Atrial Distensibility Predicts Short-Term Prognosis in Fetal Single Ventricle-Type Congenital Heart Disease with Atrioventricular Valve Regurgitation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Fetal single ventricle-type congenital heart disease (SVCHD) with atrioventricular valve regurgitation (AVVR) (n=60). Intervention: Impaired atrial distensibility on fetal echocardiography vs. Normal or preserved atrial distensibility / No-mild AVVR vs >=moderate AVVR. Primary outcome: Composite adverse events (fetal demise, neonatal death of any cause, and surgery/early infantile valvuloplasty for AVVR due to heart failure within 2 months of birth) in fetuses with SVCHD and >=moderate AVVR (AUC 0.92, 95% CI 0.76-1.0, p=0.02).

Q: What does this research mean for the field?

Reduced atrial distensibility significantly predicts short-term composite adverse perinatal outcomes in fetuses with single ventricle-type congenital heart disease and moderate-to-severe atrioventricular valve regurgitation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yohei Akazawa; Kosuke Yonehara; Haruka Obinata; Ryusuke Numata; Yuma Shibuya; Kohta Takei; Kiyohiro Takigiku

doi:10.1007/s00246-026-04535-2

October 31, 2026Pediatric CardiologyOpen Access

Atrial Distensibility Predicts Short-Term Prognosis in Fetal Single Ventricle-Type Congenital Heart Disease with Atrioventricular Valve Regurgitation

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Key result

Lower fetal atrial distensibility predicts adverse outcomes in single-ventricle congenital heart disease with AV valve regurgitation.

AUC 0.92
95% CI 0.76-1.0
P=0.02
n=60

Why the study?

Whether assessing atrial distensibility helps predict perinatal outcomes in fetuses prenatally diagnosed with single ventricle-type congenital heart disease and atrioventricular valve regurgitation was unknown.

Does quantitative echocardiographic assessment of atrial distensibility predict composite perinatal adverse events (fetal demise, neonatal death, or early valvuloplasty within 2 months of birth) in fetuses with single ventricle-type congenital heart disease and significant atrioventricular valve regurgitation?

Key Points

To determine whether quantitative assessment of atrial distensibility predicts perinatal outcomes in fetuses with single ventricle-type congenital heart disease and atrioventricular valve regurgitation.
Retrospective review of 77 consecutive fetuses diagnosed with single ventricle-type congenital heart disease between 2011 and 2023, analyzing 60 eligible fetuses after excluding 9 terminations and 8 chromosomal abnormalities.
Fetuses were stratified by atrioventricular valve regurgitation severity into no-mild (n=48) and ≥moderate (n=12) groups, with atrial distensibility and conventional echocardiographic parameters evaluated retrospectively.
The primary endpoint was a composite of adverse events comprising fetal demise, neonatal death from any cause, and early infantile valvuloplasty within 2 months of age.
Atrial distensibility was significantly reduced in fetuses with ≥moderate regurgitation compared to those with no-mild regurgitation (0.30 ± 0.17 vs 0.59 ± 0.24, p < 0.001).
Among fetuses with ≥moderate regurgitation, atrial distensibility was lower in cases with composite adverse events than in those without adverse events (0.19 ± 0.07 vs 0.40 ± 0.17, p < 0.05).
Receiver operating characteristic analysis indicated significant prognostic value for atrial distensibility in predicting composite adverse outcomes (area under the curve 0.90, p = 0.02; cutoff 0.24, sensitivity 83.3%, specificity 83.3%).

Study Design

Type

Cohort (n=60)

Blinding

Single operator blinded to clinical data for atrial area tracings

Multicenter

No

Structured PICO

Does quantitative echocardiographic assessment of atrial distensibility predict composite perinatal adverse events (fetal demise, neonatal death, or early valvuloplasty within 2 months of birth) in fetuses with single ventricle-type congenital heart disease and significant atrioventricular valve regurgitation?

P

Population

60 fetuses prenatally diagnosed with single ventricle-type congenital heart disease (median gestational age 35.2 weeks, 48 with no-mild AVVR and 12 with >=moderate AVVR) after excluding terminations and chromosomal abnormalities, followed through 2 months post-birth.

E

Exposure

Quantitative echocardiographic assessment of fetal atrial distensibility, defined as (atrial area maximum - atrial area minimum) / atrial area minimum, measured in the apical four-chamber view by tracing the endocardial border of the entire common atrium

C

Comparator

Fetuses with SVCHD and no-mild AVVR (n=48), fetuses with SVCHD and ≥moderate AVVR without adverse clinical events (n=6), and gestation-matched control fetuses from normal pregnancies (n=60)

O

Outcome

Composite of adverse clinical events: fetal demise, neonatal death of any cause, or early infantile surgery (valvuloplasty) for AVVR owing to heart failure within 2 months of birthcomposite

Main Result

Effect estimate: AUC 0.92 (95% CI 0.76-1.0)

Absolute Event Rate: 0.19% vs 0.4%

p-value: p=0.02

Quantitative fetal echocardiographic assessment of atrial distensibility is impaired in fetuses with single ventricle-type congenital heart disease and significant atrioventricular valve regurgitation, and strongly predicts short-term adverse perinatal outcomes including fetal demise, neonatal death, and early infantile valvuloplasty.

Limitations

Small, retrospective, single-center study design
Limited sample size of fetal SVCHD with significant AVVR precluded multivariate regression analysis
Mortality was ascertained from hospital records without the ability to accurately separate cardiac and non-cardiac causes of death
Small, retrospective, single-center study with inherent limitations
Limited sample size of fetal SVCHD with significant AVVR precluded an adequate multivariate regression analysis to assess independence from other factors
Mortality was ascertained by reviewing hospital records, making it impossible to accurately separate cardiac and non-cardiac causes of death

Implication

Atrial distensibility may support perinatal risk stratification in SVCHD with moderate AVVR; leaves open need for prospective validation before adoption.

Abstract

We aimed to determine whether the assessment of atrial distensibility helps predict perinatal outcomes in fetuses with a prenatal diagnosis of single ventricle-type congenital heart disease (SVCHD) with atrioventricular valve regurgitation (AVVR). We retrospectively identified 77 consecutive cases of fetuses with SVCHD examined between 2011 and 2023. Atrial distensibility and conventional echocardiographic parameters used to assess the severity of fetal heart failure were measured retrospectively. Fetuses with SVCHD were divided into two groups according to AVVR severity: no-mild or ≥moderate. The primary endpoint was the occurrence of composite adverse events (fetal demise, neonatal death of any cause, and early infantile valvuloplasty). The impact of atrial distensibility on prognosis was assessed using the receiver operating characteristic (ROC) curve analysis. Overall, 77 fetuses were diagnosed prenatally with SVCHD; 9 were terminated, and 8 were excluded due to chromosomal abnormalities. Of the 60 fetuses with SVCHD, 48 and 12 had no-mild and ≥moderate AVVR, respectively. Atrial distensibility was significantly lower in fetuses with SVCHD and ≥moderate AVVR than in those with no-mild AVVR (p < 0.001). Among fetuses with SVCHD and ≥moderate AVVR, atrial distensibility was impaired in fetuses with adverse events compared to those without adverse events (p < 0.05). ROC analysis indicated that atrial distensibility exhibited a significant predictive value for composite adverse outcomes in fetal SVCHD with ≥moderate AVVR (area under the curve 0.90; p = 0.02). Quantitative assessment of atrial distensibility may have clinical utility in predicting the perinatal outcomes of fetal SVCHD with significant AVVR.

Discussion

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Cite This Study

Akazawa et al. (2026) conducted a cohort in Fetal single ventricle-type congenital heart disease (SVCHD) with atrioventricular valve regurgitation (AVVR) (n=60). Impaired atrial distensibility on fetal echocardiography vs. Normal or preserved atrial distensibility / No-mild AVVR vs >=moderate AVVR was evaluated on Composite adverse events (fetal demise, neonatal death of any cause, and surgery/early infantile valvuloplasty for AVVR due to heart failure within 2 months of birth) in fetuses with SVCHD and >=moderate AVVR (AUC 0.92, 95% CI 0.76-1.0, p=0.02). Atrial distensibility was lower in SVCHD fetuses with >=moderate AVVR having adverse events (0.19 vs 0.40, p=0.02) and predicted composite adverse outcomes (AUC 0.92, 95% CI 0.76-1.0).

synapsesocial.com/papers/6ae92596a8a6b2adf62f5fcf https://doi.org/10.1007/s00246-026-04535-2

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Atrial Distensibility Predicts Short-Term Prognosis in Fetal Single Ventricle-Type Congenital Heart Disease with Atrioventricular Valve Regurgitation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Atrial Distensibility Predicts Short-Term Prognosis in Fetal Single Ventricle-Type Congenital Heart Disease with Atrioventricular Valve Regurgitation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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