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Zhu F, Zhao Y, Wu J, Wang M, Zhu Z, Zhang L. Post-COVID-19 Fetal Cardiac Morphology and Systolic Evaluation in Infected Pregnant Women by Fetal Heart Quantification Technology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1199-1209. [PMID: 38465462 DOI: 10.1002/jum.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/03/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Due to the government's liberalization of epidemic control, the current 2019 novel coronavirus disease (COVID-19) has started to spread widely within China. This study aimed to use the fetal heart quantification (fetal HQ) technique to assess the cardiac function and morphology of the fetuses of pregnant women diagnosed with COVID-19 in the early stages of pregnancy. METHODS Exactly 86 pregnant women diagnosed with COVID-19 infection in early pregnancy (COVID-19 group) and 90 healthy pregnant women (control group) who underwent fetal echocardiography were prospectively included in this study. The fetal HQ technique was applied to compare the differences in the global sphericity index (GSI), global strain values (GS), fractional area change (FAC), and 24-segment fractional shortening (FS) of the left and right ventricles, between the COVID-19 group and the control group. RESULTS Compared with the control group, the differences in GS and 24-segment FS of the left ventricle in the COVID-19 group were not statistically significant. However, the COVID-19 group showed lower GSI values compared with the control group (1.24 vs 1.28). FAC (48.12%) of the left ventricle and GS (-23.55%), FAC (41.74%) of the right ventricle in the COVID-19 group were reduced compared with FAC (50.50%) of the left ventricle and GS (-27.63%), FAC (46.01%) of the right ventricle in the control group. Segmental analysis revealed reduced FS in segments 20-24 in the COVID-19 group compared with the control group. Right ventricular GS was an independent predictor of adverse pregnancy outcome with an optimal cutoff value of -18.66%. CONCLUSIONS The results suggest that COVID-19 infection in early pregnancy may have a negative impact on fetal cardiac morphology and function. Fetal HQ may offer a new assessment method for the early identification of fetal cardiac alterations in pregnant women infected with COVID-19.
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Affiliation(s)
- Feihu Zhu
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Yueshu Zhao
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Juan Wu
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Ming Wang
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Ziqi Zhu
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Lingling Zhang
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
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Lou Y, Zhao B, Pan M, Huang L, Lu X, Zhang X, Peng X. Quantitative Analysis of Morphology and Function in the Fetal Heart with Severe Tricuspid Regurgitation by Speckle Tracking Imaging. Pediatr Cardiol 2024; 45:740-748. [PMID: 38393337 DOI: 10.1007/s00246-024-03454-4] [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: 11/11/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
Morphology and function in a fetal heart with severe tricuspid regurgitation remains challenging. The aim of this study was to assess cardiac morphology and function in fetuses with severe tricuspid regurgitation by fetal heart quantification (HQ) and to assess the practical value of fetal HQ. Clinical information was analyzed for 63 pregnant women who underwent fetal cardiac ultrasonography. The women were divided into those who had a fetus with severe tricuspid regurgitation (n = 20) and those with a normal fetus (n = 40). The global sphericity index (GSI), fractional area change (FAC), and global longitudinal strain (GLS) of both ventricles and the sphericity index (SI) and fractional shortening (FS) of 24 segments were quantified by fetal HQ using speckle tracking imaging. Fetuses with severe tricuspid regurgitation had a significantly lower GSI (1.14 ± 0.10 vs. 1.26 ± 0.08, p < 0.001) and a higher GSI Z-score (-0.98 ± 1.01 vs. 0.25 ± 0.87, p < 0.001) as well as a significantly lower right ventricular FAC (36.50 ± 7.34% vs. 45.19 ± 3.39%, p < 0.001), FAC Z-score (-1.02 ± 1.41 vs. 0.49 ± 0.74, p < 0.001), and GLS (-21.01 ± 5.66% vs. 45.19 ± 3.49%, p < 0.001). The SI and SI Z-score were significantly lower in segments 1-18 of the right ventricle in fetuses with severe tricuspid regurgitation (p < 0.05); furthermore, FS of segments 1-12 and 19-24 and the FS Z-score of segments 18-24 were significantly lower in fetuses with severe tricuspid regurgitation (p < 0.05). Fetal HQ is useful for evaluation of cardiac morphology and function in fetuses with severe tricuspid regurgitation and can provide important reference information for both clinical diagnosis and treatment.
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Affiliation(s)
- Yang Lou
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China
- Special Inspection Section, Hangzhou Xixi Hospital, Hangzhou, 310023, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China.
| | - Mei Pan
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China
| | | | - Xiaoxi Lu
- Hangzhou Women's Hospital, Zhejiang University, Hangzhou, 310016, China
| | - Xiaomin Zhang
- First People's Hospital of Linping District, Hangzhou City, Hangzhou, 311201, China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, 310016, China
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Li S, Wang L, Yang H, Fan L. Changes in the shape and function of the fetal heart of pre- and gestational diabetes mothers. BMC Pregnancy Childbirth 2024; 24:57. [PMID: 38212679 PMCID: PMC10782618 DOI: 10.1186/s12884-024-06262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Hyperglycemia during pregnancy can affect fetal heart in many ways, including causing cardiac malformation, leading to hypertrophic cardiomyopathy and cardiac dysfunction. Echocardiographic evaluation can assist identify alterations in heart structure, morphology and function, enabling prompt monitoring and management. However, according to earlier research, the cardiac alterations are modest in hyperglycemic mothers' fetuses, and might not be detectable using conventional methods and it is also unclear whether these changes are related to the metabolism of mothers. Fetal Heart Quantification (Fetal HQ) can assess ventricular geometry and function more sensitively and thoroughly, and identify sub-clinical cardiac dysfunction. The purpose of this study was to evaluate fetal heart by Fetal HQ in fetuses of hyperglycemic mothers who either had pre-gestational or gestational diabetes and to correlate them with maternal metabolic indices. METHODS The fetuses of 25 gestational age-matched control mothers, 48 women with gestational diabetes mellitus (GDM), and 11 women with diabetes mellitus (DM) were included in the prospective case-control research. Using fetal echocardiography and speckle tracking echocardiography (STE), the heart of the fetus was evaluated. Differences in the groups' anthropometric, metabolic, and cardiac parameters were examined. It was assessed whether maternal features, prenatal glucose, lipids, and maternal hemoglobin A1c (HbA1c) correlated with fetal cardiac parameters. RESULTS The LV EDV and ESV were significantly higher in the GDM group as compared to the DM group (p < 0.05). The GSI% was significantly lower in the GDM group compared with the control (p < 0.05). The LV SV and CO of the GDM group were both significantly higher compared with the DM group (p < 0.05). There was a significant decrease in RV FS for segments 1-7 in GDM fetuses compared to the control (p < 0.05) and for segments 5-10 compared to DM (p < 0.05). Fetal cardiac morphology and function indices correlate with maternal pregestational weight, BMI, early pregnancy fast glucose, lipids, and glycemic control levels. CONCLUSIONS Fetuses exposed to gestational diabetes have altered heart morphology and function that is linked to maternal metabolic parameters, which presents a special indication for performing geometry and function cardiac assessment. Fetal HQ can be employed to evaluate the fetal cardiac shape and function in fetuses exposed to gestational diabetes.
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Affiliation(s)
- Shuang Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
| | - Linlin Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Lixin Fan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Zhang M, Kong Y, Huang B, Peng Y, Zhou C, Yan J, Luo Y. Evaluation of the changes in cardiac morphology of fetuses with congenital heart disease using fetalHQ. J Matern Fetal Neonatal Med 2023; 36:2285239. [PMID: 38010356 DOI: 10.1080/14767058.2023.2285239] [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: 07/14/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Objective: To evaluate the changes in cardiac morphology of fetuses with congenital heart disease (CHD) using the fetal heart quantitative technique (fetalHQ).Methods: A total of 20 normal pregnant women (control group) and 20 pregnant women suspected of fetal CHD (case group) were included in this study. The dynamic images of the four-chamber view of the fetal heart were recorded and analyzed using fetalHQ. The global sphericity index (GSI) and 24-segment SI of the two groups were compared. The differences in the left and right ventricular 24-segment SI for each group were investigated.Results: There was no statistically significant difference in the GSI between the two groups (p > 0.05). The difference in the SI values of left ventricular segments 1-2 between the case group and control group was statistically significant (all p < 0.05), while the intergroup difference in SI of left ventricular segments 3-24 was not significant (all p > 0.05). The SI of the 24 segments of the right ventricle showed no significant intergroup difference (all p > 0.05). The difference in the left and right ventricular 24-segment SI in the case group did not reach statistical significance (all p > 0.05). In the control group, the SI values between the left and right ventricles were significantly different in segments 18-24 (all p < 0.05), and no significant difference was found in segments 1-17 (all p > 0.05). There was a statistically significant intergroup difference in the percentage of unusual left ventricular SI, determined based on Z-score (p < 0.05), and the percentage of outliers for the right ventricle between the two groups showed no significant difference (p > 0.05).Conclusion: The fetalHQ is regarded as a straightforward and reliable approach for assessing the cardiac GSI and 24-segment SI of left and right ventricles in fetuses diagnosed with CHD. While CHD may not significantly impact the overall shape of the fetal heart or the geometric shape of the right ventricle, in this study, a notable increase in SI values for the left ventricular 1-2 segments was observed, indicating a more flattened ventricular chamber. Additionally, the morphological distinctions between the left and right ventricles in fetuses with CHD are no longer discernible.
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Affiliation(s)
- Meixiang Zhang
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Yifan Kong
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Beilei Huang
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Yulin Peng
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Cheng Zhou
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Junyi Yan
- Clinical laboratory, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Yingchun Luo
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
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DeVore GR. Re: Correspondence on 'Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses'. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:445-448. [PMID: 37647040 DOI: 10.1002/uog.26316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/14/2023] [Indexed: 09/01/2023]
Abstract
Linked article: This Correspondence comments on van Oostrum et al. Click here to view the article.
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Affiliation(s)
- G R DeVore
- Fetal Diagnostic Centers, Pasadena, Tarzana, Lancaster, CA, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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de Vet CM, van Oostrum NHM, Clur SB, Oei SG, van Laar JOEH. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:448-449. [PMID: 37647041 DOI: 10.1002/uog.26317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Affiliation(s)
- C M de Vet
- Department of Gynecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N H M van Oostrum
- Department of Gynecology and Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - S B Clur
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart (ERN GUARDHEART)
| | - S G Oei
- Department of Gynecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Gynecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Nichting TJ, de Vet CM, van der Ven M, van der Woude DAA, Regis M, van Sloun RJG, Oei SG, van Laar JOEH, van Oostrum NHM. The impact of angles of insonation on left and right ventricular global longitudinal strain estimation in fetal speckle tracking echocardiography. PLoS One 2023; 18:e0287003. [PMID: 37437044 DOI: 10.1371/journal.pone.0287003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/28/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES Two-dimensional speckle tracking echocardiography has been considered an angle-independent modality. However, current literature is limited and inconclusive on the actual impact of angle of insonation on strain values. Therefore, the primary objective of this study was to assess the impact of angles of insonation on the estimation of fetal left ventricular and right ventricular global longitudinal strain. Secondarily, the impact of different definitions for angles of insonation was investigated in a sensitivity analysis. METHODS This is a retrospective analysis of a prospective longitudinal cohort study with 124 healthy subjects. The analyses were based on the four-chamber view ultrasound clips taken between 18+0 and 21+6 weeks of gestation. Angles of insonation were categorized into three groups: up/down, oblique and perpendicular. The mean fetal left and right ventricular and global longitudinal strain values corresponding to these three groups were compared by an ANOVA test corrected for heteroscedasticity. RESULTS Fetal left and right ventricular global longitudinal strain values were not statistically different between the three angles of insonation (p-value >0.062 and >0.149, respectively). When applying another definition for angles of insonation in the sensitivity analysis, the mean left ventricular global longitudinal strain value was significantly decreased for the oblique compared to the up/down angle of insonation (p-value 0.041). CONCLUSIONS There is no evidence of a difference in fetal left and right ventricular global longitudinal strain between the different angles of insonation in fetal two-dimensional speckle tracking echocardiography.
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Affiliation(s)
- Thomas J Nichting
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Chantelle M de Vet
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Myrthe van der Ven
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Marta Regis
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
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Huluta I, Wright A, Cosma LM, Hamed K, Nicolaides KH, Charakida M. Fetal Cardiac Function at Midgestation in Women Who Subsequently Develop Gestational Diabetes. JAMA Pediatr 2023; 177:718-725. [PMID: 37184868 PMCID: PMC10186208 DOI: 10.1001/jamapediatrics.2023.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/20/2023] [Indexed: 05/16/2023]
Abstract
Importance Fetuses in women with gestational diabetes (GD) compared with those without GD show evidence of subclinical cardiac functional and morphological changes. However, it is uncertain whether glycemia or the adverse maternal underlying risk factor profile is the main driver for fetal cardiac remodeling. Objective To assess cardiac morphology and function at midgestation in fetuses of mothers prior to development of GD and compare them with those of unaffected controls. Design, Setting, and Participants During this prospective nonintervention screening study at 19 to 23 weeks' gestation, fetal cardiac morphology and function were assessed in all participants. Pregnancy complications were obtained from the medical records of the women. Fetal cardiac morphology and function were assessed in all participants at Harris Birthright Research Institute at King's College Hospital, London, United Kingdom. Participants included pregnant women with singleton pregnancy who attended their routine fetal ultrasound examination at midgestation and agreed to participate in the Advanced Cardiovascular Imaging Study in pregnancy. Main Outcome and Measures Comparison of fetal cardiac morphology and function between mothers who subsequently developed GD and those who did not develop GD. Methods This was a prospective nonintervention screening study of 5620 women with singleton pregnancies at 19 to 23 weeks' gestation. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricle. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. Results The 5620 included patients had a mean age of 33.6 years. In 470 cases, the women were diagnosed with GD after the midgestation echocardiographic assessment (8.4%). Women with GD, compared with the non-GD group, were older, had higher BMI, higher prevalence of family history of diabetes, non-White ethnicity, chronic hypertension, and GD in a previous pregnancy. In fetuses of the GD group compared with the non-GD group, there was mild increase in interventricular millimeter thickness (0.04; 95% CI, 0.03-0.06 mm) and left atrial area (0.04; 95% CI, 0.04-0.05), whereas left and right functional indices were comparable between groups with the exception of left ventricular ejection fraction, which was marginally improved in the GD group (0.02; 95% CI, 0.03-0.03). Conclusions and Relevance This study demonstrates that prior to development of GD, there was mild alteration in fetal cardiac morphology without affecting cardiac function. This suggests that the adverse maternal risk factor profile and not only the glycemia might contribute to cardiac remodeling noted in fetuses of women with GD.
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Affiliation(s)
- Iulia Huluta
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Alan Wright
- Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Livia Mihaela Cosma
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Karam Hamed
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Kypros H. Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Marietta Charakida
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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Peng YQ, Qiu X, Wang L, Li X, Huo XY. Left atrial shortening fraction to predict fetal cardiac abnormalities and dysfunction in gestational diabetes mellitus. Front Cardiovasc Med 2022; 9:1026587. [PMID: 36588551 PMCID: PMC9800860 DOI: 10.3389/fcvm.2022.1026587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the diagnostic efficiency of left atrial shortening fraction (LASF) in the detection of fetal cardiac abnormalities and dysfunction in patients with gestational diabetes mellitus (GDM). Methods In this study, we enrolled 256 pregnant women and divided them into GDM group (n = 156) and control group (n = 100). Fetal echocardiography was performed at 24-28 weeks of gestation to measure the LASF and interventricular septum (IVS) thickness. Based on IVS thickness, the GDM group was subdivided into the septal hypertrophy group (GDM I, n = 62) and non-septal hypertrophy group (GDM II, n = 94). LASF and IVS thickness were compared between the GDM and control groups and between GDM I and GDM II groups. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of LASF in predicting septal hypertrophy. Results The GDM group had a larger IVS thickness (P < 0.05) but a lower LASF level (P < 0.001) than those of the control group. GDM I group had significantly lower LASF level than that in the GDM II group (P < 0.001). At 38.41% as the cutoff value, the LASF can predict septal hypertrophy with diagnostic sensitivity and specificity of 96.7% and 65.2%, respectively. Conclusion Fetal GDM are more likely to induce septal hypertrophy and ventricular dysfunction. LASF is a good indicator of septal hypertrophy or early diastolic dysfunction without septal hypertrophy.
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Affiliation(s)
- Yu-Qing Peng
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xuan Qiu
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Li Wang
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Xin Li
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Xin Li,
| | - Xiao-Yan Huo
- Department of Ultrasonic, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China,Xiao-Yan Huo,
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Tan F, Yang J, Shen Y, Li Y, Fan S, Xia Y, Zhao Y, Ji X. Evaluating fetal heart morphology in hypertensive disorders of pregnancy using the fetal heart quantitative technique. Transl Pediatr 2022; 11:1804-1812. [PMID: 36506770 PMCID: PMC9732594 DOI: 10.21037/tp-22-492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study sought to explore the clinical application value of fetal heart quantification (HQ) technology in the evaluation of fetal heart morphology in hypertensive disorders of pregnancy (HDP). METHODS Fetal HQ software was used to quantitatively analyze the 4-chamber global sphericity index (GSI) and 24-segment sphericity index (SI) and Z scores of 53 normal fetal hearts (the normal group) and 26 fetal hearts with gestational hypertension (the case group). The normal Z value range was set at -2 to 2. RESULTS There was a statistically significant difference between the 1-16 and 20-24 segments of the left and right ventricles in the normal group (P<0.05), but there was no statistically significant difference between the 17-19 segments (P>0.05). There was no statistically significant difference in the fetal GSI between the 2 groups (P>0.05). There was no statistically significant difference in the SI of the 24 segments of the fetal left ventricle between the 2 groups (P>0.05). There was no statistically significant difference in the SI between the 1-20 segments of the right ventricle between the 2 groups (P>0.05), but there was a statistically significant difference in the SI between the 21-24 segments (P<0.05). There was no statistically significant difference in the incorrect ratio of the Z value of the GSI between the 2 groups (P>0.05). There was no statistically significant difference in the abnormal rate of the Z value of the SI in each segment of the fetal left ventricle between the 2 groups (P>0.05). There was a significant difference in the abnormal rate of the Z value of the SI in each segment of the fetal right ventricle between the 2 groups (P<0.05). CONCLUSIONS Fetal HQ technology can be used in the quantitative analysis of cardiac morphology in gestational hypertension, and provides a new method for fetal cardiac morphology analysis.
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Affiliation(s)
- Fang Tan
- Ningxia Medical University Clinical School of Medicine, Yinchuan, China
| | - Jiaojiao Yang
- Ningxia Medical University Clinical School of Medicine, Yinchuan, China
| | - Yuqin Shen
- Functional Examination Department of Obstetrics and Gynecology Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yanfeihai Li
- Department of Ultrasound, Ningxia Women's and Children's Hospital, Beijing University First Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China
| | - Sihan Fan
- Ningxia Medical University Clinical School of Medicine, Yinchuan, China
| | - Yan Xia
- Department of Ultrasound, Ningxia Women's and Children's Hospital, Beijing University First Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China
| | - Yuan Zhao
- Department of Ultrasound, Ningxia Women's and Children's Hospital, Beijing University First Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China
| | - Xueqin Ji
- Department of Ultrasound, Ningxia Women's and Children's Hospital, Beijing University First Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China
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Sonaglioni A, Nicolosi GL, Ferrulli A, Migliori C, Lombardo M, Luzi L. Correlation between maternal and neonatal myocardial strain parameters in pregnancies complicated by gestational diabetes mellitus: A post hoc analysis. Diabet Med 2022; 39:e14939. [PMID: 35993824 DOI: 10.1111/dme.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Evaluation of Fetal Cardiac Geometry and Contractility in Gestational Diabetes Mellitus by Two-Dimensional Speckle-Tracking Technology. Diagnostics (Basel) 2022; 12:diagnostics12092053. [PMID: 36140456 PMCID: PMC9497478 DOI: 10.3390/diagnostics12092053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The most commonly known cardiac effect of gestational diabetes mellitus (GD) in the fetus is hypertrophic cardiomyopathy, but recent studies show that it is preceded by subclinical cardiac dysfunction. This study aimed to assess the effect of GD on fetal cardiac geometry and contractility by two-dimensional speckle-tracking technology. Methods: We performed a prospective observational study that included 33 pregnant patients with GD and 30 healthy individuals. For all fetuses, a four-chamber 3 s cine-loop was recorded and analyzed with Fetal Heart Quantification (FetalHQ®), a novel proprietary speckle-tracking software. The following cardiac indices were calculated: global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), and 24-segment end-diastolic diameter (EDD), fractional shortening (FS), and sphericity index (SI) for both ventricles. Demographic and cardiac differences between the two groups were analyzed, as well as intra-rater and inter-rater reliability. Results: There were significant changes in right ventricular FAC and FS for segments 4−24 in fetuses exposed to GD (−1 SD, p < 0.05). No significant differences were detected for GSI, GLS, EDD, or SI for either ventricle. Conclusions: Fetuses exposed to GD present impaired right ventricular contractility, especially in the mid and apical segments.
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Shen Y, Tan F, Yang J, Fan S, Zhang L, Ji X. A preliminary study on fetal cardiac morphology and systolic function of normal and anemic pregnant women by fetal heart quantification technology. Transl Pediatr 2022; 11:1336-1345. [PMID: 36072538 PMCID: PMC9442210 DOI: 10.21037/tp-22-315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Maternal anemia is a common nutritional problem during pregnancy. Fetal heart quantification (fetal HQ) technology is used to quantitatively evaluate the size, shape, and contractile function of the fetal heart, which can reflect the development of the fetus in the uterus. METHODS We used fetal HQ technology to evaluate the basal-apical length (BAL), the transverse width (TW) and the area (A) of the four chamber view at end-diastole in 77 normal fetuses and 40 fetuses of women with anemia. We analyzed the changes of fetal heart size and measured the global sphericity index (GSI), the fraction area change (FAC), and the global longitudinal strain (GLS). The sphericity index (SI) and the fractional shortening (FS) of 24 segments were analyzed to identify any changes of fetal heart morphology and systolic function. The normal range of Z value was set at -2 to 2. RESULTS Fetal BAL, TW, A, and gestational age (GA) were positively linearly correlated, while GSI, GLS, and FAC had no significant correlation with GA. There was no significant difference in fetal BAL, TW, A, GLS, and FAC between the two groups (P>0.05). There was no significant difference in the FS of the 24 segments of the left and right ventricles between the two groups (P>0.05). There was no significant difference in the SI of the 1-24 segments of the right ventricle between the two groups (P>0.05). The difference in fetal GSI between the two groups was statistically significant (P<0.05). There was no significant difference in SI between the 1-22 segments of the left ventricle between the two groups (P>0.05), but there was a statistically significant difference between the 23-24 segments (P<0.05). CONCLUSIONS The fetal HQ analysis technology can quickly and simply quantitatively assess the size, shape, and contractility of the fetal heart. Anemia in pregnant women has no significant effect on fetal heart size and systolic function; it only affects the morphology of the heart, showing that the heart tends to be spherical as a whole and some segments of the apical segment of the left ventricle are abnormal.
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Affiliation(s)
- Yuqin Shen
- Functional Examination Department of Obstetrics and Gynecology Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fang Tan
- Ningxia Medical University Clinical School of Medicine, Yinchuan, China
| | - Jiaojiao Yang
- Ningxia Medical University Clinical School of Medicine, Yinchuan, China
| | - Sihan Fan
- Ningxia Medical University Clinical School of Medicine, Yinchuan, China
| | - Lianxiang Zhang
- Ningxia Medical University School of Basic Medicine, Yinchuan, China
| | - Xueqin Ji
- Department of Ultrasound Medicine, Ningxia Maternal and Child Health Hospital (Ningxia Children's Hospital), Yinchuan, China
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Wang Y, Liu H, Hu X, Hu X, Zhang J, Zhang H, Wang J, Su S, Wang Y, Lyu Z. The effect of gestational diabetes mellitus on fetal right heart growth in late-term pregnancy: A prospective study. Echocardiography 2022; 39:1101-1112. [PMID: 35861350 DOI: 10.1111/echo.15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/12/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a complication of pregnancy strongly associated with an increased risk of structural fetal abnormalities. As the fetal heart grows quickly during the late-term pregnancy period, it is important to understand fetal heart growth before birth. This study explored how GDM affects fetal heart growth by evaluating basic echocardiography indicators during late pregnancy. METHODS This prospective, longitudinal study included 63 GDM patients (GDM group) and 67 healthy pregnant women (control group). All subjects underwent fetal echocardiography scans at gestational weeks 28-32, 32-36, and 36-40. Twelve echocardiographic indicators were assessed at each observation and analyzed by using a mixed model. RESULTS The left atrial diameter (LA) and left ventricular end-diastolic diameter (LV) similarly increased from the first to the third observation. The right ventricular end-diastolic diameter (RV) was significantly different between the groups, and a group × time interaction was detected. The tricuspid annular peak systolic velocity (s') increased more rapidly in the GDM than the control group during the first to second observations, and the group × time interaction was significant. The increase in the tricuspid annular plane systolic excursion (TAPSE) of the GDM group was "slow-fast", while that of the control group was "fast-slow", during three observations. After adjusting covariates, the group difference and interaction effect of TAPSE and RV remained significant. CONCLUSIONS The differences in fetal right heart indicators between the GDM and control groups suggest that GDM may affect the structure and functional growth of the fetal right heart during late-term pregnancy.
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Affiliation(s)
- Yuhan Wang
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongzhou Liu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,Department of Endocrinology, First Hospital of Handan City, Handan, Hebei Province, China
| | - Xiaona Hu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Hu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiamei Zhang
- Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei Province, China
| | - Han Zhang
- Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei Province, China
| | - Jincheng Wang
- Department of Radiology, Peking University Cancer Hospital, Haidian District, Beijing, China
| | - Shan Su
- Department of Ultrasound, Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing, China
| | - Yueheng Wang
- Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei Province, China
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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