Efficacy of fetal cardiac axis evaluation in the first trimester as a screening tool for congenital heart defect or aneuploidy

초록

ObjectiveTo prove the efficacy of determining the abnormal fetal cardiac axis for screening congenital heart defects (CHDs) andpredicting fetal aneuploidy at 11.0 to 13.6 weeks of pregnancy. MethodsThis retrospective study was performed at a single high-risk pregnancy center. The fetal cardiac axis was evaluatedbetween 11.0 and 13.6 weeks of gestation in 142 fetuses. The cardiac axis in a 4-chamber view was measured as theangle between the line tracing the long axis of the heart and the line bisecting the thorax in the anteroposteriordirection. A CHD was confirmed based on the second- to third-trimester fetal status or postnatal imaging. Aneuploidywas diagnosed using chorionic villus sampling, amniocentesis, or genetic testing after birth. Fisher’s exact test wasperformed to assess the association between the fetal cardiac axis and the abnormal fetal status. A 2-way contingencetable analysis was performed to confirm the efficacy of the fetal cardiac axis as a screening tool. ResultsAmong the 142 fetuses, 10 had a CHD while 17 had aneuploidy. The abnormal fetal cardiac axis was significantlyassociated with CHDs (P=0.013) and aneuploidy (P=0.010). None of the fetuses with CHDs or aneuploidy had anisolated abnormal cardiac axis alone without other sonographic findings. The sensitivity of the fetal cardiac axis was50.0% for CHDs and 41.2% for aneuploidy. ConclusionThe fetal cardiac axis can be an additional helpful tool for prenatal screening of CHDs and aneuploidy in the firsttrimester.

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