Comparison of the left and right ventricular size and systolic function of low-risk fetuses in the third trimester: Which is more dominant?

Chen Zhu; Man Li; Cheng-Jie Xu; Meng-Juan Ding; Yu Xiong; Rui Liu; Yun-Yun Ren

doi:10.3389/fcvm.2023.1052178

Comparison of the left and right ventricular size and systolic function of low-risk fetuses in the third trimester: Which is more dominant?

Front Cardiovasc Med. 2023 Mar 17:10:1052178. doi: 10.3389/fcvm.2023.1052178. eCollection 2023.

Authors

Chen Zhu¹, Man Li¹, Cheng-Jie Xu², Meng-Juan Ding¹, Yu Xiong³, Rui Liu¹, Yun-Yun Ren¹

Affiliations

¹ Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
² Department of Information Technology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
³ Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.

Abstract

Objective: To quantify fetal cardiovascular parameters utilizing fetal-specific 2D speckle tracking technique and to explore the differences in size and systolic function of the left and right ventricles in low-risk pregnancy.

Methods: A prospective cohort study was performed in 453 low-risk single fetuses (28⁺⁰-39⁺⁶ weeks) to evaluate ventricular size [i.e., end-diastolic length (EDL), end-systolic length (ESL), end-diastolic diameter (ED), end-systolic diameter (ES), end-diastolic area, end-systolic area, end-diastolic volume (EDV), and end-systolic volume (ESV)] and systolic function [i.e., ejection fraction (EF), stroke volume (SV), cardiac output (CO), cardiac output per kilogram (CO/KG), and stroke volume per kilogram (SV/KG)].

Results: This study showed that (1) the reproducibility of the interobserver and intraobserver measurements was good to excellent (ICC 0.626-0.936); (2) with advancing gestation, fetal ventricular size and systolic function increased, whereas right ventricular (RV) EF decreased and left ventricular (LV) EF was not significantly changed; (3) LV length was longer than RV length in diastole (2.24 vs. 1.96 cm, P < 0.001) and systole (1.72 vs. 1.52 cm, P < 0.001); (4) LV ED-S1 and ES-S1 were shorter than the RV ED-S1 and ES-S1 (12.87 vs. 13.43 mm, P < 0.001; 5.09 vs. 5.61 mm, P < 0.001); (5) there were no differences between the LV and RV in EDA or EDV; (6) the mean EDV ratio of right-to-left ventricle was 1.076 (95% CI, 1.038-1.114), and the mean ESV ratio was 1.628 (95% CI, 1.555-1.701); (7) the EF, CO and SV of the LV were greater than the RV (EF: 62.69% vs. 46.09%, P < 0.001; CO: 167.85 vs. 128.69 ml, P < 0.001; SV: 1.18 vs. 0.88 ml, P < 0.001); (8) SV and CO increased with ED-S1 and EDL, but EF was not significantly changed.

Conclusion: Low-risk fetal cardiovascular physiology is characterized by a larger RV volume (especially after 32 weeks) and greater LV outputs (EF, CO, SV, SV/KG and CO/KG).

Keywords: fetal echocardiography; fetal heart; fetalHQ; speckle tracking; systolic function; ultrasound; ventricular size.

Grants and funding

This work was supported by the special project of clinical research of the health industry of Shanghai Municipal Health Commission (No. 202140217) and the Ultrasound Branch of China Medical Doctor Association, China Ultrasound Physician “Science and Technology Rising Star” Project (No. KJXX2020004).