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A new scoring system for spontaneous closure prediction of perimembranous ventricular septal defects in children.

Sun J, Sun K, Chen S, Yao L, Zhang Y - PLoS ONE (2014)

Bottom Line: Initial contact age, ventricular septal defect (VSD) diameter, shunt flow, aneurysmal tissue of the ventricular membranous septum (ATVMS) development, associated complications, and left ventricular end-diastolic dimension (LVDD) were analyzed for correlations with SC.The scoring system also accurately predicted SC with an area under the ROC curve of 0.863 (95% CI 0.785-0.941, p<0.001) in the validation cohort.Our scoring system using factors affecting SC can predict the probability of SC in PMVSD patients.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Heart Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.

ABSTRACT

Background: Perimembranous ventricular septal defect (PMVSD) is a congenital heart aberration, which is surgically treated by patch or device closure, but also can heal without operation as spontaneous closure (SC).

Methods: We analyzed data from 1873 PMVSD patients admitted to our hospital during September 2001 and December 2009, in order to establish a Cox regression model for PMVSD SC probability prediction (derivative cohort). Initial contact age, ventricular septal defect (VSD) diameter, shunt flow, aneurysmal tissue of the ventricular membranous septum (ATVMS) development, associated complications, and left ventricular end-diastolic dimension (LVDD) were analyzed for correlations with SC. The derived scoring system based on the coefficients of the model was developed and applied to another cohort with 382 PMVSD patients to evaluate the validity for SC probability forecast (validation cohort).

Results: Multivariate Cox regression analysis revealed that SC of PMVSD was associated with age at first contact, defect size, diffuse shunt flow, ATVMS formation, associated complication, as well as increased LVDD, which were used to establish a new scoring system. The area under the receiver operating characteristic (ROC) curve of our predictive scaling was 0.831 (95% CI 0.804-0.858, p<0.001) in the derivative cohort. The scoring system also accurately predicted SC with an area under the ROC curve of 0.863 (95% CI 0.785-0.941, p<0.001) in the validation cohort.

Conclusion: Our scoring system using factors affecting SC can predict the probability of SC in PMVSD patients.

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Related in: MedlinePlus

Plots show SC probabilities occurring within 1 year(□) and 3 years(○) among PMVSD patients in the derivative cohort, plotted against the scoring system.The LOESS fit lines (the solid line for 1-year and the dashed line for 3-year) using 50% fit plots show the trend of SC probability against the score. (SC, spontaneous closure).
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pone-0113822-g002: Plots show SC probabilities occurring within 1 year(□) and 3 years(○) among PMVSD patients in the derivative cohort, plotted against the scoring system.The LOESS fit lines (the solid line for 1-year and the dashed line for 3-year) using 50% fit plots show the trend of SC probability against the score. (SC, spontaneous closure).

Mentions: With the derived data, we developed a scoring system for prediction of SC, and different score values for variables were established according to their regression coefficients with the method described in [17] (Table 5). Table 6 shows the 1-year and 3-year SC probability associated with each score. For the above case, the scoring system gives an estimated SC probability of 25.18% in 1 year, and 75.35% in 3 years, indicating that there is good agreement between the estimates produced by the Cox model and the scoring system. We plotted the SC probability in 1 year and 3 years as calculated with the Cox model for each patient against the score (Figure 2). As shown in Figure 2, higher scores resulted in increased probability of SC. Excluding all censored data (ie, individuals who did not complete the 3 years of follow-up without having SC), the area under the ROC curve obtained with the scoring system was 0.831 (95% CI 0.804–0.858, p<0.001), indicating that the scoring system could discriminate well between patients who had SC and those who did not. Finally, for comparison, all patients were divided into 3 groups based on SC probabilities against scores (Figure 2): (1) patients with a score ≤0 (low probability); (2) patients with a score between 1 and 10 (intermediate probability); (3) patients with a score>10 (high probability). A survival curve was constructed for each group. Figure 3a shows that the high-probability group had a lower probability of defect remaining open than the low-probability group (p<0.001, Figure 3A). It was proven that increased scores were associated with significantly increased SC probabilities. The observed rates of SC (and the expected probability in 3 years) in these strata were 6.5% (<4%) for low probability, 22.6% (4.82–53.35%) for intermediate probability, 75.9% (64.42–92.37%) for high probability (Table 7).


A new scoring system for spontaneous closure prediction of perimembranous ventricular septal defects in children.

Sun J, Sun K, Chen S, Yao L, Zhang Y - PLoS ONE (2014)

Plots show SC probabilities occurring within 1 year(□) and 3 years(○) among PMVSD patients in the derivative cohort, plotted against the scoring system.The LOESS fit lines (the solid line for 1-year and the dashed line for 3-year) using 50% fit plots show the trend of SC probability against the score. (SC, spontaneous closure).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4257539&req=5

pone-0113822-g002: Plots show SC probabilities occurring within 1 year(□) and 3 years(○) among PMVSD patients in the derivative cohort, plotted against the scoring system.The LOESS fit lines (the solid line for 1-year and the dashed line for 3-year) using 50% fit plots show the trend of SC probability against the score. (SC, spontaneous closure).
Mentions: With the derived data, we developed a scoring system for prediction of SC, and different score values for variables were established according to their regression coefficients with the method described in [17] (Table 5). Table 6 shows the 1-year and 3-year SC probability associated with each score. For the above case, the scoring system gives an estimated SC probability of 25.18% in 1 year, and 75.35% in 3 years, indicating that there is good agreement between the estimates produced by the Cox model and the scoring system. We plotted the SC probability in 1 year and 3 years as calculated with the Cox model for each patient against the score (Figure 2). As shown in Figure 2, higher scores resulted in increased probability of SC. Excluding all censored data (ie, individuals who did not complete the 3 years of follow-up without having SC), the area under the ROC curve obtained with the scoring system was 0.831 (95% CI 0.804–0.858, p<0.001), indicating that the scoring system could discriminate well between patients who had SC and those who did not. Finally, for comparison, all patients were divided into 3 groups based on SC probabilities against scores (Figure 2): (1) patients with a score ≤0 (low probability); (2) patients with a score between 1 and 10 (intermediate probability); (3) patients with a score>10 (high probability). A survival curve was constructed for each group. Figure 3a shows that the high-probability group had a lower probability of defect remaining open than the low-probability group (p<0.001, Figure 3A). It was proven that increased scores were associated with significantly increased SC probabilities. The observed rates of SC (and the expected probability in 3 years) in these strata were 6.5% (<4%) for low probability, 22.6% (4.82–53.35%) for intermediate probability, 75.9% (64.42–92.37%) for high probability (Table 7).

Bottom Line: Initial contact age, ventricular septal defect (VSD) diameter, shunt flow, aneurysmal tissue of the ventricular membranous septum (ATVMS) development, associated complications, and left ventricular end-diastolic dimension (LVDD) were analyzed for correlations with SC.The scoring system also accurately predicted SC with an area under the ROC curve of 0.863 (95% CI 0.785-0.941, p<0.001) in the validation cohort.Our scoring system using factors affecting SC can predict the probability of SC in PMVSD patients.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Heart Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.

ABSTRACT

Background: Perimembranous ventricular septal defect (PMVSD) is a congenital heart aberration, which is surgically treated by patch or device closure, but also can heal without operation as spontaneous closure (SC).

Methods: We analyzed data from 1873 PMVSD patients admitted to our hospital during September 2001 and December 2009, in order to establish a Cox regression model for PMVSD SC probability prediction (derivative cohort). Initial contact age, ventricular septal defect (VSD) diameter, shunt flow, aneurysmal tissue of the ventricular membranous septum (ATVMS) development, associated complications, and left ventricular end-diastolic dimension (LVDD) were analyzed for correlations with SC. The derived scoring system based on the coefficients of the model was developed and applied to another cohort with 382 PMVSD patients to evaluate the validity for SC probability forecast (validation cohort).

Results: Multivariate Cox regression analysis revealed that SC of PMVSD was associated with age at first contact, defect size, diffuse shunt flow, ATVMS formation, associated complication, as well as increased LVDD, which were used to establish a new scoring system. The area under the receiver operating characteristic (ROC) curve of our predictive scaling was 0.831 (95% CI 0.804-0.858, p<0.001) in the derivative cohort. The scoring system also accurately predicted SC with an area under the ROC curve of 0.863 (95% CI 0.785-0.941, p<0.001) in the validation cohort.

Conclusion: Our scoring system using factors affecting SC can predict the probability of SC in PMVSD patients.

Show MeSH
Related in: MedlinePlus