Characterizing cardiac dysfunction in fetuses with left congenital diaphragmatic hernia

Cruz‐Lemini, M.; Valenzuela-Alcaráz, Brenda; Granados-Montiel, Julio; Martínez, Josep M.; Crispi, F.; Gratacós, E.; Cruz‐Martínez, R.

doi:10.1002/pd.5253

Cited by 10 publications

(5 citation statements)

References 31 publications

(72 reference statements)

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“…Recently, Mod-MPI has been reported to be a valuable index for evaluating fetal cardiac function and it has been evaluated as an indicator for predicting pregnancy outcomes in a number of studies. [15][16][17][18][19][20][21][22][23] Evaluation of Mod-MPI depends on comparison to a normal reference ranges, so a large multicentre study using standardised machine settings and techniques with well-defined inclusion and exclusion criteria is still required, which forms the basis of this study. The primary aim of this study was to establish the normal reference ranges of fetal left ventricular (LV) Mod-MPI and time intervals by pulsed…”

Section: Introductionmentioning

confidence: 99%

Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study

Sun

Wang

et al. 2021

BMJ Open

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ObjectivesThe primary aim of this study was to establish the normal reference ranges of the fetal left ventricular (LV) Modified Myocardial Performance Index (Mod-MPI). A secondary aim was to evaluate the agreement between manual and automatic measurements for fetal Mod-MPI.DesignA prospective, multicentre, cross-sectional study.ParticipantsNormal singleton pregnancies.MethodsThe LV functions of normal singleton pregnancies were assessed in nine centres covering eight provinces in China using unified ultrasound protocols and settings and standardised measurements by pulsed Doppler at 20–24, 28–32 and 34–38 weeks of gestation. The isovolumetric relaxation time (IRT), isovolumetric contraction time, ejection time (ET) and Mod-MPI were measured both automatically and manually.ResultsThis cross-sectional study included 2081 fetuses, and there was a linear correlation between gestational age (GA) and Mod-MPI (0.416+0.001×GA (weeks), p<0.001, r2=0.013), IRT (36.201+0.162× GA (weeks), p<0.001, r2=0.021) and ET (171.418–0.078*GA (weeks), p<0.001, r2=0.002). This finding was verified using longitudinal data in a subgroup of 610 women. The agreement between the manual and automated measurements for Mod-MPI was good.ConclusionsWe constructed normal reference values of fetal LV Mod-MPI. Automatic measurement can be considered for ease of measurement in view of the good agreement between the automatic and manual values.

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Section: Introductionmentioning

confidence: 99%

Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study

Sun

Wang

et al. 2021

BMJ Open

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“…Our results are in accordance with Van Mieghen et al [39] who also reported a higher prevalence of a small LV in fetuses with left CDH but no differences in ventricular function. Other imaging techniques such as tissue Doppler have been also used to evaluate abnormal contractility and myocardial displacement in fetuses with CDH [40,41]. It can be concluded that CDH has an impact on the cardiac chamber shape, size, and function.…”

Section: Our Results In Relation Of What Is Knownmentioning

confidence: 99%

Abnormal Shape and Size of the Cardiac Ventricles Are Associated with a Higher Risk of Neonatal Death in Fetuses with Isolated Left Congenital Diaphragmatic Hernia

Huntley,

Hernandez-Andrade,

Papanna

et al. 2024

Fetal Diagn Ther

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Objective To evaluate the association between fetal cardiac deformation analysis (CDA) and cardiac function with severe adverse perinatal outcomes in fetuses with isolated left congenital diaphragmatic hernia (CDH). Methods CDA in each ventricle (contractility, size, and shape), evaluated by speckle tracking and novel FetalHQ software, and markers of cardiac function (E/A ratios, pulmonary and aortic peak systolic velocities, and sigmoid annular valves diameters), were evaluated in fetuses with isolated left CDH. Two evaluations were performed: at referral (CDA and function) and within three weeks of delivery (CDA). Severe adverse neonatal outcomes were considered neonatal death (ND) or survival with CDH associated pulmonary hypertension (CDH-PH). Differences and associations between CDA, cardiac function, and severe adverse outcomes were estimated. Results Fifty fetuses were included and seventeen (34%) had severe adverse neonatal outcomes (11 ND and 6 survivors with CDH-PH). At first evaluation, the prevalence of a small left ventricle was 34% (17/50) with a higher prevalence among neonates presenting severe adverse outcomes (58.8% [10/17] vs. 21.2% [7/33]; p=0.01; OR 5.03 [1.4-19.1; p=0.01]) and among those presenting with neonatal mortality (8/11 [72.7%] vs. 9/39 [23.0%]; p=0.03]; OR 8.9 1.9-40.7 p=0.005). No differences in cardiac function or strain were noted between fetuses with or without severe adverse outcomes. Within 3 weeks of delivery the prevalence of small left ventricle was higher (19/34; 55.8%) with a more globular shape (reduced transverse/longitudinal ratio TLR). A globular right ventricle was significantly associated with neonatal death or survival with CDH-PH (OR, 14.2 (1.5-138.3); p=0.02). Conclusion Fetuses with isolated CDH at risk of perinatal death or survival with CDH-PH had a higher prevalence of a small left ventricle and abnormal shape of the right ventricle.

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“…Prenatal cohort studies of myocardial function have not to date demonstrated significant fetal cardiac dysfunction (25)(26)(27)(28)(29).…”

Section: Fetal Cardiac Function In Congenital Diaphragmatic Herniamentioning

confidence: 99%

The heart in congenital diaphragmatic hernia: Knowns, unknowns, and future priorities

Patel

Massolo²,

Kraemer³

et al. 2022

Front. Pediatr.

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There is growing recognition that the heart is a key contributor to the pathophysiology of congenital diaphragmatic hernia (CDH), in conjunction with developmental abnormalities of the lung and pulmonary vasculature. Investigations to date have demonstrated altered fetal cardiac morphology, notably relative hypoplasia of the fetal left heart, as well as early postnatal right and left ventricular dysfunction which appears to be independently associated with adverse outcomes. However, many more unknowns remain, not least an understanding of the genetic and cellular basis for cardiac dysplasia and dysfunction in CDH, the relationship between fetal, postnatal and long-term cardiac function, and the impact on other parts of the body especially the developing brain. Consensus on how to measure and classify cardiac function and pulmonary hypertension in CDH is also required, potentially using both non-invasive imaging and biomarkers. This may allow routine assessment of the relative contribution of cardiac dysfunction to individual patient pathophysiological phenotype and enable better, individualized therapeutic strategies incorporating targeted use of fetal therapies, cardiac pharmacotherapies, and extra-corporeal membrane oxygenation (ECMO). Collaborative, multi-model approaches are now required to explore these unknowns and fully appreciate the role of the heart in CDH.

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Characterizing cardiac dysfunction in fetuses with left congenital diaphragmatic hernia

Abstract: Left CDH fetuses show echocardiographic signs of diastolic dysfunction, probably secondary to fetal heart compression, maintaining a preserved systolic function.

Cited by 10 publications

References 31 publications

Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study

Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study

Abnormal Shape and Size of the Cardiac Ventricles Are Associated with a Higher Risk of Neonatal Death in Fetuses with Isolated Left Congenital Diaphragmatic Hernia

The heart in congenital diaphragmatic hernia: Knowns, unknowns, and future priorities

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