Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.

INTRODUCTION: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the prognostic value of feto-placental data and prenatal echocardiography in the third...

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Autores: Nogué L, Bennasar M, Guirado L, Zölner F, Reitz J, Axt-Fliedner R, Escobar-Díaz MC, Martínez JM, Gratacós E, Crispi F, Gómez O
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Fundació Sant Joan de Déu
Repositorio:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:fsjd.fundanetsuite.com:p29791
Acceso en línea:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29791
Access Level:acceso abierto
Palabra clave:2D speckle tracking
congenital heart disease
cord blood angiogenic factors
fetal echocardiography
fetal growth restriction
placental dysfunction
strain
tetralogy of Fallot
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spelling Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.Nogué LBennasar MGuirado LZölner FReitz JAxt-Fliedner REscobar-Díaz MCMartínez JMGratacós ECrispi FGómez O2D speckle trackingcongenital heart diseasecord blood angiogenic factorsfetal echocardiographyfetal growth restrictionplacental dysfunctionstraintetralogy of FallotINTRODUCTION: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the prognostic value of feto-placental data and prenatal echocardiography in the third trimester in ToF and to compare these findings with a matched control population. MATERIAL AND METHODS: Multicenter prospective cohort study (2011-2023) at two referral centers (BCNatal and University Hospital of Gießen and Marburg). The cohort included 63 fetuses with isolated ToF and 66 healthy controls. All fetuses underwent a third trimester ultrasound and comprehensive echocardiography with 2D speckle tracking. Severe small-for-gestational age (SGA) was defined as estimated fetal weight (EFW) below the third percentile. Adverse composite outcomes were defined as the need for prostaglandin infusion, surgery or ductal stenting, corrective surgery before 3 months, and/or neonatal intensive care unit stay =7 days. The association of feto-placental and cardiac data with adverse composite outcome was evaluated. RESULTS: Compared with controls, ToF fetuses showed higher rates of severe SGA (19% vs. 0%, p < 0.001). Cardiac findings showed mild biventricular concentric hypertrophy (relative wall thickness ToF 0.7 [0.5-0.9] vs. controls 0.5 [0.5-0.6], p = 0.001), and reduced deformation (right and left ventricular global longitudinal strain: ToF -17.3% ± 3.8 vs. controls -19.3% ± 3.1, p = 0.001; ToF -18.0% ± 3.8 vs. controls -20.9% ± 3.45, p < 0.001), regardless of placental dysfunction. The adverse composite outcome occurred in 29.3% of ToF cases with pulmonary stenosis. Within this group, EFW <3rd centile (adjusted OR 9.17) and PV peak systolic velocity (aOR 1.03) showed the strongest association with adverse outcomes. Their combined performance yielded an AUC of 0.734, with a predictive value of 71.4% at a 20% false-positive rate. Assessed individually, the AUC was 0.650 for PV peak systolic velocity and 0.639 for estimated fetal weight. Optimal PV Doppler cutoff values were >70 cm/s when EFW was <3rd centile, and >144 cm/s when EFW was above the 3rd centile. CONCLUSIONS: Combining EFW with PV artery Doppler may allow identification of a high-risk subgroup of ToF-PS fetuses who may benefit from closer prenatal monitoring and prompt neonatal care.WILEY2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29791ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICAISSN: 00016349ISSNe: 16000412reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déuinstname:Fundació Sant Joan de DéuInglésinfo:eu-repo/semantics/openAccessoai:fsjd.fundanetsuite.com:p297912026-05-27T12:37:41Z
dc.title.none.fl_str_mv Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
title Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
spellingShingle Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
Nogué L
2D speckle tracking
congenital heart disease
cord blood angiogenic factors
fetal echocardiography
fetal growth restriction
placental dysfunction
strain
tetralogy of Fallot
title_short Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
title_full Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
title_fullStr Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
title_full_unstemmed Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
title_sort Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
dc.creator.none.fl_str_mv Nogué L
Bennasar M
Guirado L
Zölner F
Reitz J
Axt-Fliedner R
Escobar-Díaz MC
Martínez JM
Gratacós E
Crispi F
Gómez O
author Nogué L
author_facet Nogué L
Bennasar M
Guirado L
Zölner F
Reitz J
Axt-Fliedner R
Escobar-Díaz MC
Martínez JM
Gratacós E
Crispi F
Gómez O
author_role author
author2 Bennasar M
Guirado L
Zölner F
Reitz J
Axt-Fliedner R
Escobar-Díaz MC
Martínez JM
Gratacós E
Crispi F
Gómez O
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv 2D speckle tracking
congenital heart disease
cord blood angiogenic factors
fetal echocardiography
fetal growth restriction
placental dysfunction
strain
tetralogy of Fallot
topic 2D speckle tracking
congenital heart disease
cord blood angiogenic factors
fetal echocardiography
fetal growth restriction
placental dysfunction
strain
tetralogy of Fallot
description INTRODUCTION: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the prognostic value of feto-placental data and prenatal echocardiography in the third trimester in ToF and to compare these findings with a matched control population. MATERIAL AND METHODS: Multicenter prospective cohort study (2011-2023) at two referral centers (BCNatal and University Hospital of Gießen and Marburg). The cohort included 63 fetuses with isolated ToF and 66 healthy controls. All fetuses underwent a third trimester ultrasound and comprehensive echocardiography with 2D speckle tracking. Severe small-for-gestational age (SGA) was defined as estimated fetal weight (EFW) below the third percentile. Adverse composite outcomes were defined as the need for prostaglandin infusion, surgery or ductal stenting, corrective surgery before 3 months, and/or neonatal intensive care unit stay =7 days. The association of feto-placental and cardiac data with adverse composite outcome was evaluated. RESULTS: Compared with controls, ToF fetuses showed higher rates of severe SGA (19% vs. 0%, p < 0.001). Cardiac findings showed mild biventricular concentric hypertrophy (relative wall thickness ToF 0.7 [0.5-0.9] vs. controls 0.5 [0.5-0.6], p = 0.001), and reduced deformation (right and left ventricular global longitudinal strain: ToF -17.3% ± 3.8 vs. controls -19.3% ± 3.1, p = 0.001; ToF -18.0% ± 3.8 vs. controls -20.9% ± 3.45, p < 0.001), regardless of placental dysfunction. The adverse composite outcome occurred in 29.3% of ToF cases with pulmonary stenosis. Within this group, EFW <3rd centile (adjusted OR 9.17) and PV peak systolic velocity (aOR 1.03) showed the strongest association with adverse outcomes. Their combined performance yielded an AUC of 0.734, with a predictive value of 71.4% at a 20% false-positive rate. Assessed individually, the AUC was 0.650 for PV peak systolic velocity and 0.639 for estimated fetal weight. Optimal PV Doppler cutoff values were >70 cm/s when EFW was <3rd centile, and >144 cm/s when EFW was above the 3rd centile. CONCLUSIONS: Combining EFW with PV artery Doppler may allow identification of a high-risk subgroup of ToF-PS fetuses who may benefit from closer prenatal monitoring and prompt neonatal care.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29791
url https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=29791
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA
ISSN: 00016349
ISSNe: 16000412
reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname:Fundació Sant Joan de Déu
instname_str Fundació Sant Joan de Déu
reponame_str r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
collection r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.811543

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