# 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.

## Key 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.