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Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction

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The Relationship between Cardiac Size and Shape Measurements and Cardiac Contractility in Intrauterine

Micaela K Roy¹, Emma E H Peek¹, Roopjit Sahi¹

¹Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA.

Fetal Diagnosis and Therapy

|January 19, 2026

Abstract

Introduction:

Fetal growth restriction (FGR) affects cardiac function and increases the risk of cardiac pathologies. We describe the relationship between cardiac contractility and cardiac size and shape in FGR and small for gestational age (SGA) fetuses to determine if ultrasound measurements can indicate functional cardiac sequelae.

Methods:

This prospective cohort study included fetuses with gestational ages of 23.0-39.0 weeks (FGR: n = 55, SGA: n = 40, appropriate for gestational age/AGA: n = 22). FGR was defined as fetuses with EFW <10th centile and abnormal arterial Doppler studies; SGA was defined as fetuses with EFW <10th centile with normal Doppler studies. Two-dimensional cardiac video clips of the 4-chamber view were obtained for all fetuses and measurements of its size and shape were made. Speckle-tracking measures of contractility were obtained as previously described. Individual size, shape, and speckle-tracking measurements were compared by ANOVA between FGR, SGA, and AGA groups. Comparisons by Mann-Whitney U were used to compare a combined FGR+SGA group with the AGA group for all measurements. Abnormality was determined by simple count of values >95th centile or <5th centile based on predicted effect of FGR/SGA on each measurement. Frequency was binary, with a fetus assigned a 1 if they had any abnormal measurement, and 0 if not. Severity was determined by summing the abnormal measurements. Frequency and severity were determined independently for contractility versus size and shape and compared across groups using chi-squared and ANOVA, respectively.

Results:

Most size and shape of and ventricular contractility variables were not significantly different between FGR and AGA fetuses, except for greater RV and LV global longitudinal strain in AGA fetuses. The LV mid-chamber diameter was significantly correlated with 3 out of 7 contractility variables (RV fractional area change, RV mid-chamber fractional shortening) and LV cardiac output.

Conclusions:

While there are some correlations between size and shape and contractility variables, no robust relationships were seen, suggesting the need for monitoring of both size and shape and contractility.

Keywords:

Cardiac contractility Cardiac shape Cardiac size Fetal growth restriction

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