EP09.54: Influence of intrauterine angiogenesis imbalance in fetal cardiac development

Given the detrimental impact of placental dysfunction on fetal cardiac development, our objective was to investigate the relationship between placental angiogenic factors, placental growth factor (PlGF) and soluble Fms-like tyrosine kinase-1 (sFlt-1), and fetal cardiac structure and function, as assessed by ultrasound in the third trimester of gestation. This prospective study involved healthy pregnant women with singleton pregnancies and no evidence of fetal structural cardiovascular disease. All women underwent fetal biometric measurements, Doppler evaluation, and structural and functional echocardiography between 29 and 36 weeks of gestation. Angiogenic factor levels were determined during the same time period, with a difference of less than one week from the ultrasound examination. A non-parametric Spearman correlation coefficient was utilised to determine the relationship between variables. A significance level of 5% (p = 0.05) was established. A total of 490 patients were included in the study, with a mean gestational age at scan of 31.6 ± 1.1 weeks. sFlt-1 levels were found to be significantly associated with ventricular and atrial areas [left ventricle correlation coefficient (CC) 0.125, p = 0.021], right ventricle [CC 0.116, p = 0.032], right atrium [CC 0.147, p = 0.007]; with left A wave velocity peak [CC -0.130, p = 0.014] and right A wave velocity peak [CC -0.119, p = 0.026]; isovolumetric contraction time [CC 0.115, p = 0.034]; myocardial performance index [CC 0.114, p = 0.035]; and outflow tracts' diameter [aorta artery CC 0.177, p = 0.001] and [pulmonary artery CC 0.146, p = 0.006]. However, no significant differences were observed with fetal biometries, fetal Doppler evaluation, or cardiac longitudinal function evaluated by M-mode and speckle tracking. Imbalance in intrauterine angiogenesis may contribute to structural and functional changes in fetal cardiac development found in the third trimester of gestation.