Myocardial Deformation and Its Relation to Ventricular Shape, Preload, and Afterload in Fetuses with Suspected Coarctation of the Aorta

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.