The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography

L Noben; C Lempersz; E R van den Heuvel; Z Zhan; F P H A Vandenbussche; A B C Coumans; M C Haak; R Vullings; S G Oei; S A B Clur; J O E H van Laar

doi:10.1371/journal.pone.0275802

The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography

L Noben^*, C Lempersz, E R van den Heuvel, Z Zhan, F P H A Vandenbussche, A B C Coumans, M C Haak, R Vullings, S G Oei, S A B Clur, J O E H van Laar

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Article number	e0275802
Pages (from-to)	e0275802
Number of pages	15
Journal	PLOS ONE
Volume	17
Issue number	10
DOIs	https://doi.org/10.1371/journal.pone.0275802
Publication status	Published - 20 Oct 2022

Keywords

Humans
Pregnancy
Female
Heart Defects, Congenital/diagnostic imaging
Heart Septal Defects
Fetus
Electrocardiography
Ultrasonography, Prenatal
Fetal Heart/diagnostic imaging

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Noben, L., Lempersz, C., van den Heuvel, E. R., Zhan, Z., Vandenbussche, F. P. H. A., Coumans, A. B. C., Haak, M. C., Vullings, R., Oei, S. G., Clur, S. A. B., & van Laar, J. O. E. H. (2022). The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography. PLOS ONE, 17(10), e0275802. Article e0275802. https://doi.org/10.1371/journal.pone.0275802

@article{48798adf90d44f55a469eb1e9ae67db3,

title = "The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography",

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.",

keywords = "Humans, Pregnancy, Female, Heart Defects, Congenital/diagnostic imaging, Heart Septal Defects, Fetus, Electrocardiography, Ultrasonography, Prenatal, Fetal Heart/diagnostic imaging",

author = "L Noben and C Lempersz and {van den Heuvel}, {E R} and Z Zhan and Vandenbussche, {F P H A} and Coumans, {A B C} and Haak, {M C} and R Vullings and Oei, {S G} and Clur, {S A B} and {van Laar}, {J O E H}",

note = "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: {\textcopyright} 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.",

year = "2022",

month = oct,

day = "20",

doi = "10.1371/journal.pone.0275802",

language = "English",

volume = "17",

pages = "e0275802",

journal = "PLOS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "10",

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Noben, L, Lempersz, C, van den Heuvel, ER, Zhan, Z, Vandenbussche, FPHA, Coumans, ABC, Haak, MC, Vullings, R, Oei, SG, Clur, SAB & van Laar, JOEH 2022, 'The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography', PLOS ONE, vol. 17, no. 10, e0275802, pp. e0275802. https://doi.org/10.1371/journal.pone.0275802

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 - 2022/10/20

Y1 - 2022/10/20

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.TRIAL REGISTRATION: Clinical trial registration number: NL48535.015.14.

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.TRIAL REGISTRATION: Clinical trial registration number: NL48535.015.14.

KW - Humans

KW - Pregnancy

KW - Female

KW - Heart Defects, Congenital/diagnostic imaging

KW - Heart Septal Defects

KW - Fetus

KW - Electrocardiography

KW - Ultrasonography, Prenatal

KW - Fetal Heart/diagnostic imaging

U2 - 10.1371/journal.pone.0275802

DO - 10.1371/journal.pone.0275802

M3 - Article

C2 - 36264863

SN - 1932-6203

VL - 17

SP - e0275802

JO - PLOS ONE

JF - PLOS ONE

IS - 10

M1 - e0275802

ER -