[Fetal Heart Failure: Exploring Diagnosis and Treatment Strategies]

Area of Science:

• Cardiology
• Perinatology
• Biomarker Discovery

Background:

• Diagnosing fetal heart failure (FHF) severity is difficult with current ultrasonography methods.
• Established biomarkers for FHF in fetal blood, amniotic fluid, or maternal blood are lacking.
• Existing treatments for in utero heart failure and animal models are limited.

Purpose of the Study:

• Investigate natriuretic peptides (NPs) as biomarkers for FHF in umbilical cord blood and amniotic fluid.
• Assess maternal serum biomarkers for diagnosing FHF severity.
• Establish a murine model for FHF and evaluate tadalafil as a potential treatment.

Main Methods:

• Analyzed natriuretic peptides (ANP, BNP, NT-proBNP) in umbilical cord blood and amniotic fluid.
• Measured maternal serum levels of TNF-α, VEGF-D, and HB-EGF.
• Developed a Hrt2 knockout murine model for FHF using ultra-high-frequency ultrasound and tested tadalafil treatment.

Main Results:

• NP levels in cord blood and amniotic fluid show potential as FHF biomarkers.
• Maternal serum TNF-α, VEGF-D, and HB-EGF correlate with FHF severity.
• The Hrt2 KO embryo model demonstrated progressive left ventricular dilatation and reduced fractional shortening.
• Tadalafil treatment significantly improved left ventricular fractional shortening in Hrt2 KO embryos.

Conclusions:

• Natriuretic peptides and specific maternal serum factors are promising biomarkers for fetal heart failure.
• The Hrt2 knockout embryo serves as a viable model for studying FHF.
• Maternal tadalafil administration effectively improved fetal ventricular systolic function in the model, suggesting therapeutic potential.