Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
Por:
Nogué L, Mar Bennasar Sans, Guirado L, Zölner F, Reitz J, Axt-Fliedner R, Escobar MC, Martínez JM, Gratacós E, Crispi F and Gómez del Rincón O
Publicada:
1 mar 2026
Ahead of Print:
28 ene 2026
Resumen:
INTRODUCTION: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the prognostic value of feto-placental data and prenatal echocardiography in the third trimester in ToF and to compare these findings with a matched control population. MATERIAL AND METHODS: Multicenter prospective cohort study (2011-2023) at two referral centers (BCNatal and University Hospital of Gießen and Marburg). The cohort included 63 fetuses with isolated ToF and 66 healthy controls. All fetuses underwent a third trimester ultrasound and comprehensive echocardiography with 2D speckle tracking. Severe small-for-gestational age (SGA) was defined as estimated fetal weight (EFW) below the third percentile. Adverse composite outcomes were defined as the need for prostaglandin infusion, surgery or ductal stenting, corrective surgery before 3 months, and/or neonatal intensive care unit stay =7 days. The association of feto-placental and cardiac data with adverse composite outcome was evaluated. RESULTS: Compared with controls, ToF fetuses showed higher rates of severe SGA (19% vs. 0%, p < 0.001). Cardiac findings showed mild biventricular concentric hypertrophy (relative wall thickness ToF 0.7 [0.5-0.9] vs. controls 0.5 [0.5-0.6], p = 0.001), and reduced deformation (right and left ventricular global longitudinal strain: ToF -17.3% ± 3.8 vs. controls -19.3% ± 3.1, p = 0.001; ToF -18.0% ± 3.8 vs. controls -20.9% ± 3.45, p < 0.001), regardless of placental dysfunction. The adverse composite outcome occurred in 29.3% of ToF cases with pulmonary stenosis. Within this group, EFW <3rd centile (adjusted OR 9.17) and PV peak systolic velocity (aOR 1.03) showed the strongest association with adverse outcomes. Their combined performance yielded an AUC of 0.734, with a predictive value of 71.4% at a 20% false-positive rate. Assessed individually, the AUC was 0.650 for PV peak systolic velocity and 0.639 for estimated fetal weight. Optimal PV Doppler cutoff values were >70 cm/s when EFW was <3rd centile, and >144 cm/s when EFW was above the 3rd centile. CONCLUSIONS: Combining EFW with PV artery Doppler may allow identification of a high-risk subgroup of ToF-PS fetuses who may benefit from closer prenatal monitoring and prompt neonatal care.
Filiaciones:
:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Mar Bennasar Sans:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Zölner F:
Division of Perinatal Medicine and Fetal Therapy, Universitätsklinikum Gießen and Marburg, Gießen, Germany
Reitz J:
Division of Perinatal Medicine and Fetal Therapy, Universitätsklinikum Gießen and Marburg, Gießen, Germany
Axt-Fliedner R:
Division of Perinatal Medicine and Fetal Therapy, Universitätsklinikum Gießen and Marburg, Gießen, Germany
Escobar MC:
Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
Cardiovascular Research Group, Sant Joan de Deu Research Institute, Esplugues de Llobregat, Barcelona, Spain
Martínez JM:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Gratacós E:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
Crispi F:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
Gómez del Rincón O:
BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Open Access
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