To compare myocardial strain and mechanical dyssynchrony in fetuses with congenital heart disease (CHD) to normal controls using speckle tracking echocardiography (STE).
In this comparative cross-sectional study 23 fetuses with CHD and 105 normal controls between 19 and 41 weeks of gestation were assessed with STE. The STE sample box was placed over the myocardium of both ventricles. The parameters of interest included the segmental strain of the left (LV-S) and right lateral ventricle wall (RV-S) and the global ventricular strain of both chambers (2C-S). In order to separately assess the LV, we placed the STE sample box over the myocardium of the LV. We calculated the strain of the LV lateral wall (LW-S), the septum (SEPT-S) and the global ventricular strain of the single LV (1C-S). Furthermore, we analyzed the differences in timing of negative peak myocardial strain between the LV and RV (two-chamber dyssynchrony, 2C-DYS) and also within the LV between the lateral wall and the septum (one-chamber dyssynchrony, 1C-DYS).
The evaluation of strain and mechanical dyssynchrony was feasible in all cases. Compared to normal controls, fetuses with CHD showed lower segmental and global strain values and the extent of 2C-DYS and 1C-DYS was higher than in the healthy control group.
The deterioration of myocardial function in CHD can be measured with STE. The assessment of strain and dyssynchrony with STE may be useful for distinguishing fetuses with CHD from healthy fetuses.
We thank everyone involved in this study who voluntarily dedicated their time and effort.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Dolk H, Loane M, Garne E, European Surveillance of Congenital Anomalies (EUROCAT) Working Group. Congenital heart defects in Europe: prevalence and perinatal mortality, 2000–2005. Circulation 2011;123:841–9.10.1161/CIRCULATIONAHA.110.958405Search in Google Scholar PubMed
2. Komisar J, Srivastava S, Geiger M, Doucette J, Ko H, Shenoy J, et al. Impact of changing indications and increased utilization of fetal echocardiography on prenatal detection of congenital heart disease. Congenit Heart Dis 2017;12:67–73.10.1111/chd.12405Search in Google Scholar PubMed
3. Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA,Sklansky MS, Abuhamad A, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014;129:2183–242.10.1161/01.cir.0000437597.44550.5dSearch in Google Scholar PubMed
4. Araujo Junior E, Tonni G, Chung M, Ruano R, Martins WP.Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies. Ultrasound Obstet Gynecol 2016;48:426–33.10.1002/uog.15867Search in Google Scholar PubMed
5. Bonnet D, Coltri A, Butera G, Fermont L, Le Bidois J, Kachaner J, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999;99:916–8.10.1161/01.CIR.99.7.916Search in Google Scholar
6. Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001;103:1269–73.10.1161/01.CIR.103.9.1269Search in Google Scholar PubMed
7. Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 2002;87:67–9.10.1136/heart.87.1.67Search in Google Scholar PubMed PubMed Central
8. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography–from technical considerations to clinical applications. J Am Soc Echocardiogr 2007;20:234–43.10.1016/j.echo.2006.08.023Search in Google Scholar PubMed
9. Stefani L, Toncelli L, Gianassi M, Manetti P, Di Tante V, Vono MR, et al. Two-dimensional tracking and TDI are consistent methods for evaluating myocardial longitudinal peak strain in left and right ventricle basal segments in athletes. Cardiovasc Ultrasound 2007;5:7.10.1186/1476-7120-5-7Search in Google Scholar PubMed PubMed Central
10. Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R. Strain and strain rate imaging by echocardiography – basic concepts and clinical applicability. Curr Cardiol Rev 2009;5:133–48.10.2174/157340309788166642Search in Google Scholar PubMed PubMed Central
11. Chan YH, Wang CL, Kuo CT, Yeh YH, Wu CT, Wu LS. Clinical assessment and implication of left ventricular mechanical dyssynchrony in patients with heart failure. Acta Cardiol Sin 2013; 29:505–14.Search in Google Scholar
12. Willruth A, Geipel A, Merz W, Gembruch U. Speckle tracking – a new ultrasound tool for the assessment of fetal myocardial function. Z Geburtshilfe Neonatol 2012;216:114–21.Search in Google Scholar
13. Enzensberger C, Achterberg F, Degenhardt J, Wolter A, Graupner O, Herrmann J, et al. Feasibility and reproducibility of two-dimensional wall motion tracking (WMT) in fetal echocardiography. Ultrasound Int Open 2017;3:E26–33.10.1055/s-0042-124501Search in Google Scholar PubMed PubMed Central
14. Erickson CT, Levy PT, Craft M, Li L, Danford DA, Kutty S. Maturational patterns in right ventricular strain mechanics from the fetus to the young infant. Early Hum Dev 2019;129:23–32.10.1016/j.earlhumdev.2018.12.015Search in Google Scholar PubMed
15. Derpa VF, Koch R, Möllers M, Hammer K, Oelmeier de Murcia K, Köster HA, et al. Comparison of transversal and apical foetal speckle tracking echocardiography (STE) using tissue motion annular displacement (TMAD) and segmental longitudinal strain (SLS). Ultrasound Med Biol 2019;45:233–45.10.1016/j.ultrasmedbio.2018.09.013Search in Google Scholar PubMed
16. Willruth AM, Geipel AK, Fimmers R, Gembruch UG. Assessment of right ventricular global and regional longitudinal peak systolic strain, strain rate and velocity in healthy fetuses and impact of gestational age using a novel speckle/feature-tracking based algorithm. Ultrasound Obstet Gynecol 2011;37:143–9.10.1002/uog.7719Search in Google Scholar PubMed
17. Van Mieghem T, Giusca S, DeKoninck P, Gucciardo L, Done E, Hindryckx A, et al. Prospective assessment of fetal cardiac function with speckle tracking in healthy fetuses and recipient fetuses of twin-to-twin transfusion syndrome. J Am Soc Echocardiogr 2010;23:301–8.10.1016/j.echo.2009.12.024Search in Google Scholar PubMed
18. Crispi F, Bijnens B, Sepulveda-Swatson E, Cruz-Lemini M,Rojas-Benavente J, Gonzalez-Tendero A, et al. Postsystolic shortening by myocardial deformation imaging as a sign of cardiac adaptation to pressure overload in fetal growth restriction. Circ Cardiovasc Imaging 2014;7:781–7.10.1161/CIRCIMAGING.113.001490Search in Google Scholar PubMed
19. Barker PC, Houle H, Li JS, Miller S, Herlong JR, Camitta MG. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging. Echocardiography 2009;26:28–36.10.1111/j.1540-8175.2008.00761.xSearch in Google Scholar PubMed
20. Willruth AM, Geipel A, Berg C, Fimmers R, Gembruch U. Assessment of fetal global and regional ventricular function in congenital heart disease using a novel feature tracking technique. Ultraschall Med 2012;33:251–7.10.1055/s-0031-1273413Search in Google Scholar PubMed
21. Germanakis I, Matsui H, Gardiner HM. Myocardial strain abnormalities in fetal congenital heart disease assessed by speckle tracking echocardiography. Fetal Diagn Ther 2012;32:123–30.10.1159/000334413Search in Google Scholar PubMed
22. Kulkarni A, Li L, Craft M, Nanda M, Lorenzo JM, Danford D, et al. Fetal myocardial deformation in maternal diabetes mellitus and obesity. Ultrasound Obstet Gynecol 2017;49:630–6.10.1002/uog.15971Search in Google Scholar PubMed
23. Rolf N, Kerschke L, Braun J, Falkenberg MK, Hammer K, Koster HA, et al. Quantification of fetal myocardial function in pregnant women with diabetic diseases and in normal controls using speckle tracking echocardiography (STE). J Perinat Med 2018;47:68–76.10.1515/jpm-2018-0031Search in Google Scholar PubMed
24. Rolf D, Schmidt R, Mollers M, Oelmeier de Murcia K, Braun J, Hammer K, et al. Assessment of strain and dyssynchrony in normal fetuses using speckle tracking echocardiography – comparison of three different ultrasound probes. J Perinat Med 2018;46:960–7.10.1515/jpm-2017-0113Search in Google Scholar PubMed
25. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan 3rd J. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960–8.10.1161/CIRCULATIONAHA.105.571455Search in Google Scholar PubMed
26. Auffret V, Martins RP, Daubert C, Leclercq C, Le Breton H, Mabo P, et al. Idiopathic/iatrogenic left bundle branch block-induced reversible left ventricle dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 2018;72:3177–88.10.1016/j.jacc.2018.09.069Search in Google Scholar PubMed
27. Zhang Y, Chan AK, Yu CM, Lam WW, Yip GW, Fung WH, et al. Left ventricular systolic asynchrony after acute myocardial infarction in patients with narrow QRS complexes. Am Heart J 2005;149:497–503.10.1016/j.ahj.2004.05.054Search in Google Scholar PubMed
28. Pu DR, Zhou QC, Zhang M, Peng QH, Zeng S, Xu GQ. Assessment of regional right ventricular longitudinal functions in fetus using velocity vector imaging technology. Prenat Diagn 2010;30:1057–63.10.1002/pd.2611Search in Google Scholar PubMed
29. Falkensammer CB, Paul J, Huhta JC. Fetal congestive heart failure: correlation of Tei-index and Cardiovascular-score. J Perinat Med 2001;29:390–8.10.1515/JPM.2001.055Search in Google Scholar PubMed
31. Krause K, Möllers M, Hammer K, Falkenberg MK, Möllmann U, Görlich D, et al. Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE). J Perinat Med 2017;45:821–7.10.1515/jpm-2016-0280Search in Google Scholar PubMed
32. Enzensberger C, Rostock L, Graupner O, Gotte M, Wolter A, Vorisek C, et al. Wall motion tracking in fetal echocardiography – application of low and high frame rates for strain analysis. Echocardiography 2019;36:386–93.10.1111/echo.14238Search in Google Scholar PubMed
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