Abstract
BACKGROUND: Hypertensive disorders of pregnancy (HDP) are associated with adverse outcomes for both the mother and fetus, including impaired fetal cardiac development and function. Accurate assessment of fetal heart morphology and function is essential for the early detection and management of potential complications. This study investigated the clinical application value of fetal heart quantification (Fetal HQ) technology in evaluating the cardiac morphology and function in fetuses from pregnancies affected by HDP. METHODS: This prospective study examined 43 fetuses from singleton pregnancies complicated by HDP [mean gestational age (GA) 29.5±2.8 weeks] and 50 fetuses from normal pregnancies (mean GA 29.2±2.4 weeks). All participants underwent fetal ultrasonography from August 2023 to July 2024. Fetal HQ technology, incorporating two-dimensional speckle-tracking echocardiography (2D-STE) with quantitative analysis of cardiac segments, was used to assess heart size, shape, ventricular structure, contractility, and function. RESULTS: The HDP group exhibited significantly altered maternal clinical characteristics, including higher maternal weight, BMI, and blood pressure. Fetal cardiac morphometry indicated that compared to the control group, the HDP group had larger left ventricular (LV) dimensions yet lower volumes but had smaller right ventricular (RV) dimensions. Notably, compared with the control group, the HDP group had a larger LV end-diastolic (ED) area (2.52±0.88 vs. 1.92±0.62 cm(2); P<0.001) and ED length (2.35±0.37 vs. 1.89±0.33 cm; P<0.001) but a smaller LV ED volume (2.17±0.83 vs. 3.09±0.69 mL; P<0.001). Additionally, the HDP group exhibited significantly higher LV global strain (-30.53%±9.88% vs. -25.22%±8.33%; P=0.006), indicating altered cardiac function. The 24-segment analysis revealed notable alterations in ventricular geometry and function within the HDP group, with lower sphericity index (SI) and fractional shortening (FS) values across various segments of both ventricles. These findings closely align with the results of the Z score analysis, further highlighting the extent of cardiac dysfunction. CONCLUSIONS: Fetal HQ technology effectively identified significant alterations in fetal heart structure and function in pregnancies complicated by HDP. These findings suggest that Fetal HQ is a useful tool for the early detection of fetal heart abnormalities and can facilitate timely intervention and accurate prognosis in affected pregnancies.