Midtrimester Evaluation of Fetal Heart with Fetal Heart Quantification (FetalHQ) Related to Maternal Pathology

TL;DR

This study shows that fetal heart changes can be detected in high-risk pregnancies as early as the second trimester using advanced imaging techniques.

Contribution

The study demonstrates early detection of fetal cardiac remodeling in high-risk pregnancies using FetalHQ.

Findings

Myocardial thickness was increased in pre-pregnancy diabetes and reduced in fetal growth restriction.

Left ventricular mass was higher in obesity and diabetes compared to controls.

FetalHQ enables early risk stratification for fetal cardiac issues in high-risk pregnancies.

Abstract

Background: Echocardiography currently represents the gold standard for the anatomical and functional assessment of the fetal heart by experienced operators. FetalHQ (VolusonTM) provides a semi-automated speckle-tracking analysis of the fetal heart with promising results for the reliable assessment of cardiac remodeling, specifically of size, shape, and contractility. Methods: We conducted a retrospective study comparing 108 controls, 119 obesity (BMI ≥ 30), 69 pre-pregnancy diabetes mellitus (DM), 41 gestational diabetes mellitus (GDM), and 37 early fetal growth restriction (FGR) cases (19+0–22+6 weeks). FetalHQ was utilized during midtrimester echocardiographic exams to evaluate fetal myocardial thickness and left ventricular mass. Results: Myocardial thickness was increased in DM (median 0.21 [IQR 0.17–0.23] cm) vs. controls (0.17 [0.15–0.21] cm; p < 0.01) and reduced in FGR (0.13 [0.11–0.18] cm; p < 0.01). Left ventricular mass increased in obesity (0.98 [0.62–1.19] g) and DM (1.12 [0.94–1.17] g) vs. controls (0.73 [0.56–0.97] g; both p < 0.01). Conclusions: Fetal cardiac remodeling, especially myocardial thickness and left ventricular mass adaptations, is detectable in fetuses from high-risk pregnancies starting from the second trimester. Advanced speckle-tracking techniques, such as fetalHQ, provide valuable early risk stratification and may support the need for systematic fetal cardiac screening and monitoring during gestation in selected groups of patients.

Figures