Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 83(13), 1225–1239. https://doi.org/10.1016/j.jacc.2024.02.005 Fu-Tsuen Lee et al.
Points
- The study investigated fetal hemodynamics and early outcomes in 144 fetuses with cyanotic congenital heart disease (CHD)
- Utilized late gestational fetal cardiovascular magnetic resonance (CMR) to measure vessel blood flow and oxygen content
- Diminished fetal combined ventricular output is associated with mortality, while cerebral blood flow and oxygen delivery are linked to early cognitive, language, and motor development.
- Fetal superior vena cava (SVC) flow served as a proxy for cerebral blood flow and was strongly associated with cognitive and language outcomes.
- Findings support the inclusion of fetal CMR to identify patients at risk of adverse neurodevelopmental outcomes.
Summary
In a longitudinal observational study involving 144 fetuses with cyanotic congenital heart disease (CHD), the relationship between fetal hemodynamics and early survival, as well as neurodevelopmental (ND) outcomes, was investigated. The study utilized late gestational fetal cardiovascular magnetic resonance (CMR) to measure vessel blood flow and oxygen content, with superior vena cava (SVC) flow as a proxy for cerebral blood flow. The primary outcomes assessed were 18-month mortality and Bayley Scales of Infant Development-III assessment.
The findings revealed that by 18 months, 18 patients (12.5%) had succumbed to the condition. Early mortality was associated with reduced combined ventricular output, descending aortic, and umbilical vein flow. Among the surviving patients, ND outcomes were assessed in 71 individuals. It was observed that cerebral oxygen delivery was the fetal hemodynamic variable most strongly linked to cognitive, language, and motor outcomes. Additionally, fetal SVC flow was associated with cognitive, language, and motor outcomes and remained an independent predictor of cognitive and language outcomes after adjusting for diagnosis. Notably, diminished SVC flow outperformed other fetal CMR and echocardiographic predictors of cognitive ND delay.
In conclusion, the study demonstrated that among fetuses with cyanotic CHD, diminished fetal combined ventricular output is linked to mortality. At the same time, cerebral blood flow and oxygen delivery are associated with early cognitive, language, and motor development at 18 months of age. These findings underscore the importance of incorporating fetal CMR in identifying patients at risk of adverse ND outcomes, providing valuable insights for clinical management and intervention strategies.
Link to the article: https://www.sciencedirect.com/science/article/pii/S0735109724002560
References Lee, F.-T., Sun, L., Van Amerom, J. F. P., Portnoy, S., Marini, D., Saini, A., Milligan, N., Lim, J. M., Saini, B., Selvanathan, T., Kazazian, V., Sananes, R., Jaeggi, E., Kingdom, J. C., Macgowan, C. K., Ly, L., Chau, V., Miller, S. P., & Seed, M. (2024). Fetal Hemodynamics, Early Survival, and Neurodevelopment in Patients With Cyanotic Congenital Heart Disease. Journal of the American College of Cardiology, 83(13), 1225–1239. https://doi.org/10.1016/j.jacc.2024.02.005
