Ethnicity and other factors that may affect the prevalence of echogenic intracardiac foci in the fetus

Intracardiac echogenic focus and its location: association with congenital heart defects

Purpose: Significance of intracardiac echogenic focus (ICEF) in the fetal heart remains controversial. We aimed to investigate whether the location of ICEF is associated with fetal cardiac structure defects (CSDs) in low-risk pregnant women. Materials and Methods: A retrospective cohort study was conducted. Singleton pregnancies with normal values of triple fetal serum markers were included. 758 of 9782 fetuses with ICEF were reviewed for involvement of three ICEF locations (left, right, and bilateral ventricles (BVs)) in CSDs. χ² or Fisher's exact test was performed for statistical analysis. Results: ICEF prevalence was 7.7% and its location was most frequently in the left ventricle (LV) (84.8%), followed by the BV (11.6%) and the right ventricle (RV) (3.6%). No statistically significant difference was found between the ICEF location and maternal age (χ² = 3.92, p-value = .1409). There were cardiac defects with an isolated echogenic focus in 24 of 758 fetuses (3.2%). Significant difference for CSDs was observed among groups of RV, LV, and BV (p-fisher = .0146). Conclusions: Significantly more CSDs cases were identified in fetuses with ICEF in RV. Further investigation is warranted to examine the histological characteristics of fetal echogenic focus in the RV.

Intracardiac echogenic focus and fetal outcome - review of cases from a tertiary care centre in Karachi, Pakistan

OBJECTIVE

To study the outcome in fetuses with intracardiac echogenic focus (ICEF) at the time of second trimester scan.

METHODS

All women with the sonographic findings of ICEF from January 2009 to December 2010 were included in this retrospective study.

RESULTS

ICEF were found in 71 out of 8226 screened (0.86%) women. Mean maternal age in the population was 26.9 ± 3.9 years. Foci were the isolated marker in 69 (97%) cases. In two cases there were additional findings of choroid plexus cysts. A fetal echocardiograph was done only in 13 (18.3%) patients. Majority of these pregnancies (95.7%) had a normal outcome. Postnatal echocardiograph was performed in 11 neonates (15%) out of which one had a small VSD, and in another case Tetralogy of Fallot was found. In addition, Pulmonary artery hypertension was diagnosed in one case. There was one intrauterine fetal demise and two neonatal deaths in this cohort.

CONCLUSIONS

The prevalence of ICEF was 0.86% in our study population. About 95.77% of these cases had an uncomplicated perinatal outcome. It was an isolated finding in almost all cases. These findings will be helpful in counseling parents in our setting.

Intracardiac echogenic focus and fetal outcome

BACKGROUND

To study the outcome of the fetuses with intracardiac echogenic focus (ICEF).

METHODS

All patients who were found to have one or more ICEF on sonographic (US) examination at our center from January 2007 through January 2009 were included in this retrospective study. ICEF was defined as a discrete area of echogenicity noted in the left or right ventricle, which was as bright as bone. Patients were followed up to know pregnancy outcome.

RESULTS

Of 762 fetuses evaluated by US, 48 (6.3%) were found to have an ICEF. Thirty-one of these 48 fetuses had an isolated ICEF; 11 had associated major malformations, and the remaining 6 had no major US abnormalities but were found to have other soft markers. Invasive prenatal testing was done in 21 cases for risk factors other than ICEF and was found to be abnormal in two cases. Seven pregnancies were terminated due to associated major malformations.

CONCLUSION

The prevalence of ICEF was 6.3%. Of 31 fetuses with an isolated ICEF, outcomes of 28 fetuses are known and all neonates were reported to be normal at birth. Thus we infer that the presence of an isolated ICEF has no adverse effect on outcome of the neonate.

The association of maternal BMI with fetal echogenic intracardiac foci and echogenic bowel

OBJECTIVES

To evaluate the impact of maternal body mass index (BMI) as well as maternal ethnicity on the detection of either echogenic intra-cardiac focus (EIF) or echogenic bowel (EB).

METHODS

This prospective study identified 74 uncomplicated singleton fetuses in which EIF and/or EB were detected between 18 and 21 weeks of gestation (i.e. study group). Seventy four consecutively scanned fetuses without EIF or EB, at the same gestational age, were selected as controls. The differences in maternal BMI and maternal ethnicity were compared between the two groups using the chi(2) test, Fisher's exact test, and the Student t-test. A multivariable logistic regression model was constructed to control for confounders. Odds ratios (OR) and their 95% confidence interval (CI) were computed.

RESULTS

The mean maternal BMI was significantly lower in the study group as compared to controls (22.9 +/- 3.1 vs. 28.0 +/- 7.5 kg/m(2), respectively; p < 0.0001). Patients with fetal EIF and/or EB were significantly more likely to be Asians (20.3% vs. 5.4%, OR = 4.5; 95% CI 1.3-16.9). Using a multivariable analysis, controlling for ethnicity, the association between maternal BMI and fetal EIF or EB remained significant (OR = 0.83; 95% CI 0.76-0.91). However, based on this model Asian ethnicity was not an independent risk factor for the detection of EIF and/or EB (OR = 2.6; 95% CI 0.8-8.9).

CONCLUSIONS

Our data suggests an inverse relationship between the maternal BMI and the detection of fetal EIF and/or EB. Moreover, it appears that low maternal BMI, and not Asian ethnicity, is an independent risk factor for the detection of these echogenic fetal findings.

Choroid plexus cyst, intracardiac echogenic focus, hyperechogenic bowel and hydronephrosis in screening for trisomy 21 at 11 + 0 to 13 + 6 weeks

OBJECTIVES

To investigate the potential value of choroid plexus cyst, intracardiac echogenic focus, hydronephrosis and hyperechogenic bowel as markers of trisomy 21 at 11 + 0 to 13 + 6 weeks.

METHODS

We examined three-dimensional volumes from 228 fetuses with trisomy 21 and 797 chromosomally normal fetuses at 11 + 0 to 13 + 6 weeks of gestation. We looked for choroid plexus cysts with a minimum diameter of 1.5 mm, intracardiac echogenic focus, hydronephrosis with a minimum anteroposterior diameter of the pelvis of 1.5 mm and hyperechogenic bowel.

RESULTS

The prevalence of intracardiac echogenic focus, hydronephrosis and hyperechogenic bowel was significantly higher in trisomy 21 than in normal fetuses (9.6% vs. 1.5%, 17.1% vs. 5.3% and 11.4% vs. 2.4%, respectively). There was no significant difference between the two groups in the prevalence of choroid plexus cysts (7.5% vs. 5.0%). There were no significant differences in crown-rump length or nuchal translucency thickness in either chromosomally normal or trisomy 21 fetuses between those with and those without any one of the markers.

CONCLUSIONS

At 11 + 0 to 13 + 6 weeks the prevalence of intracardiac echogenic focus, hydronephrosis and hyperechogenic bowel is higher in trisomy 21 than in chromosomally normal fetuses. As there is no significant association between the presence of these markers and nuchal translucency thickness, they could be included in the assessment of risk to improve accuracy of screening.