OP05.02: Cardiac remodelling in late‐onset fetal growth restriction: any relation between the phenotype of cardiac remodelling and speckle tracking fetal echocardiography?

To investigate the patterns of cardiac remodelling in fetuses with late-onset fetal growth restriction (FGR) and evaluate the fetal cardiac function using speckle tracking fetal echocardiography (STE) with respect to the cardiac remodelling phenotype. Single-centre prospective study conducted on singleton pregnancies complicated by suspected late-onset FGR. Two-dimensional ultrasound clips of the 4-chamber view of the fetal heart were prospectively collected and offline analysed using STE by one single member, who also performed the measurement of the cardiac biometric indices. These latter were then analysed using hierarchical cluster analysis to identify possible subgroups of cardiac remodelling phenotypes within. 54 cases and 166 ultrasound clips were included. Hierarchical cluster analysis showed the presence of three distinct cardiac remodelling phenotypes: phenotype 1, corresponding to a morphologically normal heart (13 cases, 24%); phenotype 2, corresponding to a morphologically elongated heart (23 cases, 43%); phenotype 3, corresponding to a morphologically globular heart (18 cases, 33%). The comparison of the cardiac functional parameters using STE showed a higher left ventricular strain in phenotype 1 compared to phenotype 2 [LV MyoGLS (-18.14 ± 3.90 vs -16.74 ± 2.80, p = 0.02), LV EndoGLS (-22.12 ± 4.29 vs -20.34 ± 3.35, p = 0.02)], furthermore LV MyoGLS was higher in phenotype 1 compared to phenotype 3 (-18.14 ± 3.90 vs -15.48 ± 4.15, p = 0.01). A higher right ventricular strain was also demonstrated by the higher RV MyoGLS in phenotype 1 compared to phenotype 2 (-15.94 ± 3.78 vs -13.61 ± 3.91, p = 0.01) and in phenotype 1 compared to phenotype 3 (-15.94 ± 3.78 vs -13.40 ± 4.16, p = 0.01). This study has shown the existence of three distinct cardiac remodelling phenotypes in fetuses with suspected late-onset FGR. Such morphological phenotypes are associated with differences in terms of right and left ventricular strain which can be demonstrated using STE.