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JACC Heart Fail. 2014 Aug;2(4):403-11. doi: 10.1016/j.jchf.2014.02.010. Epub 2014 Jul 9.

Spectrum and outcome of primary cardiomyopathies diagnosed during fetal life.

Author information

1
Fetal Cardiac Program, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
2
Heart Failure Program, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
3
Prenatal Diagnosis and Medical Genetics Programs, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada.
4
Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada.
5
Fetal Cardiac Program, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: edgar.jaeggi@sickkids.ca.

Abstract

OBJECTIVES:

The purpose of this study was to determine the phenotypic presentation, causes, and outcome of fetal cardiomyopathy (CM) and to identify early predictors of outcome.

BACKGROUND:

Although prenatal diagnosis is possible, there is a paucity of information about fetal CM.

METHODS:

This was a retrospective review of 61 consecutive fetal cases with a diagnosis of CM at a single center between 2000 and 2012.

RESULTS:

Nonhypertrophic CM (NHCM) was diagnosed in 40 and hypertrophic CM (HCM) in 21 fetuses at 24.7 ± 5.7 gestational weeks. Etiologies included familial (13%), inflammatory (15%), and genetic-metabolic (28%) disorders, whereas 44% were idiopathic. The pregnancy was terminated in 13 of 61 cases (21%). Transplantation-free survival from diagnosis to 1 month and 1 year of life for actively managed patients was better in those with NHCM (n = 31; 58% and 58%, respectively) compared with those with HCM (n = 17; 35% and 18%, respectively; hazard ratio [HR]: 0.44; 95% confidence interval [CI]: 0.12 to 0.72; p = 0.007). Baseline echocardiographic variables associated with mortality in actively managed patients included ventricular septal thickness (HR: 1.21 per z-score increment; 95% CI: 1.07 to 1.36; p = 0.002), cardiothoracic area ratio (HR: 1.06 per percent increment; 95% CI: 1.02 to 1.10; p = 0.006), ≥3 abnormal diastolic Doppler flow indexes (HR: 1.44; 95% CI: 1.07 to 1.95; p = 0.02), gestational age at CM diagnosis (HR: 0.91 per week increment; 95% CI: 0.83 to 0.99; p = 0.03), and, for fetuses in sinus rhythm, a lower cardiovascular profile score (HR: 1.45 per point decrease; 95% CI: 1.16 to 1.79; p = 0.001).

CONCLUSIONS:

Fetal CM originates from a broad spectrum of etiologies and is associated with substantial mortality. Early echocardiographic findings appear useful in predicting adverse perinatal outcomes.

KEYWORDS:

cardiomyopathy; echocardiography; fetal; noncompaction; outcome

PMID:
25023818
DOI:
10.1016/j.jchf.2014.02.010
[Indexed for MEDLINE]
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