Is Cardiomegaly an Indication of "heart-Sparing Effect" in Small Fetuses?

Silvia Salvi, Sara De Carolis, Antonio Lanzone, Laura D'Emidio, Michael Roughton, Amar Bhide, Julene S. Carvalho

Research output: Contribution to journalArticle


Introduction: This study aimed to test the hypothesis that cardiac size is maintained in small fetuses presenting with cardiomegaly. Materials and Methods: We identified singleton fetuses with estimated fetal weight <10th centile and with cardiomegaly without another more likely cardiac or extra-cardiac cause. We used Z-scores for cardiac and thoracic circumferences normalized for gestational age (GA), biparietal diameter (BPD), head circumference (HC), and femur length (FL), obtained from 188 normally grown fetuses. Results: When comparing chest size, small fetuses had significantly lower thoracic circumferences median Z-scores (IQR) for GA = -4.82 (-6.15 to -3.51), BPD = -2.42 (-4.04 to -1.48), HC = -2.72 (-4.53 to -1.90), and FL = -1.60 (-2.87 to -0.71); p < 0.001 for all. When comparing heart size, small fetuses showed lower cardiac circumferences median Z-scores (IQR) for GA = -1.59 (-2.79 to -0.16); p < 0.001, similar cardiac circumferences Z-scores for BPD = 0.29 (-0.65 to 1.28); p = 0.284 and HC = 0.11 (-1.13 to 0.96); p = 0.953, and higher cardiac circumferences Z-scores for FL = 0.94 (-0.05 to 2.13); p < 0.001. Conclusions: Our results show that in small fetuses with cardiomegaly, the heart maintains normal dimensions when normalized to cranial diameters and higher dimensions when normalized to long bones. This provides insight into cardiac adaptation to adverse intrauterine environment.
Original languageEnglish
Pages (from-to)701-707
Number of pages7
JournalFetal Diagnosis and Therapy
Publication statusPublished - 2021


  • Cardiomegaly
  • Female
  • Fetal Weight
  • Fetal growth restriction
  • Fetal heart
  • Fetus
  • Gestational Age
  • Heart
  • Humans
  • Intrauterine growth restriction
  • Pregnancy
  • Small for gestational age


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