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Objective: To evaluate ventricular contractility and profile heart deformations in fetuses of hyperglycemic mothers using the Speckle tracking imaging (STI). The fractional area change (FAC), global longitudinal strain (GLS) and global sphericity index (GSI) of the 4-chamber view (4-CV) were computed.Study Design: Dynamic 4-CV images of 60 fetuses exposed to maternal diabetes (MD) and 60 controls were retrospectively collected between 19 and 37 weeks of gestation. Speckle-tracking analysis was used to compute and compare GSI, GLS and FAC of the right ventricle (RV) and the left ventricle (LV) between the groups. By definition, GSI was the ratio of the epicardial basal-apical length in end-diastole (BAL) to the overall transverse length of RV and LV in end-diastole (TL). The FAC was calculated by dividing the difference between end-diastolic area and end-systolic area by the end-diastolic area. Similarly, the GLS of the RV and LV was obtained by dividing the difference between the endocardial length in end-systole and endocardial length in end-diastole to the endocardial length in end-diastole. Data for conventional echocardiographic parameters, standard biological measurements of fetus and maternal baseline characteristics were also recorded and compared between the groups. Linear regression analysis was performed to assess the association between age, BMI and the inter-ventricular septum thickness (IVST).Results: Gestational age at the time of examination did not differ significantly between the control and gestational diabetes group (p = 0.74). In fetuses exposed to MD, the thickness of the IVS was higher while the FAC of RV, GLS of RV and the GSI were all significantly lower. The FAC and global strain of LV generally decreased with progress in gestation but the difference between the two groups was not statistically significant. Conventional echocardiography in fetuses exposed to MD revealed a lower mitral E/A ratio and a larger myocardial performance index (MPI) of the RV and LV. Although the annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE) and septal annular plane systolic excursion (SAPSE) were also lower in this group, the difference was not statistically significant compared to fetuses of the control group. No regression relationship between age, BMI and IVST were noticed in any group.Conclusion: This study found that diastolic dysfunction among fetuses of gestational diabetic mothers is accompanied by global cardiac deformation and functional decrease of the RV in systole in the second and third trimester. The GSI, global strain and FAC acquired by SRI can be used as convenient and reliable quantitative parameters in the assessment of cardiac function in fetuses exposed to gestational diabetes. [ABSTRACT FROM AUTHOR]

Anti-Ro/SSA antibodies are associated with a risk of 1-2 % to develop complete atrioventricular block (AVB) in fetuses of positive mothers. Complete AVB is irreversible, but studies suggest that anti-inflammatory treatment during the transition period from a normal fetal heart rate (FHR) to an AVB might stop this progression and restore sinus rhythm. The most efficient method for diagnostic evaluation of this arrhythmia is the pulsed-Doppler fetal echocardiography. However, weekly or bi-weekly recommended fetal echocardiographic surveillance can rarely identify an AVB in time for treatment success, also because the transition from a normal rhythm to a third degree AVB is very fast. Daily FHR monitoring in a medical facility could increase the chances of identifying the AVB onset but is difficult to realize. For this reason, an alternative method of FHR monitoring, performed directly by mothers in their home context, has been recently proposed. We present a case report utilizing this approach and review the current evidence about this condition. [ABSTRACT FROM AUTHOR]

Background Fetal growth restriction (FGR), defined as an estimated fetal weight (EFW)<10th percentile, is associated with an increased risk for adverse fetal and neonatal outcome. Early antenatal diagnosis is important and remains challenging. Deformation changes in the fetal myocardium are early signs of myocardial dysfunction. These changes can be measured using two-dimensional speckle tracking echocardiography (2D-STE) to predict impaired placental function in the growth restricted fetus. Aim To review the literature on fetal heart deformation values measured with 2D-STE, in fetuses with an EFW< 10th centile and appropriate for gestational age (AGA) fetuses, and to compare the results in both groups. Methods The EMBASE, Medline, and Cochrane databases were searched from inception until April 2020. Observational studies on evaluating the cardiac deformation values longitudinal strain, strain rate, and/or global dyssynchrony of both ventricles in FGR, using 2D-STE, were included. Methodological quality was assessed using the Newcastle-Ottowa risk of bias scale. Results Four studies met the inclusion criteria. The mean gestational age (GA) varied from 30 to 38 weeks in the FGR group and 20 to 40 weeks in AGA fetuses. The number of included FGR fetuses (with or without Doppler abnormalities), varied from 30 to 50. Longitudinal strain in FGR fetuses was described as comparable (n = 2), increased (n = 1) and>95th percentile (n = 1) compared to AGA fetuses. Strain rate was measured in two studies. One reported an increased strain rate, another showed comparable strain rate. Two studies addressed global left ventricle (LV) and right ventricle (RV) dyssynchrony. Dyssynchrony was increased in FGR compared to AGA fetuses. Conclusion The currently published data is limited and heterogeneous concerning GA and Doppler profiles. The data presentation and the interpretation thereof make qualitative comparisons impossible. Large prospective longitudinal cohort studies looking at the value of deformation measurements of the fetal heart in FGR and AGA fetuses are needed to assess the clinical significance of deformation values measured with 2D-STE. [ABSTRACT FROM AUTHOR]

Establishment of the maturational patterns of the fetal left and right ventricle strain and strain rate by two-dimensional speckle tracking echocardiography is a prerequisite for its routine clinical adaptation in pregnancy. The aim of this study is to review systematically current literature on the development of left and right ventricle strain and strain rate derived by speckle tracking during gestation. EMBASE, Medline and Central were searched, from inception to October 2019, for observational studies of singletons in uncomplicated, non-anomalous pregnancies, measuring global longitudinal strain and strain rate with 2D speckle tracking echocardiography in the fetal heart during gestation. 23 Studies met the inclusion criteria. The gestational age of the included fetuses varied from 12 to 42 weeks. Four studies used a longitudinal study design, with few consecutive measurements at varying gestational ages. 19 Studies performed either cross sectional or both longitudinal and cross sectional measurements. The ultrasound devices and speckle tracking algorithm software used, varied. Strain and strain rate during gestation increased, decreased or remained stable in the left and right fetal ventricle with increasing gestation. Due to considerable variation in the included gestational ages measured and inconsistency in the direction of strain and strain rate development, a meta-analysis could not be performed. Contradictory results concerning the development of strain and strain rate during gestation were shown, probably due to suboptimal study designs and varying algorithms and ultrasound devices used. A large longitudinal cohort study is needed to obtain reference values for fetal cardiac deformation in the uncomplicated, singleton pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to evaluate if pregestational diabetes affects fetal heart rate (FHR) readings at 11-14 weeks of pregnancy.Study Design: For each patient, we recorded age, body mass index (BMI), presence of pregestational diabetes, nuchal translucency (NT), FHR, crown-rump length (CRL), biparietal diameter (BPD) and gestational age. Pregnancies were grouped according to the presence or absence of pregestational diabetes and maternal and fetal variables were compared. Ordinal regression analysis was performed to assess the influence of maternal and fetal variables on the FHR.Results: We included 994 pregnancies from 2009 to 2016. Kruskal-Wallis test showed that median FHR was higher in women with pregestational diabetes than in controls (161; IQR 11 vs. 158; IQR 10, χ2 = 5.13, p = 0.02). Ordinal regression analysis showed that differences in FHR were significantly correlated with the presence of pregestational diabetes (p = 0.007) and the CRL (p = 0.042) but not with the maternal BMI, maternal age, gestational age, BPD and NT.Conclusions: First trimester FHR is higher in diabetic pregnancies than in non-diabetic pregnancies. Therefore, further research is needed to assess whether these pregnancies may benefit from a correction of FHR for a better estimation of the chromosomal abnormalities risk. [ABSTRACT FROM AUTHOR]

Objectives: To establish a prediction model for fetal congenital heart disease (CHD) that could facilitate selective fetal echocardiography screening for diabetic women, and to provide cost analysis of selective versus global screening of these women.Study Design: A historical cohort study included women with pre-gestational diabetes who received perinatal care at Mayo Clinic, Minnesota from 2007 through 2013. Anatomical scans and fetal echocardiograms were reviewed and charts for postnatal outcomes were abstracted. Logistic regression models were utilized to identify predictors of CHD. Cost of global versus selective screening was estimated using cost per case detected.Results: A cohort of 152 women was included. Abnormal anatomy scan was reported in five (3.3%). Among 51 (33.6%) who had fetal echocardiography, eight (15.7%) had abnormal findings. Postnatal echocardiography was conducted in 36 neonates, 12 had abnormalities. Only first trimester HbA1c was independent predictor with observed incidence of CHD of 1.8, 14.3, and 40% and HbA1c of <8, 8-10, and >10% respectively. Global screening strategy missed 22% of fetal cardiac abnormalities, while selective screening missed 33%.Conclusions: According to our probability model, selective screening based on HbA1c and/or anatomic surveys seems to be an accurate and cost effective strategy for prenatal diagnosis of CHD among diabetic pregnancies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To test the hypothesis that there are differences in the level of maternal–fetal attachment before and after fetal echocardiography in the presence or absence of cardiac abnormalities. Study design: Cohort study in which the mothers responded to a validated Maternal–Fetal Attachment Scale. The study compared a group of pregnant women with diagnosis of fetal heart disease (FHD) with a group without this diagnosis (“no fetal heart disease” – NFHD). Results: 197 pregnant women were included, 96 FHD and 101 NFHD. Maternal–fetal attachment at the initial and final periods showed no significant baseline differences between groups (p =0.081). At the final period, migration from medium to high level of attachment was significantly higher in FHD (p =0.017). Transition from medium to high levels comparing the initial and final periods was more pronounced in FHD (p =0.009). Conclusion: Diagnosis of fetal heart disease increases the level of maternal–fetal attachment. [Copyright &y& Elsevier]

Abstract: Objective: The main objective of this study was to evaluate the spectrum of cardiac anomalies found in routinely performed fetal autopsies and to establish the correlation between prenatal and postmortem diagnosis. Study design: A retrospective study of fetal autopsies was performed. Cases with cardiac anomalies were analyzed. Seven main categories were established and each case was assigned to a single group. Cardiac defects were also classified as isolated or with associated anomalies. In the cases with prenatal diagnosis, we performed a correlation between prenatal and postmortem findings. Results: Abnormal cardiac findings were identified in 99 fetuses (13.6%). The two most common categories were septal defects and complex anomalies, each occurring in 21 fetuses (21.2%). Sixty-seven (67.7%) had associated anomalies. Septal anomalies were more frequent in cases with associated anomalies (p =0.012). Prenatal diagnosis had been performed in 50 cases. There was complete agreement between prenatal and postmortem diagnosis in 36 cases (72%), and major agreement with additional information in ten (20%). When the echocardiogram was not performed by a specialist, the number of cases classified with complete disagreement was higher (33.3% vs 2.4%) (p =0.002). Conclusion: The high prevalence of cardiac defects in lost pregnancies, some of them lacking prenatal diagnosis, highlights the importance of examining the heart in all cases. [Copyright &y& Elsevier]

Abstract: Objectives: To determine the reproducibility, both reliability and agreement, of measurements of fetal left ventricular parameters from volumes obtained by spatio-temporal image correlation (STIC) acquisition applying virtual organ computer-aided analysis (VOCAL) and Simpson''s rule (method of discs). Furthermore the success rate of STIC acquisition was determined. Study design: In 84 pregnancies between 20 and 34 weeks of gestation the fetal heart was scanned using the STIC modality. An optimal four-chamber view in end-diastole and end-systole was obtained. Left ventricular end-diastolic volume, left ventricular end-systolic volume, stroke volume and ejection fraction were determined. For calculations based on Simpson''s rule only one plane was traced, whereas for VOCAL six planes were traced. To quantify the reliability intraclass correlation coefficients were calculated for both intra- and inter-observer measurements. Agreement of measurements was evaluated by Bland–Altman plots. Results: The STIC volumes of 54 women (64%) were excluded from the study because of poor quality, leaving 30 volumes for further analysis. Intraclass correlation coefficients for intra-observer reliability for VOCAL and Simpson were 0.99 and 0.99 for left ventricular end-diastolic volume, 0.95 and 0.92 for left ventricular end-systolic volume, 0.98 and 0.97 for stroke volume, 0.76 and 0.77 for ejection fraction, respectively. Intraclass correlation coefficients for inter-observer reliability for VOCAL and Simpson were 0.97 and 0.86 for left ventricular end-diastolic volume, 0.97 and 0.86 for left ventricular end-systolic volume, 0.95 and 0.81 for stroke volume, 0.68 and 0.63 for ejection fraction, respectively. According to Bland–Altman plots, the mean percentage difference and 95% limits of intra- and inter-observer agreement for left ventricular stroke volume measurements using VOCAL were −0.2 (−25.1, 24.7)% and 2.8 (−34.2, 39.8)%, respectively. For left ventricular stroke volume measured with Simpson versus VOCAL the mean percentage difference and 95% limits of agreement were −1.8 (−22.1, 18.5)%. Conclusions: 4D STIC enables reproducible measurements of left ventricular volumes. Reliability of the VOCAL mode is not essentially different from the single-plane method used in Simpson''s rule. The large percentage of poor quality STIC volumes and the wide limits of inter-observer agreement would create obstacles for the clinical applicability of this technique. [Copyright &y& Elsevier]

Abstract: Objective: To make a global evaluation of the fetal myocardial changes in a well-controlled gestational diabetic population. Study design: Twenty-four pregnant well-controlled diabetic patients were selected. Sixteen normal pregnancies were randomly collected as a control group. Measurements of morphological and functional myocardial parameters were performed. Data from the left ventricular outflow tract and peripheral Doppler data were obtained. Result: The thickness of the interventricular septum was increased in diabetic pregnancies (p <0.001). Tricuspid E/A index was the only functional parameter showing a significant variation, with lower values in diabetic pregnancies. Doppler parameters from the left ventricular outflow tract and peripheral Doppler waveforms were similar between groups. Conclusion: A tendency towards interventricular septum hypertrophy was observed even in well-controlled diabetic pregnancies. Mild hypertrophic cardiac changes were not associated with abnormal cardiac function or signs of left ventricular outflow obstruction, although minor changes in right ventricular diastolic function were recorded. [Copyright &y& Elsevier]