Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2026
Fetal Cardiac Remodeling and Subclinical Myocardial Dysfunction in Pregnancies Complicated by Placenta Accreta Spectrum: A Prospective Echocardiographic Study.
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Pekkolay Hamdullah, Alpay Verda, Bilirer Kübra Kurt, Boza Barış, Ersan Fırat
Аннотация
OBJECTIVES: To investigate the pattern of fetal cardiac remodeling and dysfunction associated with placenta accreta spectrum (PAS), a disorder characterized by abnormal placental angioarchitecture, and to test the hypothesis that PAS imposes a distinct hemodynamic burden on the fetal heart.
METHODS: This prospective case-control study included 50 singleton pregnancies diagnosed with PAS and 50 gestational age-matched uncomplicated pregnancies as controls. Comprehensive fetal echocardiography was performed to assess structural parameters-including right and left ventricular free wall thickness, interventricular septal thickness, and the cardiothoracic ratio-and functional parameters including the modified myocardial performance index (Mod-MPI), isovolumetric contraction time, isovolumetric relaxation time, and ejection time. Standard fetoplacental Doppler indices were also evaluated.
RESULTS: Standard Doppler parameters, including the umbilical artery pulsatility index, did not differ between groups (p = .240). However, significant cardiac alterations were observed in the PAS group. Compared with controls, fetuses in the PAS group demonstrated thicker right ventricular free wall (4.59 ± 0.73 versus 4.21 ± 0.68 mm; p = .008) and interventricular septum (4.72 ± 0.47 versus 4.27 ± 0.83 mm; p = .001), as well as a higher cardiothoracic ratio (0.56 ± 0.06 versus 0.49 ± 0.04; p < .001). Functionally, the Mod-MPI was significantly increased in the PAS group (0.53 ± 0.07 versus 0.46 ± 0.08; p < .001), primarily driven by prolongation of the isovolumetric relaxation time (53.3 ± 7.74 versus 45.9 ± 10.35 ms; p = .001), consistent with impaired diastolic function.
CONCLUSION: PAS is associated with a distinct fetal cardiac phenotype characterized by eccentric hypertrophy and diastolic dysfunction, compatible with a chronic volume-overload state. This remodeling occurs despite normal standard fetoplacental Doppler indices, suggesting that the low-resistance vascular architecture of PAS imposes a unique hemodynamic load on the fetal heart. Fetal echocardiography appears to be a sensitive tool for detecting this subclinical cardiac involvement, which may have implications for fetal programming and long-term cardiovascular health.
METHODS: This prospective case-control study included 50 singleton pregnancies diagnosed with PAS and 50 gestational age-matched uncomplicated pregnancies as controls. Comprehensive fetal echocardiography was performed to assess structural parameters-including right and left ventricular free wall thickness, interventricular septal thickness, and the cardiothoracic ratio-and functional parameters including the modified myocardial performance index (Mod-MPI), isovolumetric contraction time, isovolumetric relaxation time, and ejection time. Standard fetoplacental Doppler indices were also evaluated.
RESULTS: Standard Doppler parameters, including the umbilical artery pulsatility index, did not differ between groups (p = .240). However, significant cardiac alterations were observed in the PAS group. Compared with controls, fetuses in the PAS group demonstrated thicker right ventricular free wall (4.59 ± 0.73 versus 4.21 ± 0.68 mm; p = .008) and interventricular septum (4.72 ± 0.47 versus 4.27 ± 0.83 mm; p = .001), as well as a higher cardiothoracic ratio (0.56 ± 0.06 versus 0.49 ± 0.04; p < .001). Functionally, the Mod-MPI was significantly increased in the PAS group (0.53 ± 0.07 versus 0.46 ± 0.08; p < .001), primarily driven by prolongation of the isovolumetric relaxation time (53.3 ± 7.74 versus 45.9 ± 10.35 ms; p = .001), consistent with impaired diastolic function.
CONCLUSION: PAS is associated with a distinct fetal cardiac phenotype characterized by eccentric hypertrophy and diastolic dysfunction, compatible with a chronic volume-overload state. This remodeling occurs despite normal standard fetoplacental Doppler indices, suggesting that the low-resistance vascular architecture of PAS imposes a unique hemodynamic load on the fetal heart. Fetal echocardiography appears to be a sensitive tool for detecting this subclinical cardiac involvement, which may have implications for fetal programming and long-term cardiovascular health.