L Noben1,2, C Lempersz1,2, E R van den Heuvel3, Z Zhan3, F P H A Vandenbussche4, A B C Coumans5, M C Haak6, R Vullings1,7, S G Oei1,2,7, S A B Clur8, J O E H van Laar1,2,8. 1. Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands. 2. Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands. 3. Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands. 4. Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands. 6. Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. 8. Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Abstract
OBJECTIVES: To determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation. METHODS: Non-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection. RESULTS: The MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02). The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively. CONCLUSION: The MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect. TRIAL REGISTRATION: Clinical trial registration number: NL48535.015.14.
OBJECTIVES: To determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation. METHODS: Non-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection. RESULTS: The MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02). The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively. CONCLUSION: The MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect. TRIAL REGISTRATION: Clinical trial registration number: NL48535.015.14.
Authors: Rik Vullings; Chris H L Peters; Iman Mossavat; S Guid Oei; Jan W M Bergmans Journal: IEEE Trans Biomed Eng Date: 2009-10-20 Impact factor: 4.538
Authors: A Galindo; A Mendoza; J Arbues; A Grañeras; D Escribano; O Nieto Journal: Eur J Obstet Gynecol Reprod Biol Date: 2009-05-29 Impact factor: 2.435
Authors: Carlijn Lempersz; Lore Noben; Sally-Ann B Clur; Edwin van den Heuvel; Zhouzhao Zhan; Monique Haak; S Guid Oei; Rik Vullings; Judith O E H van Laar Journal: PLoS One Date: 2021-12-16 Impact factor: 3.240