TY - JOUR
T1 - The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography
AU - Noben, L.
AU - Lempersz, C.
AU - van den Heuvel, E. R.
AU - Zhan, Z.
AU - Vandenbussche, F. P. H. A.
AU - Coumans, A. B. C.
AU - Haak, M. C.
AU - Vullings, R.
AU - Oei, S. G.
AU - Clur, S. A. B.
AU - van Laar, J. O. E. H.
N1 - Funding Information: The authors would like to express their gratitude to N. Eijsvoogel, D. Aben, O. Hulsenboom, M. Sengers, J. Drinkwaard, C. van den Oord, M. van Wierst, L. Cornelissen, C. de Vet and M. van Bruggen for their role in the data collection. Publisher Copyright: © 2022 Noben et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85140285005&partnerID=8YFLogxK
U2 - https://doi.org/10.1371/journal.pone.0275802
DO - https://doi.org/10.1371/journal.pone.0275802
M3 - Article
C2 - 36264863
SN - 1932-6203
VL - 17
SP - e0275802
JO - PLOS ONE
JF - PLOS ONE
IS - 10 October
M1 - e0275802
ER -