Vigneswaran Trisha V, Woodgate Tomas, Rato Joao, Razavi Reza, Simpson John M
School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK.
Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK.
Pediatr Cardiol. 2025 May 8. doi: 10.1007/s00246-025-03878-6.
Detailed characterization of myocardial deformation, ventricular shape, outflow tract size, inflow Doppler patterns, cerebroplacental circulation, and cardiac output of fetuses with suspected coarctation of the aorta (COA) and a control group to gain further insights into differences between these groups. Expectant women were prospectively recruited for assessment during the third trimester of pregnancy and a comparison of echocardiographic characteristics and fetoplacental circulation according to postnatal diagnosis of either confirmed COA (c-COA), false-positive COA (fp-COA), and a control population. There were 42 fetuses recruited with suspected COA of whom 20/42 (48%) had c-COA. Fetuses with c-COA demonstrated lower (less negative) LV global longitudinal strain (LV-GLS) compared to controls (- 20.2% ± 4.3 vs. - 23.1% ± 2.7, p = 0.01) and a non-significant trend to lower strain in the fp-COA group (LV-GLS: - 20.7% ± 5.0, p = 0.053) compared to controls. RV-GLS was significantly reduced in the fp-COA group compared to the c-COA and control groups (fp-COA: - 19.8% ± 4.5, c-COA: - 23.1% ± 4.4, control: - 23.5% ± 3.6, p = 0.04). C-COA and fp-COA had a less spherical (narrower) LV, shorter LV, and a more spherical RV compared to controls. The arterial duct diameter was larger in c-COA compared to fp-COA and controls. When analyzed according to diagnostic group, determinants of GLS and sphericity index differed between groups. For c-COA, there was correlation between LV-GLS and RV-GLS (r = - 0.51, p = 0.021). Determinants of LV-GLS in fp-COA were distal transverse aortic arch z-score and umbilical artery PI (p = 0.026, p = 0.037 respectively). The only determinant of RV-GLS in the FP-COA was arterial duct z-score (r = - 0.51, p = 0.019). There are measurable differences in functional parameters between c-COA, fp-COA, and controls. The hemodynamic characteristics of c-COA and fp-COA merit further study and should include study of the RV and cerebroplacental evaluation.
详细描述疑似主动脉缩窄（COA）胎儿及对照组胎儿的心肌变形、心室形态、流出道大小、流入多普勒模式、脑胎盘循环和心输出量，以进一步了解这些组之间的差异。前瞻性招募妊娠晚期的孕妇进行评估，并根据产后确诊的COA（c-COA）、假阳性COA（fp-COA）和对照组进行超声心动图特征及胎儿-胎盘循环的比较。共招募了42例疑似COA的胎儿，其中20/42（48%）为c-COA。与对照组相比，c-COA胎儿的左心室整体纵向应变（LV-GLS）较低（负值较小）（-20.2%±4.3 vs. -23.1%±2.7，p = 0.01），与对照组相比，fp-COA组的应变有降低趋势但无统计学意义（LV-GLS: -20.7%±5.0，p = 0.053）。与c-COA组和对照组相比，fp-COA组的右心室整体纵向应变（RV-GLS）显著降低（fp-COA: -19.8%±4.5，c-COA: -23.1%±4.4，对照组: -23.5%±3.6，p = 0.04）。与对照组相比，c-COA和fp-COA的左心室球形度较低（更窄）、左心室较短，右心室球形度更高。与fp-COA和对照组相比,c-COA的动脉导管直径更大。根据诊断组分析，GLS和球形指数的决定因素在各组之间存在差异。对于c-COA，LV-GLS与RV-GLS之间存在相关性（r = -0.51，p = 0.021）。fp-COA中LV-GLS的决定因素是主动脉弓远端横向z评分和脐动脉搏动指数（分别为p = 0.026，p = 0.037）。FP-COA中RV-GLS的唯一决定因素是动脉导管z评分（r = -0.51，p = 0.019）。c-COA、fp-COA和对照组之间的功能参数存在可测量的差异。c-COA和fp-COA的血流动力学特征值得进一步研究，应包括对右心室和脑胎盘评估的研究。
