurgitation. In the AS and MR groups each, one patient had valve intervention following from the initial diagnosis by Vscan, two and one respectively are under follow-up in the valve clinic, while two and four respectively refused TTE or follow-up. Two patients with moderate MR by Vscan had mild and mild/moderate MR respectively by TTE and were discharged. Total cost for scanning 100 patients was $18,201–i.e. $182/patient.Conclusions Screening with a hand-held scanner (Vscan), we identified 5/100 elderly subjects who needed valve replacement or follow-up in valve clinic, at a cost of $182/patient. These findings have potential significance for the allocation of resources in the context of an ageing population.

Pulse oximetry as a screening tool for congenital heart disease in neonates: A diagnostic study

Introduction: Many studies have been done for screening of congenital heart disease (CHD) in the neonatal period utilizing pulse oximetry as a screening tool along with routine clinical assessment, but none of them from our province. Objective: The objective of the study was to find out the diagnostic accuracy of pulse oximeter at three different sites as a screening tool to diagnose CHD among neonates. Methods: A diagnostic study was conducted in neonatal intensive care unit of a tertiary care hospital of Odisha from October 2016 to September 2018 after approval from the Institutional Ethics Committee. Three hundred and seventy-four neonates (both inborn and outborn) with gestational age &gt;34 weeks were included in the study. Oxygen saturation (SpO2) in the right hand (RH), right foot (RF), and left foot (LF) was estimated by pulse oximeter among all participants after 10 min of postnatal life. All the study subjects were evaluated by two-dimensional (2D) echocardiography for the detection of CHDs. All the diagnostic accuracy tests (sensitivity [Sn], specificity [Sp], positive predictive value, negative predictive value, and diagnostic odds ratio) were calculated taking 2D echocardiography as the gold standard with software, and for all statistical purpose, p&lt;0.05 was considered statistically significant. Results: Cutoff value of the RH SpO2 was 90.0% with Sn of 68.80% and Sp of 98.20%; area under curve (AUC) 0.851 (0.766 and 0.914), p&lt;0.001, for the RF, SpO2 was 90.0% with Sn 78.0% and Sp 92.1%; AUC 0.865 (0.782 and 0.925), p&lt;0.001, and for LF, it was 87% with Sn 77.1% and Sp 94.0%; AUC 0.864 (0.781 and 0.924), p&lt;0.001. Conclusion: Along with the clinical skills, pulse oximetry can be used as an early screening tool for the detection of CHD in the neonatal period and of three different sites, RF found to be better.

The accuracy of prenatal diagnosis of major congenital heart disease is increasing

Regular audit of results of prenatal screening for congenital heart disease (CHD) is crucial to ensure reliable prenatal diagnosis. We aimed to assess the accuracy of prenatal diagnosis of major CHD between 1996 and 2013. During the study period, prenatal detection of major CHD improved from 4.5% to 71.0% (p<.001). Prenatal diagnoses on 628 live born children and terminated pregnancies were compared with postnatal findings or autopsy reports. The proportion of correct diagnoses increased throughout the study period from 42.9% in 1996 and reached 88.2% in 2013 (p<.001). A total of 32 foetuses with suspected major CHD were terminated though no major CHD was found at autopsy. In these pregnancies, termination was mainly performed due to other anomalies in the foetus.Along with improved detection of major CHD, the validity of a prenatal diagnosis is increasing. No cases of misinterpreted major CHD resulted in the termination of a healthy foetus in this study.Impact statementWhat is already known on this subject? Prenatal diagnosis of isolated congenital heart disease (CHD) correlates well with lesions found during autopsy performed in terminated foetuses. Few studies have assessed the accuracy of prenatal diagnosis of major CHD in live born children, cases with associated anomalies and the time trend in validity.What the results of this study add? This study illustrates that the validity of prenatal diagnosis of major CHD is increasing. Prenatal diagnoses in terminated pregnancies as well as in live born children is high except for coarctation of the aorta and atrioventricular septal defects. Chromosomal anomalies are associated with lower accuracy of prenatal diagnosis.What the implications are of these findings for clinical practice and/or further research? Prenatal diagnosis is an accurate tool for detecting major CHD. Misinterpretation has not led to the termination of a healthy foetus; however, this study illustrates that vigilant care should be placed on the cardiac evaluation when termination is considered due to the cardiac defect.

Improving Critical Congenital Heart Disease Screening With Addition of Perfusion Measurements

Improving Critical Congenital Heart Disease Screening With Addition of Perfusion Measurements