Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term

Patey, O.; Carvalho, J. S.; Thilaganathan, B.

doi:10.1002/uog.19193

Cited by 57 publications

(62 citation statements)

References 29 publications

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“…2D speckle-tracking echocardiography uses an automated analysis to detect the endocardial border through the cardiac cycle, which can be advantageous to reduce the variability of manual tracing but requires specialized software to compute the measurements and calculate RV FAC. Although speckle-tracking technique is being progressively introduced into adult cardiology and postnatal pediatric practice, in fetal cardiology, there are still relatively few data [43][44][45][46][47] and more studies are needed to validate its clinical utility. Overall, prenatal assessment of RV FAC seems a feasibility and highly reproducible method using traditional 2D delineation or speckle tracking.…”

Section: Discussionmentioning

confidence: 99%

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

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Objectives: Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. Methods: Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area -ES area]/ED area) × 100. RV FAC intra-and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). Results: RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93-0.98], RV ES area 0.97 [0.94-0.98], and FAC 0.69 [0.44-0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10-90th centiles: 25-47%, respectively] to 29% at 41 weeks [10-90th centiles: 18-40%, Guirado et al. respectively]). The best models for RV areas and FAC were a second-degree polynomial. Conclusions: RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.

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Section: Discussionmentioning

confidence: 99%

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

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“…2c). In addition, 35% of the cases present mild pericardial effusion and most of them show signs of systolic and diastolic dysfunction (reduced longitudinal motion and impaired relaxation) [8,26]. It has been postulated to be a compensatory fetal cardiac hypertrophic response to myocardial damage associated with toxicity.…”

Section: Myocardial Hypertrophy With Cardiomegalymentioning

confidence: 99%

“…Apart from the above mentioned, other patterns of fetal cardiac remodeling have also been reported describing ventricular elongation or hypoplasia, thinning of the ventricular walls, asymmetric remodeling, endocardial fibroelastosis, etc. [25][26][27][28][29][30][31][32].…”

Section: Myocardial Hypertrophy With Cardiomegalymentioning

confidence: 99%

Main Patterns of Fetal Cardiac Remodeling

et al. 2020

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The heart is a central organ in the fetal adaptation to an adverse environment. Fetal cardiac changes may persist postnatally and increase the risk of cardiovascular disease in adulthood. Knowledge about fetal cardiac structural as well as functional remodeling has radically improved over the last few years. As it occurs in postnatal life, the fetal heart remodels -changing its structure and shape -to adapt to an insult. Several conditions have been reported to be associated with fetal cardiac remodeling including intrauterine growth restriction, diabetes, exposure to antiretroviral drugs, conception by assisted reproductive technologies, pulmonary stenosis, and other congenital heart diseases. Here we summarized the main observable patterns of cardiac remodeling, i.e., globular shape, hypertrophy without dilation, and hypertrophy with cardiomegaly. We discuss the potential pathophysiology behind different types of remodeling. Defining precisely the distinct patterns of fetal cardiac remodeling is critical for advancing in the understanding of fetal cardiovascular programming and its consequences on adult health, and potentially for the design of preventive strategies that might have an impact on long-term cardiovascular health.

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“…In early-onset FGR, defined as that occurring before 32 weeks of gestation [3], severe placental insufficiency leads to redistribution of cardiac output resulting in decreased right to left cardiac output ratio [4][5][6]. Conversely, in late FGR, cardiac hemodynamic changes are subtler and mainly characterized by a remodeling of ventricular geometry [1,[7][8][9]. The sphericity index (SI), calculated as the ratio between the end-diastolic mid-basal-apical and transverse lengths, is among the most reproducible parameters used to quantify cardiac remodeling and has been shown to be reduced in pregnancies complicated by late FGR [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic factors associated with fetal cardiac remodeling in late fetal growth restriction: a prospective study

Rizzo

Mattioli

Mappa

et al. 2019

Journal of Perinatal Medicine

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Background Altered cardiac geometry affects a proportion of fetuses with growth restriction (FGR). The aim of this study was to explore the hemodynamic factors associated with cardiac remodeling in late FGR. Methods This was a prospective study of singleton pregnancies complicated by late-onset FGR undergoing assessment of left (LV) and right (RV) ventricular sphericity-index (SI). The study population was divided in two groups according to the presence of cardiac remodelling, defined as LVSI <5th centile. The following outcomes were explored: gestational age at birth, birthweight, caesarean section (CS) for fetal distress, umbilical artery (UA) pH and neonatal admission to special care unit. The differences between the 2 groups in UA pulsatility index (PI), middle cerebral artery (MCA) PI, uterine artery PI, cerebroplacental ratio (CPR) and umbilical vein (UV) flow corrected for fetal abdominal circumference (UVBF/AC) were tested. Results In total, 212 pregnancies with late FGR were enrolled in the study. An abnormal LV SI was detected in 119 fetuses (56.1%). Late FGR fetuses with cardiac remodeling had a lower birthweight (2390 g vs. 2490; P = 0.04) and umbilical artery pH (7.21 vs. 7.24; P = 0.04) and were more likely to have emergency CS (42.8% vs. 26.9%; P = 0.023) and admission to special care unit (13.4% vs. 4.3%; P = 0.03) compared to those with normal LVSI. No difference in either UA PI (p = 0.904), MCA PI (P = 0.575), CPR (P = 0.607) and mean uterine artery PI (P = 0.756) were present between fetuses with or without an abnormal LV SI. Conversely, UVBF/AC z-score was lower (−1.84 vs. −0.99; P ≤ 0.001) in fetuses with cardiac remodeling and correlated with LV (P ≤ 0.01) and RV SI (P ≤ 0.02). Conclusion Fetal cardiac remodelling occurs in a significant proportion of pregnancies complicated by late FGR and is affected by a high burden of short-term perinatal compromise. The occurrence of LV SI is independent from fetal arterial Dopplers while it is positively associated with umbilical vein blood flow.

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Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term

Cited by 57 publications

References 29 publications

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

Main Patterns of Fetal Cardiac Remodeling

Hemodynamic factors associated with fetal cardiac remodeling in late fetal growth restriction: a prospective study

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