Divergent Right Ventricular Adaptation in Fetal Growth Restriction Subtypes Revealed by Quantitative Cardiac Profiling.

OBJECTIVE

This investigation delineates ventricular adaptive patterns across clinical subtypes of fetal growth restriction (FGR) using fetal heart quantification (fetal HQ) technology.

METHODS

Between June 2021 and June 2022, 30 singleton FGR pregnancies (16 early-onset, 14 late-onset) and 60 normal controls were enrolled, according to the inclusion and exclusion criteria. Data collected included maternal-fetal parameters, fetal biometry, and Doppler indices. Standard dynamic four-chamber views were analyzed offline using fetal HQ.

RESULTS

Both FGR groups delivered earlier and had lower birth weights than controls (both p ˂ 0.05). Myocardial performance index was elevated in FGR fetuses. Left ventricle (LV) global longitudinal strain (GLS) and fractional area change (FAC) were reduced in both early- and late-onset FGR compared to controls (GLS: -22% ± 5% vs. -27% ± 4%, p = 0.001; -23% ± 5% vs. -27%±4%, p = 0.020; FAC: 0.43 ± 0.06 vs. 0.50 ± 0.06, p = 0.002; 0.44 ± 0.08 vs. 0.50 ± 0.06, p = 0.022). Right ventricle (RV) FAC was also lower in both FGR groups (0.36 ± 0.09 vs. 0.42 ± 0.06, p = 0.028; 0.33 ± 0.13 vs. 0.42 ± 0.06, p = 0.001). Fractional shortening (FS) was impaired in RV selected segments in early-onset FGR and across most segments in late-onset FGR (both p ˂ 0.05).

CONCLUSION

GLS and FS detect subclinical ventricular dysfunction in FGR, with alterations in either parameter paralleling subsequent FAC modifications. The two clinical subtypes demonstrate distinct right ventricular adaptive patterns.