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Peer-reviewedCC BY 4.0Fetal Diagnosis and Therapy

Prospective Assessment of Myocardial Deformation in Fetuses With Suspected Aortic Coarctation

  • Fleur Zwanenburg1,2
  • Janine Trigler-Rinner3
  • Renée M. Smit1,2
  • Renate Oberhoffer3
  • Annette Wacker-Gussmann3
  • Arend D.J. Ten Harkel2,4
  • Monique C. Haak1,2
4 affiliations
  1. 1Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
  3. 3Technical University of Munich, TUM School of Medicine and Health, German Heart Center, TUM University Hospital, Pediatric Cardiology and Congenital Heart Defects, Munich, Germany
  4. 4Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract

Introduction: Prenatal identification of true aortic coarctation (CoA) remains challenging, as evidenced by high false-positive rates. Myocardial deformation has been proposed to improve prediction of postnatal outcome. This prospective study aimed to determine whether fetal myocardial deformation analysis can differentiate true CoA from false-positive cases throughout gestation.

Methods: All fetuses with a prenatal suspicion of isolated CoA were prospectively recruited at our fetal cardiology services. Cases were classified as true CoA or false-positives based on their postnatal diagnosis. Speckle-tracking echocardiography was performed longitudinally to assess left and right ventricular global longitudinal strain (GLS), strain rate, and segmental strain throughout gestation. Measurements were compared between true CoA and false-positive cases.

Results: Thirty-eight fetuses were included (19 true CoA and 19 false-positive cases). True CoA cases exhibited smaller left-sided cardiac dimensions, including the aortic valve (mean Z-score −3.2 vs. −1.6, p < 0.001), aortic isthmus (−3.5 vs. −1.7, p = 0.001), and mitral valve (−4.9 vs. −3.1, p < 0.001), whereas right-sided cardiac dimensions were comparable (pulmonary valve Z-score 3.0 vs. 2.6, p = 0.64; arterial duct Z-score 1.9 vs. 3.2, p = 0.61). No clinically relevant differences in myocardial deformation parameters were observed between groups, with similar left ventricular GLS (−20.1% vs. −20.5%, p = 0.57), right ventricular GLS (−20.0% vs. −19.1%, p = 0.13), strain rates, and segmental strain.

Conclusion: Fetal myocardial deformation analysis does not provide additional predictive value for postnatal outcome in prenatally suspected isolated CoA. Conventional assessment of cardiac dimensions and flow patterns remains the cornerstone of prenatal CoA diagnosis, yet current imaging modalities cannot provide sufficient diagnostic certainty to safely triage perinatal management.

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Cite

BibTeXRIS
BibTeX
@article{zwanenburg2026prospective,
  title = {{Prospective Assessment of Myocardial Deformation in Fetuses With Suspected Aortic Coarctation}},
  author = {Fleur Zwanenburg and Janine Trigler-Rinner and Renée M. Smit and Renate Oberhoffer and Annette Wacker-Gussmann and Arend D.J. Ten Harkel and Monique C. Haak},
  journal = {Fetal Diagnosis and Therapy},
  year = {2026},
  month = oct,
  doi = {10.1159/fdt/acuag016},
  url = {https://doi.org/10.1159/fdt/acuag016},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Prospective Assessment of Myocardial Deformation in Fetuses With Suspected Aortic Coarctation
AU  - Fleur Zwanenburg
AU  - Janine Trigler-Rinner
AU  - Renée M. Smit
AU  - Renate Oberhoffer
AU  - Annette Wacker-Gussmann
AU  - Arend D.J. Ten Harkel
AU  - Monique C. Haak
PY  - 2026
DA  - 2026/10/12
JO  - Fetal Diagnosis and Therapy
DO  - 10.1159/fdt/acuag016
UR  - https://doi.org/10.1159/fdt/acuag016
AB  - Introduction: Prenatal identification of true aortic coarctation (CoA) remains challenging, as evidenced by high false-positive rates. Myocardial deformation has been proposed to improve prediction of postnatal outcome. This prospective study aimed to determine whether fetal myocardial deformation analysis can differentiate true CoA from false-positive cases throughout gestation.  Methods: All fetuses with a prenatal suspicion of isolated CoA were prospectively recruited at our fetal cardiology services. Cases were classified as true CoA or false-positives based on their postnatal diagnosis. Speckle-tracking echocardiography was performed longitudinally to assess left and right ventricular global longitudinal strain (GLS), strain rate, and segmental strain throughout gestation. Measurements were compared between true CoA and false-positive cases.  Results: Thirty-eight fetuses were included (19 true CoA and 19 false-positive cases). True CoA cases exhibited smaller left-sided cardiac dimensions, including the aortic valve (mean Z-score −3.2 vs. −1.6, p < 0.001), aortic isthmus (−3.5 vs. −1.7, p = 0.001), and mitral valve (−4.9 vs. −3.1, p < 0.001), whereas right-sided cardiac dimensions were comparable (pulmonary valve Z-score 3.0 vs. 2.6, p = 0.64; arterial duct Z-score 1.9 vs. 3.2, p = 0.61). No clinically relevant differences in myocardial deformation parameters were observed between groups, with similar left ventricular GLS (−20.1% vs. −20.5%, p = 0.57), right ventricular GLS (−20.0% vs. −19.1%, p = 0.13), strain rates, and segmental strain.  Conclusion: Fetal myocardial deformation analysis does not provide additional predictive value for postnatal outcome in prenatally suspected isolated CoA. Conventional assessment of cardiac dimensions and flow patterns remains the cornerstone of prenatal CoA diagnosis, yet current imaging modalities cannot provide sufficient diagnostic certainty to safely triage perinatal management.
SN  - 1015-3837
SN  - 1421-9964
ER  -