Early cardiac remodeling in aortic coarctation: insights from fetal and neonatal functional and structural assessment

Soveral, I.; Crispi, F.; Walter, Carin; Guirado, L.; García-Cañadilla, Patricia; Cook, Andrew C.; Bonnin, Anne; Dejea, Hector; Rovira-Zurriaga, C.; Toledo, Joan Sánchez de; Gratacós, E.; Martínez, Josep M.; Bijnens, Bart; Gómez, O.

doi:10.1002/uog.21970

Cited by 16 publications

(20 citation statements)

References 43 publications

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“…Likewise, increased ventricular-to-heart area ratio has been reported in CHD (tricuspid or pulmonary insufficiency 39 , abnormal pulmonary venous return 40 , restrictive foramen ovale 41 , outflow tract obstruction 4,42 ), fetal hyperdynamic states (arteriovenous malformations 43 , anemia 36 , tumors 44 ) and in FGR 37 . A decrease in atrial-to-heart and/or ventricular-to-heart area ratios has been described in CHD (aortic stenosis 42 , coarctation of the aorta 6 , hypoplastic left-heart syndrome 45 , pulmonary atresia 46 ) and in lung malformations 47 .…”

Section: Cardiac Atrial and Ventricular Relative Sizementioning

confidence: 99%

“…The heart, atria and ventricles can show a more spherical shape (i.e. decreased sphericity index) secondary to pressure or volume overload such as in FGR and aortic stenosis with evolving hypoplastic left heart syndrome 37,42 , or an elongated shape (increased sphericity index) secondary to preload or volume decrease as in aortic coarctation 6,11 .…”

Section: Cardiac Atrial and Ventricular Sphericity Indicesmentioning

confidence: 99%

“…Following technical advances, the role of fetal echocardiography, originally focused primarily on the diagnosis of congenital heart defects (CHD) 1 , has been extended to the evaluation of fetal cardiac remodeling, which is defined as a change in the size, shape and function of the heart in response to an insult 2 . Fetal cardiac remodeling is present in CHD [3][4][5][6] and other prenatal conditions, such as conception by assisted reproductive techniques (ART) 7 , fetal growth restriction (FGR) 8 , maternal diabetes 9 and drug exposure 10 . Accurate measurement of fetal cardiac, ventricular and atrial size and geometry is essential to assess the patterns of cardiac remodeling 11 and help understand and monitor fetal cardiac adaptations to an adverse environment.…”

Section: Introductionmentioning

confidence: 99%

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Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks

García‐Otero

Soveral

Bijnens

et al. 2021

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?We provide novel reference ranges for fetal cardiac, atrial and ventricular relative size and sphericity, ventricular dominance, wall thickness asymmetry and relative wall thickness, from 18 to 41 weeks' gestation, created from a prospective cohort of low-risk singleton pregnancies undergoing fetal echocardiography following standardized methodology. What are the clinical implications of this work?The provided nomograms constitute a clinically useful tool for the accurate assessment of fetal cardiac remodeling patterns in different clinical scenarios, including congenital heart disease, which could contribute to the better understanding and monitoring of fetal adaptations to an adverse environment.

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Section: Cardiac Atrial and Ventricular Relative Sizementioning

confidence: 99%

Section: Cardiac Atrial and Ventricular Sphericity Indicesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks

García‐Otero

Soveral

Bijnens

et al. 2021

Ultrasound in Obstet & Gyne

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“…Fetuses with CoA had FTF and ETF within the normal ranges, reflecting the different pathophysiologies of fetal CoA and AoS, in which the ejection obstruction is more proximal. This might allow fetuses with CoA to compensate by volume redistribution and prevent LV pressure overload, reducing LV wall stress and resulting in normal FTF and ETF 35 .…”

Section: Discussionmentioning

confidence: 99%

Fetal cardiac filling and ejection time fractions by pulsed‐wave Doppler: reference ranges and potential clinical application

Soveral

Crispi

Guirado

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives Fetal cardiac function can be evaluated using a variety of parameters. Among these, cardiac cycle time‐related parameters, such as filling time fraction (FTF) and ejection time fraction (ETF), are promising but rarely studied. We aimed to report the feasibility and reproducibility of fetal FTF and ETF measurements using pulsed‐wave Doppler, to provide reference ranges for fetal FTF and ETF, after evaluating their relationship with heart rate (HR), gestational age (GA) and estimated fetal weight (EFW), and to evaluate their potential clinical utility in selected fetal conditions. Methods This study included a low‐risk prospective cohort of singleton pregnancies and a high‐risk population of fetuses with severe twin–twin transfusion syndrome (TTTS), aortic stenosis (AoS) or aortic coarctation (CoA), from 18 to 41 weeks' gestation. Left ventricular (LV) and right ventricular inflow and outflow pulsed‐wave Doppler signals were analyzed, using valve clicks as landmarks. FTF was calculated as: (filling time/cycle time) × 100. ETF was calculated as: (ejection time/cycle time) × 100. Intraclass correlation coefficients (ICC) were used to evaluate the intra‐ and interobserver reproducibility of FTF and ETF measurements in low‐risk fetuses. The relationships of FTF and ETF with HR, GA and EFW were evaluated using multivariate regression analysis. Reference ranges for FTF and ETF were then constructed using the low‐risk population. Z‐scores of FTF and ETF in the high‐risk fetuses were calculated and analyzed. Results In total, 602 low‐risk singleton pregnancies and 54 high‐risk fetuses (nine pairs of monochorionic twins with severe TTTS, 16 fetuses with AoS and 20 fetuses with CoA) were included. Adequate Doppler traces for FTF and ETF could be obtained in 95% of low‐risk cases. Intraobserver reproducibility was good to excellent (ICC, 0.831–0.905) and interobserver reproducibility was good (ICC, 0.801–0.837) for measurements of all timing parameters analyzed. Multivariate analysis of FTF and ETF in relation to HR, GA and EFW in low‐risk fetuses identified HR as the only variable predictive of FTF, while ETF was dependent on both HR and GA. FTF increased with decreasing HR in low‐risk fetuses, while ETF showed the opposite behavior, decreasing with decreasing HR. Most recipient twins with severe TTTS showed reduced FTF and preserved ETF. AoS was associated with decreased FTF and increased ETF in the LV, with seemingly different patterns associated with univentricular vs biventricular postnatal outcome. The majority of fetuses with CoA had FTF and ETF within the normal range in both ventricles. Conclusions Measurement of FTF and ETF using pulsed‐wave Doppler is feasible and reproducible in the fetus. The presented reference ranges account for associations of FTF with HR and of ETF with HR and GA. These time fractions are potentially useful for clinical monitoring of cardiac function in severe TTTS, AoS and other fetal conditions overloading the heart. © 2020 International Society of Ultrasound in Obstetri...

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“…Interactions between the heart and the arterial system, the “ventricular–arterial coupling”, could be a crucial determinant of cardiovascular performance ( 9 ). Recent studies have presented variable results on the changes in the ventricular structure and function in fetuses with aortic coarctation ( 10 , 11 ). Increased vascular stiffness has been shown to be associated with left ventricular diastolic function in adult and pediatric patients after the repair of aortic coarctation ( 4 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Aortic Elasticity and Cardiac Function in Fetuses With Aortic Coarctation

Zhou

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThe purpose of the study was to observe the elasticity of the ascending aorta (AAo) in normal fetuses and fetuses with coarctation of the aorta (CoA) by M-mode echocardiography.MethodsThis was a prospective clinical study performed on 16 fetuses with CoA and 48 gestational-age matched normal fetuses. The minimum internal diameter in the diastolic phase (Dmin) and the maximum internal diameter in the systolic phase (Dmax) of the AAo were measured by M-mode echocardiography. The aortic strain was calculated using the formula 100 × (Dmax−Dmin)/Dmin). Doppler echocardiography was performed to measure the cardiac function parameters. Correlations between aortic strain and cardiac function were assessed in fetuses with CoA.ResultsThe aortic strain of the ascending aorta in the fetuses with CoA was significantly lower than that in normal fetuses (18.12 ± 4.88% vs. 25.22 ± 4.92%, p < 0.01). The fetuses with CoA showed significantly higher combined cardiac output than the controls (471.89 ± 93.98 vs. 411.57 ± 46.35 ml/min/kg, p < 0.05). Compared with the normal group, the early diastolic velocities (E') and peak systolic velocities (S') of the left side were obviously decreased in the CoA group (p < 0.05), while the left early diastolic velocity ratio (E/E') was significantly increased in the fetuses with CoA (p < 0.01). For the fetuses with CoA, the aortic strain of the AAo was correlated with the left E/E' and S' (r = −0.522 and 0.504, respectively, P < 0.05).ConclusionsThe aortic strain of the ascending aorta was significantly decreased in fetuses with CoA in middle-late gestation. The impaired strain of the ascending aorta was correlated with the left ventricle function in the fetuses with CoA. These findings imply that the abnormalities of the intrinsic aortic wall of CoA might develop early in utero.

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Early cardiac remodeling in aortic coarctation: insights from fetal and neonatal functional and structural assessment

Cited by 16 publications

References 43 publications

Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks

Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks

Fetal cardiac filling and ejection time fractions by pulsed‐wave Doppler: reference ranges and potential clinical application

Aortic Elasticity and Cardiac Function in Fetuses With Aortic Coarctation

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