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Yang X, Huang X, Wei C, Yu J, Yu X, Dong C, Chen J, Chen R, Wu X, Yu Z, Sun B, Wang J, Liu H, Han W, Sun B, Jiang Z, Ding J, Liu Z, Peng J, Ni D, Deng X, Liu L, Gou Z. An intelligent quantification system for fetal heart rhythm assessment: A multicenter prospective study. Heart Rhythm 2024; 21:600-609. [PMID: 38266752 DOI: 10.1016/j.hrthm.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The motion relationship and time intervals of the pulsed-wave Doppler (PWD) spectrum are essential for diagnosing fetal arrhythmia. However, few technologies currently are available to automatically calculate fetal cardiac time intervals (CTIs). OBJECTIVE The purpose of this study was to develop a fetal heart rhythm intelligent quantification system (HR-IQS) for the automatic extraction of CTIs and establish the normal reference range for fetal CTIs. METHODS A total of 6498 PWD spectrums of 2630 fetuses over the junction between the left ventricular inflow and outflow tracts were recorded across 14 centers. E, A, and V waves were manually labeled by 3 experienced fetal cardiologists, with 17 CTIs extracted. Five-fold cross-validation was performed for training and testing of the deep learning model. Agreement between the manual and HR-IQS-based values was evaluated using the intraclass correlation coefficient and Spearman's rank correlation coefficient. The Jarque-Bera test was applied to evaluate the normality of CTIs' distributions, and the normal reference range of 17 CTIs was established with quantile regression. Arrhythmia subset was compared with the non-arrhythmia subset using the Mann-Whitney U test. RESULTS Significant positive correlation (P <.001) and moderate-to-excellent consistency (P <.001) between the manual and HR-IQS automated measurements of CTIs was found. The distribution of CTIs was non-normal (P <.001). The normal range (2.5th to 97.5th percentiles) was successfully established for the 17 CTIs. CONCLUSIONS Using our HR-IQS is feasible for the automated calculation of CTIs in practice and thus could provide a promising tool for the assessment of fetal rhythm and function.
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Affiliation(s)
- Xin Yang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaoqiong Huang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Chenchen Wei
- Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Junxuan Yu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Xuejuan Yu
- Department of Ultrasonography, Suzhou Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Caixia Dong
- Department of Ultrasonography, Wulin Hospital, Hangzhou, Zhejiang, China
| | - Ju Chen
- Department of Ultrasonography, Taicang First People's Hospital, Suzhou, Jiangsu, China
| | - Ruifeng Chen
- Department of Ultrasound Diagnosis, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Xiafang Wu
- Department of Ultrasonography, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Zhuan Yu
- Department of Ultrasonography, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Baojuan Sun
- Department of Ultrasonography, Huai'an Maternal and Child Health Hospital, Huai'an, Jiangsu, China
| | - Junli Wang
- Department of Ultrasonography, Wuhu No.2 People's Hospital, Wuhu, Anhui, China
| | - Hongmei Liu
- Department of Ultrasonography, Panzhou Emerging Hospital, Panzhou, Guizhou, China
| | - Wen Han
- Department of Ultrasonography, Suzhou Gaoxin District People's Hospital, Suzhou, Jiangsu, China
| | - Biyun Sun
- Department of Ultrasonography, The Affiliated Yijishan Hospital of Wannan Medical University, Wuhu, Anhui, China
| | - Zhiyong Jiang
- Department of Ultrasonography, The Huaren Hospital, Wuhu, Zhejiang, China
| | - Jie Ding
- Department of Ultrasonography, The Affiliated Suzhou Hospital of Nanjing University, Suzhou, Jiangsu, China
| | - Zhe Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Jin Peng
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Lian Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China.
| | - Zhongshan Gou
- Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China.
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Pasieczna M, Kuran-Ohde J, Grzyb A, Bokiniec R, Wójcik-Sęp A, Czajkowski K, Szymkiewicz-Dangel J. Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes. J Perinat Med 2024; 0:jpm-2023-0448. [PMID: 38639637 DOI: 10.1515/jpm-2023-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Cardiopulmonary and infectious complications are more common in preterm newborns after preterm premature rupture of membranes (pPROM). Fetal echocardiography may be helpful in predicting neonatal condition. Our aim was to assess the cardiovascular changes in fetuses from pregnancies complicated by pPROM and possible utility in predicting the intrauterine or neonatal infection, and neonatal heart failure (HF). METHODS It was a prospective study enrolling 46 women with singleton pregnancies complicated by pPROM between 18+0 and 33+6 weeks of gestation and followed until delivery. 46 women with uncomplicated pregnancies served as a control group. Fetal echocardiographic examinations with the assessment of cardiac structure and function (including pulmonary circulation) were performed in all patients. RESULTS Mean gestational age of pPROM patients was 26 weeks. Parameters suggesting impaired cardiac function in fetuses from pPROM were: higher right ventricle Tei index (0.48 vs. 0.42 p<0.001), lower blood flow velocity in Ao z-score (0.14 vs. 0.84 p=0.005), lower cardiovascular profile score (CVPS), higher rate of tricuspid regurgitation (18.2 % vs. 4.4 % p=0.04) and pericardial effusion (32.6 vs. 0 %). Intrauterine infection was diagnosed in 18 patients (39 %). 4 (8.7 %) newborns met the criteria of early onset sepsis (EOS). HF was diagnosed in 9 newborns. In fetal echocardiographic examination HF group had shorter mitral valve inflow time and higher left ventricle Tei index (0.58 vs. 0.49 p=0.007). CONCLUSIONS Worse cardiac function was observed in fetuses from pPROM compared to fetuses from uncomplicated pregnancies.
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Affiliation(s)
- Monika Pasieczna
- 2nd Department of Obstetrics and Gynecology, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Joanna Kuran-Ohde
- 2nd Department of Obstetrics and Gynecology, 37803 Medical University of Warsaw , Warsaw, Poland
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agnieszka Grzyb
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Renata Bokiniec
- Department of Neonatology and Neonatal Intensive Care, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Agata Wójcik-Sęp
- Department of Neonatology and Neonatal Intensive Care, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, 37803 Medical University of Warsaw , Warsaw, Poland
| | - Joanna Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Defects, Centre of Postgraduate Medical Education, Warsaw, Poland
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Rücker B, Vigneswaran TV, Zidere V, Simpson JM. Association of Prenatally Diagnosed Isolated Single Left Superior Vena Cava and Postnatal Development of Coarctation of the Aorta. Pediatr Cardiol 2024; 45:749-758. [PMID: 38381183 DOI: 10.1007/s00246-024-03407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
To report the prevalence of coarctation of the aorta (CoA) in fetuses with single left superior vena cava (SL-SVC) and to evaluate changes in echocardiographic measurements. Additionally, to report the prevalence of associated malformations. Retrospective observational study of fetuses diagnosed with SL-SVC between 2012 and 2021 at a tertiary fetal cardiology unit. In fetuses without intracardiac abnormalities, Z-scores of the ventricles, great arteries, and Doppler flow patterns are reported. We identified 47 fetuses with SL-SVC of which 8/47 (17%) had abnormal intracardiac anatomy. One fetus was lost to follow-up. Of those with normal intracardiac anatomy and postnatal follow-up (38), karyotype abnormalities were confirmed in 2/38 (5%) and ECA in 8/38 (21%). 33/38 were live-born. None developed CoA postnatally. Paired analysis of Z-scores between early and late scans of 24 fetuses showed that diameters of the right heart structures and Doppler flows of tricuspid valve increased significantly during pregnancy, while the left heart structures and flow patterns did not change. The median risk of CoA did not change between the early and the late scan. We did not observe CoA in this cohort. A degree of ventricular asymmetry was present, but this was due to right heart dominance rather than hypoplasia of left heart structures. This likely reflects redistribution of blood and does not appear to confer increased risk of CoA. Predictive models of the postnatal development of CoA which set the dimensions of right and left heart structures in relation might not be applicable in this situation.
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Affiliation(s)
- Beate Rücker
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK.
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
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Prats P, Izquierdo MT, Rodríguez MÁ, Rodríguez I, Rodríguez-Melcón A, Serra B, Albaiges G. Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms. AJOG GLOBAL REPORTS 2024; 4:100325. [PMID: 38586615 PMCID: PMC10994973 DOI: 10.1016/j.xagr.2024.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks. OBJECTIVE This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks. STUDY DESIGN We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated. RESULTS A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks. CONCLUSION The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.
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Affiliation(s)
- Pilar Prats
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - M. Teresa Izquierdo
- Gynecologic and Obstetric Ultrasound Unit, Hospital VITHAS 9 Octubre, Valencia, Spain (Dr Izquierdo)
| | - M. Ángeles Rodríguez
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
| | - Ignacio Rodríguez
- Epidemiological Unit, Department Obstetrics, Gynecology, Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Mr Rodríguez)
| | - Alberto Rodríguez-Melcón
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - Bernat Serra
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - Gerard Albaiges
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
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Huntley ES, Hernandez-Andrade E, Papanna R, Bergh E, Espinoza J, Soto E, Lopez SM, Harting MT, Johnson A. 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. Fetal Diagn Ther 2024; 51:191-202. [PMID: 38194948 DOI: 10.1159/000536171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION The objective of this study was 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 valve diameters), were evaluated in fetuses with isolated left CDH. Two evaluations were performed: at referral (CDA and function) and within 3 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). A globular right ventricle was significantly associated with ND 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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Affiliation(s)
- Erin S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Fetal Intervention and McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Fetal Intervention and McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Ramesha Papanna
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Fetal Intervention and McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Eric Bergh
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Fetal Intervention and McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Fetal Intervention and McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Eleazar Soto
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Maternal Fetal Medicine, McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Suzanne M Lopez
- Department of Pediatrics, McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
| | - Anthony Johnson
- Department of Obstetrics and Gynecology and Reproductive Sciences, Divisions of McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Fetal Intervention and McGovern Medical School at The University of Texas, Health Science Center at Houston, Houston, Texas, USA
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Moon-Grady AJ, Lee H, Lopez L, Fatusin O, Freud LR, Hogan W, Krishnan A, McFarland C, Minich LL, Morris SA, Pinto N, Presson AP, Tacy TA, Donofrio MT. Fetal Echocardiographic Z Score Pilot Project: Study Design and Impact of Gestational Age and Variable Type on Reproducibility of Measurements Within and Across Investigators. J Am Soc Echocardiogr 2023; 36:978-997. [PMID: 37302438 DOI: 10.1016/j.echo.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/27/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Fetal echocardiography is widely available, but normative data are not robust. In this pilot study, the authors evaluated (1) the feasibility of prespecified measurements in a normal fetal echocardiogram to inform study design and (2) measurement variability to assign thresholds of clinical significance and guide analyses in larger fetal echocardiographic Z score initiatives. METHODS Images from predefined gestational age groups (16-20, >20-24, >24-28, and >28-32 weeks) were retrospectively analyzed. Fetal echocardiography expert raters attended online group training and then independently analyzed 73 fetal studies (18 per age group) in a fully crossed design of 53 variables; each observer repeated measures for 12 fetuses. Kruskal-Wallis tests were used to compare measurements across centers and age groups. Coefficients of variation (CoVs) were calculated at the subject level for each measurement as the ratio of SD to mean. Intraclass correlation coefficients were used to show inter- and intrarater reliabilities. Cohen's d > 0.8 was used to define clinically important differences. Measurements were plotted against gestational age, biparietal diameter, and femur length. RESULTS Expert raters completed each set of measurements in a mean of 23 ± 9 min/fetus. Missingness ranged from 0% to 29%. CoVs were similar across age groups for all variables (P < .05) except ductus arteriosus mean velocity and left ventricular ejection time, which were both higher at older gestational age. CoVs were >15% for right ventricular systolic and diastolic widths despite fair to good repeatability (intraclass correlation coefficient > 0.5); ductal velocities and two-dimensional measures, left ventricular short-axis dimensions, and isovolumic times all had high CoVs and high interobserver variability despite good to excellent intraobserver agreement (intraclass correlation coefficient > 0.6). CoVs did not improve when ratios (e.g., tricuspid/mitral annulus) were used instead of linear measurements. Overall, 27 variables had acceptable inter- and intraobserver repeatability, while 14 had excessive variability between readers despite good intraobserver agreement. CONCLUSIONS There is considerable variability in fetal echocardiographic quantification in clinical practice that may affect the design of multicenter fetal echocardiographic Z score studies, and not all measurements may be feasible for standard normalization. As missingness was substantial, a prospective design will be needed. Data from this pilot study may aid in the calculation of sample sizes and inform thresholds for distinguishing clinically significant from statistically significant effects.
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Affiliation(s)
- Anita J Moon-Grady
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Hyejung Lee
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Leo Lopez
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Oluwatosin Fatusin
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Whitnee Hogan
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California; Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anita Krishnan
- Children's National Hospital, Washington, District of Columbia
| | - Carol McFarland
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - L LuAnn Minich
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Shaine A Morris
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Nelangi Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Theresa A Tacy
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
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7
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Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, Michelfelder E, Morris SA, Peyvandi S, Pinto NM, Pruetz J, Sethi N, Simpson J, Srivastava S, Tian Z. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:679-723. [PMID: 37227365 DOI: 10.1016/j.echo.2023.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Joe Kreeger
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wesley Lee
- Baylor College of Medicine, Houston, Texas
| | | | - Shaine A Morris
- Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
| | - Shabnam Peyvandi
- University of California, San Francisco, San Francisco, California
| | | | - Jay Pruetz
- Children's Hospital of Los Angeles, Los Angeles, California
| | | | - John Simpson
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Zhiyun Tian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Systematic review of long QT syndrome identified during fetal life. Heart Rhythm 2022; 20:596-606. [PMID: 36566891 DOI: 10.1016/j.hrthm.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Fetal long QT syndrome (LQTS) may present with sinus bradycardia, functional 2:1 atrioventricular block (AVB), and ventricular arrhythmias (ventricular tachycardia [VT]/torsades de pointes [TdP]) and lead to fetal or postnatal death. We performed a systematic review and individual participant data meta-analysis of 83 studies reporting outcomes of 265 fetuses for which suspected LQTS was confirmed postnatally and determined risk of adverse perinatal and postnatal outcomes using logistic and stepwise logistic regression. A longer fetal QTc was more predictive of death than any other antenatal factor (receiver operating characteristic [ROC] area under the curve [AUC] 0.85; 95% confidence interval [CI] 0.66-1.00). Risk of death was significantly increased with fetal QTc >600 ms. Neither fetal heart rate nor heart rate z-score predicted death (ROC AUC 0.51; 95% CI 0.31-0.71; and ROC AUC 0.59; 95% CI 0.37-0.80, respectively). The combination of antenatal VT/TdP or functional 2:1 AVB and lack of family history of LQTS was also highly predictive of death (ROC AUC 0.82; 95% CI 0.76-0.88). Our data provide clinical screening tools to enable prediction and intervention for fetuses with LQTS at risk of death.
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Zidere V, Vigneswaran TV, Dumitrascu-Biris I, Regan W, Simpson JM, Homfray T. Presentation and genetic confirmation of long QT syndrome in the fetus. HeartRhythm Case Rep 2022; 8:674-678. [PMID: 36310718 PMCID: PMC9596364 DOI: 10.1016/j.hrcr.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
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Treatment of Fetal Arrhythmias. J Clin Med 2021; 10:jcm10112510. [PMID: 34204066 PMCID: PMC8201238 DOI: 10.3390/jcm10112510] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
Fetal arrhythmias are mostly benign and transient. However, some of them are associated with structural defects or can cause heart failure, fetal hydrops, and can lead to intrauterine death. The analysis of fetal heart rhythm is based on ultrasound (M-mode and Doppler echocardiography). Irregular rhythm due to atrial ectopic beats is the most common type of fetal arrhythmia and is generally benign. Tachyarrhythmias are diagnosed when the fetal heart rate is persistently above 180 beats per minute (bpm). The most common fetal tachyarrhythmias are paroxysmal supraventricular tachycardia and atrial flutter. Most fetal tachycardias can be terminated or controlled by transplacental or direct administration of anti-arrhythmic drugs. Fetal bradycardia is diagnosed when the fetal heart rate is slower than 110 bpm. Persistent bradycardia outside labor or in the absence of placental pathology is mostly due to atrioventricular (AV) block. Approximately half of fetal heart blocks are in cases with structural heart defects, and AV block in cases with structurally normal heart is often caused by maternal anti-Ro/SSA antibodies. The efficacy of prenatal treatment for fetal AV block is limited. Our review aims to provide a practical guide for the diagnosis and management of common fetal arrythmias, from the joint perspective of the fetal medicine specialist and the cardiologist.
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