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Estimated cardiac output and cardiovascular profile score in fetuses with high cardiac output lesions
C J Statile1, J F Cnota, S Gomien
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Insights
High cardiac output lesions in fetuses are linked to worsening cardiovascular status, indicated by a lower cardiovascular profile score (CVPS). This score may help identify fetuses at higher risk for adverse outcomes.
Area of Science:
- Fetal Cardiology
- Perinatal Medicine
- Medical Imaging
Background:
- High cardiac output lesions in fetuses increase the risk of fetal death due to cardiac failure and hydrops fetalis.
- The cardiovascular profile score (CVPS) assesses fetal cardiovascular wellbeing and predicts outcomes in various conditions.
- Elevated combined cardiac output (CCO) may indicate compromised fetal cardiovascular status.
Purpose of the Study:
- To investigate the relationship between elevated combined cardiac output (CCO) and cardiovascular status in fetuses with high output lesions.
- To determine if a lower cardiovascular profile score (CVPS) is associated with increased CCO in this population.
- To evaluate the utility of CVPS in risk stratification for fetuses with high output lesions.
Main Methods:
- Retrospective review of fetal echocardiography data from July 2006 to November 2010.
- Included fetuses diagnosed with high output lesions such as sacrococcygeal teratoma, placental chorioangioma, and vein of Galen aneurysm.
- Assessed CVPS and estimated combined cardiac output indexed to fetal weight (CCOi), analyzing their relationship.
Main Results:
- A significant inverse relationship was observed between mean logCCOi and CVPS (r² = 0.48, P = 0.008) in 35 fetuses.
- Fetuses experiencing in-utero demise or intervention (10/31) predominantly had a CVPS < 8 (80%).
- Sacrococcygeal teratoma was the most common diagnosis (27/35).
Conclusions:
- An inverse relationship exists between combined cardiac output and cardiovascular profile score in fetuses with high output lesions.
- The CVPS may serve as a valuable tool for assessing fetal cardiovascular wellbeing in this cohort.
- CVPS can aid in risk stratification and guiding interventions for fetuses with high output lesions.
Objective:
High cardiac output lesions are associated with an increased risk of fetal death, largely as a result of cardiac failure and hydrops fetalis. The cardiovascular profile score (CVPS) has been used to characterize cardiovascular wellbeing, and has been linked to fetal outcomes in other conditions. We aimed to test the hypothesis that elevated combined cardiac output (CCO) in fetuses with high output lesions may be associated with worsening cardiovascular status, as evidenced by a lower CVPS.
Methods:
A retrospective review was performed of fetuses with high cardiac output lesions that underwent echocardiography between July 2006 and November 2010. Diagnoses included sacrococcygeal teratoma, placental chorioangioma and vein of Galen aneurysm. Fetal echocardiographic evaluation included assessment of CVPS, as well as Doppler/two-dimensional estimation of CCO, indexed to estimated fetal weight (CCOi). The relationship between CCO and CVPS was assessed.
Results:
A total of 35 fetuses were studied: 27 had sacrococcygeal teratoma, seven had chorioangioma and one had vein of Galen aneurysm. There was a significant inverse relationship between mean logCCOi and CVPS (r2 = 0.48, P = 0.008). Of 31 patients with clinical outcome data, 10 experienced either in-utero demise or intervention; 80% of these fetuses had a CVPS of < 8.
Conclusions:
There is an inverse relationship between CCO and CVPS in the fetus with high cardiac output lesions. As a measure of fetal cardiovascular wellbeing in this population, the CVPS may be a useful tool for stratifying risk and for selection for intervention in these fetuses.
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