Abstract：
BACKGROUND: Fetuses with cyanotic congenital heart disease (CHD) exhibit profound fetal circulatory disturbances that may affect early outcomes.
OBJECTIVE: This study sought to investigate the relationship between fetal hemodynamics and early survival and neurodevelopmental (ND) outcomes in patients with cyanotic CHD.
METHODS: In this longitudinal observational study, fetuses with cyanotic CHD underwent late gestational fetal cardiovascular magnetic resonance (CMR) to measure vessel blood flow and oxygen content. Superior vena cava (SVC) flow was used as a proxy for cerebral blood flow. Primary outcomes were 18-month mortality and Bayley Scales of Infant Development-III assessment.
RESULTS: A total of 144 fetuses with cyanotic CHD were assessed. By 18 months, 18 patients (12.5%) died. Early mortality was associated with reduced combined ventricular output (P = 0.01), descending aortic flow (P = 0.04), and umbilical vein flow (P = 0.03). Of the surviving patients, 71 had ND outcomes assessed. Cerebral oxygen delivery was the fetal hemodynamic variable most strongly associated with cognitive, language, and motor outcomes (P < 0.05). Fetal SVC flow was also associated with cognitive, language, and motor outcomes (P < 0.01), and it remained an independent predictor of cognitive (P = 0.002) and language (P = 0.04) outcomes after adjusting for diagnosis. Diminished SVC flow also performed better than other fetal CMR and echocardiographic predictors of cognitive ND delay (receiver-operating characteristic curve area: 0.85; SE 0.05).
CONCLUSIONS: Among fetuses with cyanotic CHD, diminished fetal combined ventricular output is associated with mortality, whereas cerebral blood flow and oxygen delivery are associated with early cognitive, language, and motor development at 18 months of age. These results support the inclusion of fetal CMR to help identify patients at risk of adverse ND outcomes.
OBJECTIVE: This study sought to investigate the relationship between fetal hemodynamics and early survival and neurodevelopmental (ND) outcomes in patients with cyanotic CHD.
METHODS: In this longitudinal observational study, fetuses with cyanotic CHD underwent late gestational fetal cardiovascular magnetic resonance (CMR) to measure vessel blood flow and oxygen content. Superior vena cava (SVC) flow was used as a proxy for cerebral blood flow. Primary outcomes were 18-month mortality and Bayley Scales of Infant Development-III assessment.
RESULTS: A total of 144 fetuses with cyanotic CHD were assessed. By 18 months, 18 patients (12.5%) died. Early mortality was associated with reduced combined ventricular output (P = 0.01), descending aortic flow (P = 0.04), and umbilical vein flow (P = 0.03). Of the surviving patients, 71 had ND outcomes assessed. Cerebral oxygen delivery was the fetal hemodynamic variable most strongly associated with cognitive, language, and motor outcomes (P < 0.05). Fetal SVC flow was also associated with cognitive, language, and motor outcomes (P < 0.01), and it remained an independent predictor of cognitive (P = 0.002) and language (P = 0.04) outcomes after adjusting for diagnosis. Diminished SVC flow also performed better than other fetal CMR and echocardiographic predictors of cognitive ND delay (receiver-operating characteristic curve area: 0.85; SE 0.05).
CONCLUSIONS: Among fetuses with cyanotic CHD, diminished fetal combined ventricular output is associated with mortality, whereas cerebral blood flow and oxygen delivery are associated with early cognitive, language, and motor development at 18 months of age. These results support the inclusion of fetal CMR to help identify patients at risk of adverse ND outcomes.
摘要：
背景：紫红色先天性心脏病（CHD）胎儿表现出严重的胎儿循环障碍，可能影响早期结局。
目的：本研究旨在探讨紫红色CHD患者的胎儿血流动力学与早期生存和神经发育（ND）结局之间的关系。
方法：在这项纵向观察研究中，紫红色CHD胎儿在妊娠晚期接受胎儿心血管磁共振(CMR)检测血管血流量和氧含量.上腔静脉（SVC）流量用作脑血流量的代表。主要结果是18个月死亡率和Bayley婴儿发育量表-III评估。
结果：共评估了144例紫红色CHD胎儿。到18个月,18例（12.5%）死亡。早期死亡率与合并心室输出量减少相关(P=0.01),降主动脉血流（P=0.04），和脐静脉血流（P=0.03）。幸存的病人中，71人评估了ND结果。脑氧分娩是与认知最密切相关的胎儿血流动力学变量，语言,和运动结局(P<0.05)。胎儿SVC流量也与认知相关，语言,和运动结果(P<0.01)，在调整诊断后,它仍然是认知(P=0.002)和语言(P=0.04)结局的独立预测因子.SVC流量减少的表现也优于其他胎儿CMR和超声心动图预测的认知ND延迟（受试者工作特征曲线面积：0.85；SE0.05）。
结论：在患有紫红色CHD的胎儿中，胎儿合并心室输出量减少与死亡率相关,而脑血流量和氧气输送与早期认知有关，语言,和运动发育在18个月大。这些结果支持纳入胎儿CMR以帮助识别有不良ND结局风险的患者。
目的：本研究旨在探讨紫红色CHD患者的胎儿血流动力学与早期生存和神经发育（ND）结局之间的关系。
方法：在这项纵向观察研究中，紫红色CHD胎儿在妊娠晚期接受胎儿心血管磁共振(CMR)检测血管血流量和氧含量.上腔静脉（SVC）流量用作脑血流量的代表。主要结果是18个月死亡率和Bayley婴儿发育量表-III评估。
结果：共评估了144例紫红色CHD胎儿。到18个月,18例（12.5%）死亡。早期死亡率与合并心室输出量减少相关(P=0.01),降主动脉血流（P=0.04），和脐静脉血流（P=0.03）。幸存的病人中，71人评估了ND结果。脑氧分娩是与认知最密切相关的胎儿血流动力学变量，语言,和运动结局(P<0.05)。胎儿SVC流量也与认知相关，语言,和运动结果(P<0.01)，在调整诊断后,它仍然是认知(P=0.002)和语言(P=0.04)结局的独立预测因子.SVC流量减少的表现也优于其他胎儿CMR和超声心动图预测的认知ND延迟（受试者工作特征曲线面积：0.85；SE0.05）。
结论：在患有紫红色CHD的胎儿中，胎儿合并心室输出量减少与死亡率相关,而脑血流量和氧气输送与早期认知有关，语言,和运动发育在18个月大。这些结果支持纳入胎儿CMR以帮助识别有不良ND结局风险的患者。
