1
|
van den Wildenberg S, van Beynum IM, Havermans MEC, Boersma E, DeVore GR, Simpson JM, Steegers EAP, Go ATJI, Cornette JMJ. Fetal Speckle Tracking Echocardiography Measured Global Longitudinal Strain and Strain Rate in Congenital Heart Disease: A Systematic Review and Meta-Analysis. Prenat Diagn 2024. [PMID: 39367541 DOI: 10.1002/pd.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/23/2024] [Accepted: 09/04/2024] [Indexed: 10/06/2024]
Abstract
Fetal two-dimensional speckle tracking echocardiography (2D-STE) is a novel technique that provides information on fetal heart function by measuring global longitudinal strain (GLS) and global longitudinal strain rate (GLSR). These features assess the longitudinal deformity of the fetal cardiac wall. 2D-STE is shown to be of prognostic value in children and adults with congenital heart disease (CHD). Therefore, its importance in fetal life should also be considered. This systematic review and meta-analysis provides an overview of the literature on 2D-STE (GLS/GLSR) in fetuses with CHD, focusing on the left and right ventricles (LV/RV). Findings indicated that LV-GLS was significantly lower in fetuses with coarctation of the aorta (CoA) and Tetralogy of Fallot (ToF) compared to controls. Conversely, fetuses with a single left ventricle exhibited higher LV-GLS. RV-GLS was significantly lower in fetuses with hypoplastic left heart syndrome (HLHS) and ToF compared to controls. LV-GLSR was significantly lower in fetuses with CoA. Overall, considerable heterogeneity was observed, possibly due to differences in study design. More prospective longitudinal studies on 2D-STE in fetuses with CHD, considering heterogeneity parameters, could offer better insights into this promising technique.
Collapse
Affiliation(s)
- Sarah van den Wildenberg
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Department of Pediatrics, Division of Cardiology, Erasmus Medical Center Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Malou E C Havermans
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Clinical Epidemiology and Statistics Unit, Thorax Center, Cardiovascular Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Greggory R DeVore
- Fetal Diagnostics Centers, Pasadena, California, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - John M Simpson
- Fetal Cardiology Unit, Evelina London Children's Hospital, London, UK
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Attie T J I Go
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Anuwutnavin S, Russameecharoen K, Ruangvutilert P, Viboonchard S, Sklansky M, DeVore GR. Reference Ranges and Development Patterns of Fetal Myocardial Function Using Speckle Tracking Echocardiography in Healthy Fetuses at 17 to 24 Weeks of Gestation. Am J Perinatol 2024; 41:1432-1444. [PMID: 37164318 DOI: 10.1055/a-2090-5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The purposes of the study were to develop reference ranges and maturation patterns of fetal cardiac function parameters measured by speckle tracking echocardiography (STE) using multiple biometric variables at 17 to 24 weeks' gestation among Thai fetuses and to compare with other previous reports. STUDY DESIGN The four-chamber view of the fetal heart in 79 healthy fetuses was suitably analyzed by STE to establish the best-fit regression model. The 95% reference intervals and Z-score equations of fetal cardiac function parameters were computed. RESULTS The fractional area change of both ventricles, left ventricular (LV) end-diastolic and end-systolic volumes, LV stroke volume, LV cardiac output (CO), and LV CO per kilogram were all increased according to gestational age (GA) and five fetal biometric measurements. However, the global longitudinal strain, basal-apical length fractional shortening (BAL-FS), BAL annular free wall and septal wall FS, BAL free wall and septal wall annular plane systolic excursions, 24-segment transverse width FS, as well as LV ejection fraction were all independent of GA or other somatic characteristics. There were varying development patterns between fetal right and left ventricles of these cardiac function indices across the gestation period. CONCLUSION Our study created Z-score and corresponding centile calculators, 5th and 95th centile reference tables, and corresponding graphs and determined the normal evolution across gestation using multiple somatic growth and age variables between 17 and 24 gestational weeks. These nomograms serve as an essential prerequisite for quantitatively evaluating fetal cardiac contractility and allow for precisely detecting early changes in the fetal heart function. KEY POINTS · Most fetal cardiac function measurements were correlated with all the independent variables.. · Fetal ventricular function parameters have their own characteristic maturation changes.. · Racial variability may not occupy an important place for fetal myocardial function during these GA..
Collapse
Affiliation(s)
- Sanitra Anuwutnavin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kusol Russameecharoen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpimol Ruangvutilert
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sommai Viboonchard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California
- The Fetal Diagnostic Centers, Pasadena, California
| |
Collapse
|
3
|
Scharf JL, Dracopoulos C, Gembicki M, Rody A, Welp A, Weichert J. How automated techniques ease functional assessment of the fetal heart: Applicability of two-dimensional speckle-tracking echocardiography for comprehensive analysis of global and segmental cardiac deformation using fetalHQ®. Echocardiography 2024; 41:e15833. [PMID: 38873982 DOI: 10.1111/echo.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 05/05/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Prenatal echocardiographic assessment of fetal cardiac function has become increasingly important. Fetal two-dimensional speckle-tracking echocardiography (2D-STE) allows the determination of global and segmental functional cardiac parameters. Prenatal diagnostics is relying increasingly on artificial intelligence, whose algorithms transform the way clinicians use ultrasound in their daily workflow. The purpose of this study was to demonstrate the feasibility of whether less experienced operators can handle and might benefit from an automated tool of 2D-STE in the clinical routine. METHODS A total of 136 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by targeted ultrasound. 2D-STE was performed separately by beginner and expert semiautomatically using a GE Voluson E10 (FetalHQ®, GE Healthcare, Chicago, IL). Several fetal cardiac parameters were calculated (end-diastolic diameter [ED], sphericity index [SI], global longitudinal strain [EndoGLS], fractional shortening [FS]) and assigned to gestational age (GA). Bland-Altman plots were used to test agreement between both operators. RESULTS The mean maternal age was 33 years, and the mean maternal body mass index prior to pregnancy was 24.78 kg/m2. The GA ranged from 16.4 to 32.0 weeks (average 22.9 weeks). Averaged endoGLS value of the beginner was -18.57% ± 6.59 percentage points (pp) for the right and -19.58% ± 5.63 pp for the left ventricle, that of the expert -14.33% ± 4.88 pp and -16.37% ± 5.42 pp. With increasing GA, right ventricular endoGLS decreased slightly while the left ventricular was almost constant. The statistical analysis for endoGLS showed a Bland-Altman-Bias of -4.24 pp ± 8.06 pp for the right and -3.21 pp ± 7.11 pp for the left ventricle. The Bland-Altman-Bias of the ED in both ventricles in all analyzed segments ranged from -.49 mm ± 1.54 mm to -.10 mm ± 1.28 mm, that for FS from -.33 pp ± 11.82 pp to 3.91 pp ± 15.56 pp and that for SI from -.38 ± .68 to -.15 ± .45. CONCLUSIONS Between both operators, our data indicated that 2D-STE analysis showed excellent agreement for cardiac morphometry parameters (ED and SI), and good agreement for cardiac function parameters (EndoGLS and FS). Due to its complexity, the application of fetal 2D-STE remains the domain of scientific-academic perinatal ultrasound and should be placed preferably in the hands of skilled operators. At present, from our perspective, an implementation into clinical practice "on-the-fly" cannot be recommended.
Collapse
Affiliation(s)
- Jann Lennard Scharf
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Christoph Dracopoulos
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Michael Gembicki
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Amrei Welp
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Jan Weichert
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| |
Collapse
|
4
|
Nichting TJ, van Lier ZA, de Vet C, van der Ven M, van der Woude DAA, Clur SA, van Oostrum NHM, Oei SG, van Laar JOEH. Feasibility and reliability of fetal two dimensional speckle tracking echocardiography at 16 weeks gestational age: A pilot study. PLoS One 2024; 19:e0302123. [PMID: 38630708 PMCID: PMC11023584 DOI: 10.1371/journal.pone.0302123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Fetal two-dimensional speckle tracking echocardiography (2D-STE) is an emerging technique for assessing fetal cardiac function by measuring global longitudinal strain. Alterations in global longitudinal strain may serve as early indicator of pregnancy complications, making 2D-STE a potentially valuable tool for early detection. Early detection can facilitate timely interventions to reduce fetal and maternal morbidity and mortality. Therefore, the aim of this study was to investigate the feasibility of performing 2D-STE at 16 weeks gestational age. METHODS This pilot study utilized 50 ultrasound clips of the fetal four-chamber view recorded between 15+5 and 16+2 weeks gestational age from a prospective cohort study. A strict protocol assessed three parameters essential for 2D-STE analysis: fetal four-chamber view ultrasound clip quality, region of interest, and frame rates. Two independent researchers measured global longitudinal strain in all adequate fetal four-chamber view ultrasound clips to determine inter- and intra-operator reliability. RESULTS Out of the 50 ultrasound clips, 37 (74%) were feasible for 2D-STE analysis. The inter-operator reliability for global longitudinal strain measurements of the left and right ventricles was moderate (ICC of 0.64 and 0.74, respectively), while the intra-operator reliability was good (ICC of 0.76 and 0.79, respectively). CONCLUSIONS Our findings demonstrate that fetal 2D-STE analysis at 16 weeks gestational age is feasible when adhering to a strict protocol. However, further improvements are necessary to enhance the inter- and intra-operator reliability of 2D-STE at this gestational age.
Collapse
Affiliation(s)
- Thomas J. Nichting
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Zoé A. van Lier
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Chantelle de Vet
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Myrthe van der Ven
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Daisy A. A. van der Woude
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Sally A. Clur
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart–ERN GUARD-Heart, Amsterdam, The Netherlands
| | | | - S. Guid Oei
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Judith O. E. H. van Laar
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| |
Collapse
|
5
|
Kühle H, Cho SKS, Barber N, Goolaub DS, Darby JRT, Morrison JL, Haller C, Sun L, Seed M. Advanced imaging of fetal cardiac function. Front Cardiovasc Med 2023; 10:1206138. [PMID: 37288263 PMCID: PMC10242056 DOI: 10.3389/fcvm.2023.1206138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Over recent decades, a variety of advanced imaging techniques for assessing cardiovascular physiology and cardiac function in adults and children have been applied in the fetus. In many cases, technical development has been required to allow feasibility in the fetus, while an appreciation of the unique physiology of the fetal circulation is required for proper interpretation of the findings. This review will focus on recent advances in fetal echocardiography and cardiovascular magnetic resonance (CMR), providing examples of their application in research and clinical settings. We will also consider future directions for these technologies, including their ongoing technical development and potential clinical value.
Collapse
Affiliation(s)
- Henriette Kühle
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Cardiac and Thoracic Surgery, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Division of Cardiac Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Steven K. S. Cho
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Nathaniel Barber
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Datta Singh Goolaub
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jack R. T. Darby
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Janna L. Morrison
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiac Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
van Oostrum NHM, de Vet CM, Clur SB, van der Woude DAA, van den Heuvel ER, Oei SG, van Laar JOEH. Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:651-659. [PMID: 34558747 PMCID: PMC9321172 DOI: 10.1002/uog.24781] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Two-dimensional speckle-tracking echocardiography (2D-STE) is a promising technique which allows assessment of fetal cardiac function, and can be used in the evaluation of cardiac and non-cardiac diseases in pregnancy. However, reliable fetal reference values for deformation parameters measured using 2D-STE are needed before it can be introduced into clinical practice. This study aimed to obtain reference values for fetal global longitudinal strain (GLS) and GLS rate (GLSR) measured using 2D-STE and compare right and left ventricular values. METHODS This was a prospective longitudinal cohort study of uncomplicated pregnancies that underwent echocardiography every 4 weeks from inclusion at 18-21 weeks until delivery to obtain four-chamber loops of the fetal heart. Left and right ventricular GLS and GLSR were measured using 2D-STE at each examination. Using Bayesian mixed-effects models, reference values with lower and upper 5% prediction limits were calculated according to gestational age. Right and left ventricular GLS values according to gestational age were compared using the Wilcoxon signed-rank test. RESULTS A total of 592 left ventricular and 566 right ventricular GLS and GLSR measurements were obtained from 124 women with uncomplicated pregnancy and non-anomalous, appropriately grown fetuses. Reference values were obtained for both fetal ventricles according to gestational week. GLS and GLSR values of both ventricles increased (i.e. became less negative) significantly during pregnancy. Right ventricular GLS values were significantly higher (i.e. less negative) than the respective left ventricular values at every gestational week. CONCLUSIONS Reference values were obtained for fetal GLS and GLSR measured using 2D-STE. GLS and GLSR values increased significantly for both ventricles from the second trimester until delivery. GLS values were significantly higher for the right ventricle compared with the left ventricle. Future studies are needed to assess whether the obtained reference values are helpful in clinical practice in the assessment of pregnancy complications, such as fetal growth restriction or cardiac anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- N. H. M. van Oostrum
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsGhent UniversityGhentBelgium
| | - C. M. de Vet
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - S. B. Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical CenterAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - D. A. A. van der Woude
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - E. R. van den Heuvel
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Mathematics & Computer ScienceEindhoven University of TechnologyEindhovenThe Netherlands
| | - S. G. Oei
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - J. O. E. H. van Laar
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| |
Collapse
|
7
|
Feasibility of 4D-Spatio Temporal Image Correlation (STIC) in the Comprehensive Assessment of the Fetal Heart Using FetalHQ ®. J Clin Med 2022; 11:jcm11051414. [PMID: 35268505 PMCID: PMC8911117 DOI: 10.3390/jcm11051414] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Fetal Heart Quantification (FetalHQ®) is a novel speckle tracking software that permits the study of global and regional ventricular shape and function from a 2D four-chamber-view loop. The 4D-Spatio Temporal Image Correlation (STIC) modality enables the offline analysis of optimized and perfectly aligned cardiac planes. We aimed to evaluate the feasibility and reproducibility of 4D-STIC speckle tracking echocardiography (STE) using FetalHQ® and to compare it to 2D STE. We conducted a prospective study including 31 low-risk singleton pregnancies between 20 and 40 weeks of gestation. Four-chamber view volumes and 2D clips were acquired with an apex pointing at 45° and with a frame rate higher than 60 Hz. Morphometric and functional echocardiography was performed by FetalHQ®. Intra- and interobserver reproducibility were evaluated by the intraclass correlation coefficient (ICC). Our results showed excellent reproducibility (ICC > 0.900) for morphometric evaluation (biventricular area, longitudinal and transverse diameters). Reproducibility was also good (ICC > 0.800) for functional evaluation (biventricular strain, Fractional Area Change, left ventricle volumes, ejection fraction and cardiac output). On the contrary, the study of the sphericity index and shortening fraction of the different ventricular segments showed lower reproducibility (ICC < 0.800). To conclude, 4D-STIC is feasible, reproducible and comparable to 2D echocardiography for the assessment of cardiac morphometry and function.
Collapse
|
8
|
Pasieczna M, Duliban J, Grzyb A, Szymkiewicz-Dangel J. 4D imaging of fetal right ventricle-feasibility study and a review of the literature. Int J Cardiovasc Imaging 2022; 38:319-329. [PMID: 34545461 PMCID: PMC8888475 DOI: 10.1007/s10554-021-02407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/02/2021] [Indexed: 12/02/2022]
Abstract
Functional analysis of the fetal cardiovascular system is crucial for the assessment of fetal condition. Evaluation of the right ventricle with standard 2D echocardiography is challenging due to its complex geometry and irregular muscle fibers arrangement. Software package TOMTEC 4D RV-Function is an analysis tool which allows assessment of right ventricular function based on volumetric measurements and myocardial deformation. The aim of this study was to determine the feasibility of this method in fetal echocardiography. The retrospective study was conducted in the high-flow Referral Center for Fetal Cardiology. We recorded 4D echocardiographic sequences of 46 fetuses with normal hearts. Following parameters were calculated: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), right ventricle longitudinal free-wall (RVLS free-wall) and septal strain (RVLS septum). Tei index was calculated as a standard measure or RV function for comparison. 4D assessment was feasible in 38 out of 46 fetuses (83%). RV volumetric parameters-EDV, ESV and SV-increased exponentially with gestational age. Functional parameters-RV Tei index, EF and strains-were independent of gestational age. Mean EF was 45.2% (± 6%), RV free-wall strain was - 21.2% and RV septal strain was - 21.5%. There was a statistically significant correlation between septal and free-wall strains (r = 0.51, p = 0.001) as well as between EF and RV free-wall strain (r = - 0.41, p = 0.011). 4D RV assessment is feasible in most fetuses. Its clinical application should be further investigated in larger prospective studies.
Collapse
Affiliation(s)
- M. Pasieczna
- 2nd Department Of Obstetrics and Gynecology, Medical University of Warsaw, Karowa Street 2, 00-315 Warsaw, Poland
| | - J. Duliban
- Department of Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - A. Grzyb
- Department of Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
- Department of Perinatal Cardiology and Congenital Anomalies, The Centre of Postgraduate Medical Education, Warsaw, Poland
| | - J. Szymkiewicz-Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, The Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
9
|
Huntley ES, Hernandez-Andrade E, Soto E, DeVore G, Sibai BM. Novel Speckle Tracking Analysis Showed Excellent Reproducibility for Size and Shape of the Fetal Heart and Good Reproducibility for Strain and Fractional Shortening. Fetal Diagn Ther 2021; 48:541-550. [PMID: 34515112 DOI: 10.1159/000517625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate reproducibility and agreement of fetal cardiac shape and deformation using FetalHQ. METHODS Fifty normal fetuses at 20-38 weeks of gestation were evaluated. Two operators independently selected an optimal cardiac cycle using FetalHQ®™software for speckle tracking analysis. Intra- and interobserver correlation coefficient and limits of agreement for cardiac shape and deformation were estimated. RESULTS Global cardiac markers: high correlation (r = 0.98) and agreement (mean difference, standard deviation [MD, SD] 5.07, 75.8) for ventricular area; moderate correlation (r = 0.78) and agreement (MD, SD: 0.016, 0.08) for global sphericity index (SI) and for left ventricle (LV) global strain (r = 0.65; MD, SD: -4.48, 11.9); and low but still significant correlation (r = 0.58) and agreement (MD, SD: -3.77, 12.27) for right ventricle (RV) global strain. For individual ventricular parameters: high correlation for LV ([median r; range] 0.98; 0.93-0.99) and RV (r = 0.98; 0.97-1.0) SI, and for LV (r = 0.92: 0.56-0.99) and RV (r = 0.96; 0.67-0.99) end diastolic diameters; moderate correlation for LV fractional shortening (r = 0.53; 0.87-0.98); and no significant correlation for RV fractional shortening (r = 0.36; 0.32-0.97). Inter- and intraobserver correlation and agreement were similar for all evaluated parameters. CONCLUSION Speckle tracking analysis of the fetal heart provides reliable estimations of global and LV shape and deformation. Low correlation in the RV can be related to anatomical structures such as the moderator band.
Collapse
Affiliation(s)
- Erin S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Eleazar Soto
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Gregory DeVore
- Fetal Diagnostic Centers, Pasadena, California, USA.,Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Baha M Sibai
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| |
Collapse
|
10
|
Ohira A, Hayata K, Mishima S, Tani K, Maki J, Mitsui T, Eto E, Masuyama H. The assessment of the fetal heart function using two-dimensional speckle tracking with a high frame rate. Early Hum Dev 2020; 151:105160. [PMID: 32866674 DOI: 10.1016/j.earlhumdev.2020.105160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Two-dimensional (2D) speckle tracking echography (STE) is a new diagnostic modality that allows for the assessment of myocardial deformation. The present study assessed the feasibility of fetal 2D-STE at a high frame rate and determined the reference values for left ventricular (LV)- and right ventricular (RV)- global longitudinal strain (GLS). METHODS In this prospective study, 109 fetuses with gestational ages ranging from 18 to 38 weeks underwent 2D echocardiography between August 2018 and December 2019. All recordings were performed using the Aplio i800 (CANON Medical Systems Corporation, Tochigi, Japan) and a convex probe (4 MHz) for fetuses. RESULTS Longitudinal peak systolic strain measurements were obtained in 98 of 109 healthy fetuses (90%). All ultrasound videos were recorded with a median frame rate of 172 (range, 100-274) frames/s. The LV-GLS was almost constant, regardless of the number of weeks since the second trimester (r = -0.0087, p = ns). The RV-GLS decreased significantly with gestational age (r = 0.39, p < 0.01). CONCLUSIONS STE may be useful for quantifying the systolic myocardial function in a fetus.
Collapse
Affiliation(s)
- Akiko Ohira
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Kei Hayata
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Sakurako Mishima
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Kazumasa Tani
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Takashi Mitsui
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-cho, Kita-ku, Okayama-shi, Okayama, Japan.
| |
Collapse
|
11
|
Lee-Tannock A, Hay K, Gooi A, Kumar S. Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:396-404. [PMID: 32191357 DOI: 10.1002/jcu.22826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To construct longitudinal fetal reference ranges for global longitudinal myocardial deformation (strain and strain rate) of the left and right ventricles in the second half of pregnancy. METHODS A prospective, observational, longitudinal study of 120 women with uncomplicated singleton pregnancies. The participants underwent ultrasonographic scans every 4 weeks from enrolment (18-28 weeks) until delivery. Strain and strain rate were measured at each examination using velocity vector imaging. Changes in strain and strain rate as functions of gestational age (GA) were modeled using Bayesian mixed effects models. RESULTS A total of 406 assessments of global longitudinal strain and strain rate were performed for 120 women. Global longitudinal strain and strain rate decreased with increasing GA in the left ventricle. There was, however, no change in strain measurements of the right ventricle over the same gestational time frame. Posterior predictive distributions were used to derive reference centiles for each week of GA. CONCLUSION Assessment of myocardial deformation of the fetal heart is easily performed and may be useful for quantitative assessment of heart function, particularly in fetuses at risk of cardiac dysfunction.
Collapse
Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
| | - Karen Hay
- QMIR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alex Gooi
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
12
|
van Oostrum NHM, de Vet CM, van der Woude DAA, Kemps HMC, Oei SG, van Laar JOEH. Fetal strain and strain rate during pregnancy measured with speckle tracking echocardiography: A systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 250:178-187. [PMID: 32446149 DOI: 10.1016/j.ejogrb.2020.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/05/2023]
Abstract
Establishment of the maturational patterns of the fetal left and right ventricle strain and strain rate by two-dimensional speckle tracking echocardiography is a prerequisite for its routine clinical adaptation in pregnancy. The aim of this study is to review systematically current literature on the development of left and right ventricle strain and strain rate derived by speckle tracking during gestation. EMBASE, Medline and Central were searched, from inception to October 2019, for observational studies of singletons in uncomplicated, non-anomalous pregnancies, measuring global longitudinal strain and strain rate with 2D speckle tracking echocardiography in the fetal heart during gestation. 23 Studies met the inclusion criteria. The gestational age of the included fetuses varied from 12 to 42 weeks. Four studies used a longitudinal study design, with few consecutive measurements at varying gestational ages. 19 Studies performed either cross sectional or both longitudinal and cross sectional measurements. The ultrasound devices and speckle tracking algorithm software used, varied. Strain and strain rate during gestation increased, decreased or remained stable in the left and right fetal ventricle with increasing gestation. Due to considerable variation in the included gestational ages measured and inconsistency in the direction of strain and strain rate development, a meta-analysis could not be performed. Contradictory results concerning the development of strain and strain rate during gestation were shown, probably due to suboptimal study designs and varying algorithms and ultrasound devices used. A large longitudinal cohort study is needed to obtain reference values for fetal cardiac deformation in the uncomplicated, singleton pregnancy.
Collapse
Affiliation(s)
- Noortje H M van Oostrum
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Chantelle M de Vet
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands.
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.
| | - Hareld M C Kemps
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands.
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| |
Collapse
|
13
|
Normal fetal cardiac deformation values in pregnancy; a prospective cohort study protocol. BMC Pregnancy Childbirth 2019; 19:524. [PMID: 31881860 PMCID: PMC6935123 DOI: 10.1186/s12884-019-2662-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background Myocardial deformation imaging offers the potential to measure myocardial function. Remodelling, the change in size, shape and function, appears as a result of pressure or volume changes and is thought to be the first sign of fetal adaptation to placental dysfunction. Deformation can be measured using speckle tracking echocardiography (STE). STE in the fetus might be useful for detection and follow up of the fetus endangered by placental dysfunction. Reference values for fetal myocardial deformation during gestation have not been comprehensively described and need further investigation before STE can be introduced in daily clinical practice. The aim of this study is to determine reference values for fetal myocardial deformation throughout gestation in uncomplicated pregnancies. Methods A longitudinal cohort will be performed. 150 Women, pregnant from a non-anomalous singleton, will be included from 19 to 21 + 6 weeks gestational age. Thereafter, fetal heart ultrasounds will be performed 4 weekly, until 41 weeks gestational age or delivery. Ultrasound data will be analysed using STE software to determine reference values for fetal cardiac deformation during gestation. Discussion Measuring cardiac deformation changes in pregnancy can be a promising tool to detect preclinical cardiac adaptation to placental dysfunction. However, previous studies used different ultrasound scans and STE software resulting in incomparable and contradictory results on deformation values. In this prospective study reference values during pregnancy, cardiac deformation values will be assessed with the same ultrasound and software package in 150 uncomplicated pregnancies. Trial registration National Trial Register number: NTR7132. Date of inclusion: 2018/04/06.
Collapse
|
14
|
Natori N, Oyama R, Baba T, Isurugi C, Chida H, Haba G, Sasaki Y, Kanasugi T, Itamochi H, Kikuchi A. Velocity vector imaging for evaluation of fetal vertical function throughout gestation. HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Noriko Natori
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Rie Oyama
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Chizuko Isurugi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Hideyuki Chida
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
- Department of Obstetrics and Gynecology, Iwate Prefectural Ninohe Hospital
| | - Gen Haba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Yuri Sasaki
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Tomonobu Kanasugi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
- Department of Obstetrics and Gynecology, Iwate Prefectural Ofunato Hospital
| | - Hiroaki Itamochi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Akihiko Kikuchi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
- Center for Maternal, Fetal and Neonatal Medicine, Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
| |
Collapse
|
15
|
Day TG, Charakida M, Simpson JM. Using speckle-tracking echocardiography to assess fetal myocardial deformation: are we there yet? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:575-581. [PMID: 30740804 DOI: 10.1002/uog.20233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/07/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Affiliation(s)
- T G Day
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Charakida
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Imaging Science and Biomedical Engineering, King's College London, London, UK
| | - J M Simpson
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Imaging Science and Biomedical Engineering, King's College London, London, UK
| |
Collapse
|
16
|
Sun X, Zhao B, Chen Y, Pan M, Wang B, Peng X. Preliminary results analysis for left ventricular systolic function in normal fetuses by automated cardiac motion quantitation. J Matern Fetal Neonatal Med 2019; 34:2701-2709. [PMID: 31599167 DOI: 10.1080/14767058.2019.1670810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fetal heart evaluation has been proven to have the utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. The purpose of this study is to introduce a novel method that can measure the global and regional longitudinal strain of left ventricle in fetuses, described as automated cardiac motion quantitation (aCMQ). Furthermore, to evaluate the feasibility and value of aCMQ. METHODS A cross-sectional study was conducted in 138 fetuses with normal heart structure, then were divided into four groups by gestational age, standard four-chamber view clips were collected, the global and segmental longitudinal peak systolic strain of the left ventricle were measured by aCMQ, interobserver and intraobserver variability was analyzed. RESULTS The success rate of aCMQ analysis was 90.6% (125/138). aCMQ can obtain more comprehensive data to evaluate fetal cardiac function by on-line analysis, including the left ventricular end-systolic volume (LVESV, 0.64 ± 0.16 ml), the left ventricular end-diastolic volume (LVEDV, 0.85 ± 0.35 ml), strain and so on. There was no significant correlation between the gestational age and the global and segmental longitudinal peak strain of the left ventricle (all p > .05). The base and middle segmental strain values of left ventricular free wall were similar to those of the interventricular septum. No significant differences were found in base segments and middle segments for left ventricular free wall (LVLW) and the interventricular septum (IVS) (p > .05). The strain of the apex segment was higher than that of the base and middle segment (p < .05), and there were significant differences between the apex and the base and the middle (p < .05). Interobserver and intraobserver variability showed a small bias among the observers. CONCLUSIONS The global and regional strain values of fetus have no correlation with gestational ages, and the strain values of apical segment are higher than those of basal and middle segments. The base and middle segmental strain values of left ventricular free wall were similar to those of the interventricular septum. aCMQ is a novel method of two dimensional speckle tracking echocardiography to assess the global and regional systolic function of fetuses. It's a feasible and reproducible approach to evaluate normal cardiac function of fetus quantitatively and may have potential in fetuses with congenital heart diseases.
Collapse
Affiliation(s)
- Xiaolu Sun
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Yan Chen
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Mei Pan
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Bei Wang
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| |
Collapse
|
17
|
Zanardini C, D'Antonio F, Hvingel B, Vårtun Å, Prefumo F, Flacco ME, Manzoli L, Acharya G. Agreement between anatomical M-mode and tissue Doppler imaging in the assessment of fetal atrioventricular annular plane displacement in uncomplicated pregnancies: A prospective longitudinal study. J Obstet Gynaecol Res 2019; 45:2150-2157. [PMID: 31441198 DOI: 10.1111/jog.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 07/04/2019] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the level of agreement between M-mode and pulsed-wave tissue Doppler imaging (PW-TDI) techniques in assessing fetal mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE) and septal annular plane systolic excursion (SAPSE) in a low-risk population. METHODS This prospective longitudinal study included healthy fetuses assessed from 18 to 40 weeks of gestation. Tricuspid annular plane systolic excursion, MAPSE and SAPSE were measured using anatomical M-mode and PW-TDI. The agreement between the two diagnostic tests was assessed using Bland-Altman analysis. RESULTS Fifty fetuses were included in the final analysis. Mean values of TASPE were higher than that of MAPSE. There was a progressive increase of TAPSE, MAPSE and SAPSE values with advancing gestation. For each parameter assessed, there was an overall good agreement between the measurements obtained with M-mode and PW-TDI techniques. However, the measurements made with M-mode were slightly higher than those obtained with PW-TDI (mean differences: 0.03, 0.05 and 0.03 cm for TAPSE, MAPSE and SAPSE, respectively). When stratifying the analyses by gestational age, the mean values of TAPSE, MAPSE and SAPSE measured with M-Mode were higher compared to those obtained with PW-TDI, although the mean differences between the two techniques tended to narrow with increasing gestation. Tricuspid annular plane systolic excursion, MAPSE and SAPSE measurements were all significantly, positively associated with gestational age (all P < 0.001). CONCLUSION Fetal atrioventricular annular plane displacement can be assessed with M-mode technique, or with PW-TDI as the velocity-time integral of the myocardial systolic waveform. Atrioventricular annular plane displacement values obtained with M-mode technique are slightly higher than those obtained with PW-TDI.
Collapse
Affiliation(s)
- Cristina Zanardini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Francesco D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Bodil Hvingel
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Åse Vårtun
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
18
|
Maturational patterns in right ventricular strain mechanics from the fetus to the young infant. Early Hum Dev 2019; 129:23-32. [PMID: 30616038 DOI: 10.1016/j.earlhumdev.2018.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/23/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Abstract
AIM To test the hypothesis that right ventricular (RV) function has age-specific patterns of development, we tracked the evolution of RV strain mechanics by 2D-speckle tracking echocardiography (2DSTE) in healthy subjects from mid-gestation through one year of age. METHODS We conducted a prospective longitudinal echocardiography study in 50 healthy subjects at five time periods across gestation (16-20 weeks, 21-25 weeks, 26-30 weeks, 31-35 weeks, and 36-40 weeks) and four time periods following delivery (1 week, 1 month, 6 months, and 1 year of age). We characterized RV function by measuring RV global and free wall longitudinal strain and systolic strain rate, and segmental longitudinal strain at the apical-, mid-, and basal- ventricular levels of the free wall. Possible associations of gestational age, postnatal age, estimated fetal weight, body surface area, gender, and heart rate on strain were investigated. RESULTS The magnitudes of RV global and free wall longitudinal strain and global strain rate were decreased throughout gestation (p < 0.05 for all). Following birth, the magnitudes of all measures increased from one week through one year (p < 0.001 for all). RV segmental longitudinal strain maintained a base-to-apex gradient (highest-to-lowest) from mid-gestation through one year (p < 0.001). There was no significant difference in strain patterns based on gender or hear rate. CONCLUSION The maturational patterns of RV strain are gestational- and postnatal age- specific. With accepted physiological maturation patterns in healthy subjects, these myocardial deformation parameters can provide a valid basis that allows comparison between health and disease.
Collapse
|
19
|
Alsolai AA, Bligh LN, Greer RM, Gooi A, Kumar S. Myocardial strain assessment using velocity vector imaging in normally grown fetuses at term. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:352-358. [PMID: 28608400 DOI: 10.1002/uog.17549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/08/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess prospectively fetal myocardial deformation at term in normally grown fetuses using the velocity vector imaging (VVI) two-dimensional speckle-tracking technique, and to explore myocardial deformation changes over the last 4 weeks of pregnancy. METHODS This was a prospective, observational cohort study of 276 women with an uncomplicated singleton pregnancy who underwent fortnightly ultrasound from 36 weeks' gestation until delivery at the Mater Mother's Hospital, Brisbane, Australia. Fetal myocardial deformation (assessed by global and segmental longitudinal systolic myocardial strain and strain rate of both right and left ventricles) was measured using VVI software. RESULTS Mean global longitudinal left and right ventricular strain and strain rate values decreased between each time point. At 36, 38 and 40 weeks' gestation, left ventricular global strain (%) and strain rate (/s) decreased, respectively, as follows: -14.6 ± 3.8% and -1.2 ± 0.3/s at 36 weeks; -13.6 ± 3.3% and -1.1 ± 0.3/s at 38 weeks; and -12.3 ± 3.1% and -1.0 ± 0.3/s at 40 weeks. At 36, 38 and 40 weeks, mean right ventricular global strain (%) and mean strain rate (/s) decreased, respectively, as follows: -14.2 ± 3.4% and -1.2 ± 0.2/s at 36 weeks; -13.4 ± 3.0% and -1.1 ± 0.2/s at 38 weeks; and -12.8 ± 2.8% and -1.1 ± 0.2/s at 40 weeks. CONCLUSIONS Global ventricular strain values diminish with advancing gestational age. Myocardial deformation imaging is feasible in late gestation and may be useful as an adjunct for the assessment of fetal cardiac function close to birth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A A Alsolai
- College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - L N Bligh
- School of Biomedical Science, University of Queensland, St Lucia, Queensland, Australia
| | - R M Greer
- School of Medicine, University of Queensland, Herston, Queensland, Australia
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - A Gooi
- Mater Health Services, South Brisbane, Queensland, Australia
| | - S Kumar
- School of Medicine, University of Queensland, Herston, Queensland, Australia
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Mater Health Services, South Brisbane, Queensland, Australia
| |
Collapse
|
20
|
DeVore GR, Klas B, Satou G, Sklansky M. Longitudinal Annular Systolic Displacement Compared to Global Strain in Normal Fetal Hearts and Those With Cardiac Abnormalities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1159-1171. [PMID: 29086430 DOI: 10.1002/jum.14454] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to compare a new technique that measures the midventricular basal-apical longitudinal diastolic and systolic lengths, computes the longitudinal displacement fractional shortening, and compares it to global strain. METHODS Two hundred control fetuses were examined between 20 and 40 weeks' gestation, in whom the longitudinal displacement fractional shortening was computed from end-diastolic and end-systolic lengths measured from the apex to the mid portion of the distance between the level of the basal lateral and septal walls using 2-dimnsional speckle tracking. In addition, global strain was computed using speckle tracking. A correlation analysis was used to compare the longitudinal displacement fractional shortening to global strain. The longitudinal displacement fractional shortening of the right ventricle (RV) and left ventricle (LV) was measured in 10 fetuses with heart abnormalities. RESULTS The longitudinal displacement fractional shortening for the RV (mean ± SD, 22.94% ± 4.73%) and LV (21.05% ± 4.21%) was independent of gestational age and other biometric growth parameters, as was global strain (RV, -22.7% ± 4.07%); LV, -22.93% ± 3.52%). The RV longitudinal displacement fractional shortening was greater than that of the LV (P < .024). The correlations between the longitudinal displacement fractional shortening and global strain were 0.95 for the RV and 0.97 for the LV. Comparing the longitudinal displacement fractional shortening and global strain in fetuses with abnormal cardiac findings showed concordant findings in 9 of 10 fetuses. CONCLUSIONS The RV and LV longitudinal displacement fractional shortening can be computed from 2-dimensional images of the 4-chamber view and correlated with global strain. The longitudinal displacement fractional shortening was significantly greater for the RV than the LV and was abnormal in fetuses with RV and LV cardiac abnormalities.
Collapse
Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
| | - Berthold Klas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, TomTec Imaging Systems GmbH, Munich, Germany
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
21
|
DeVore GR, Klas B, Satou G, Sklansky M. Twenty-four Segment Transverse Ventricular Fractional Shortening: A New Technique to Evaluate Fetal Cardiac Function. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1129-1141. [PMID: 29068072 DOI: 10.1002/jum.14455] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/29/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Because of various fetal and maternal disease states, this study was conducted to evaluate the fractional shortening of 24 transverse segments distributed from the base to the apex of the ventricular chambers. METHODS Two hundred control fetuses were examined between 20 and 40 weeks' gestation. The transverse displacement of the ventricular endocardium during the cardiac cycle was computed by using offline software. From the output of the analysis, 24 end-diastolic and end-systolic segments were measured from the base (segment 1) to the apex (segment 24) of the right and left ventricles, and the fractional shortening was computed: [(end-diastolic length - end-systolic length)/end-diastolic length] × 100. Examples of fetal cardiovascular abnormalities were selected to demonstrate the utility of this technique. RESULTS The fractional shortening for each segment was independent of gestational age and fetal biometric measurements. There was no significant difference in fractional shortening for segments 1 to 5 between the right and left ventricles. However, the fractional shortening of the left ventricle was significantly greater (P < .0001) than that of the right ventricle for segments 6 to 24, suggesting that the mid and apical segments of the left ventricle have increased displacement toward the center of the chamber compared to the right ventricle. Fetuses with various cardiac structural abnormalities had abnormal fractional shortening values. CONCLUSIONS The fractional shortening of 24 segments of the right and left ventricles provides a comprehensive method to examine the contractility of the ventricular chambers.
Collapse
Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
| | - Berthold Klas
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
| | - Gary Satou
- TomTec Imaging Systems GmbH, Munich, Germany
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
22
|
Zhang LJ, Chen KQ, Shi YY, Zheng XZ. Fetal regional myocardial strain rate in the membranous ventricular septum: changes with gestational age and the left ventricular mass and predictive value for a complete membranous ventricular septum (without defect). Int J Cardiovasc Imaging 2018; 34:1403-1408. [PMID: 29667079 DOI: 10.1007/s10554-018-1354-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
Abstract
To describe the fetal regional myocardial strain rate in the membranous ventricular septum across gestation and to determine their predictive value for a complete membranous ventricular septum (without defect) after delivery. In 1150 fetuses, the peak systolic strain rate (SRs), peak early diastolic strain rate (SRe) and peak late diastolic strain rate (SRa) in the membranous ventricular septum were measured at four time points across gestation (18-20, 24-26, 30-32 and 36-38 weeks). The integrity of the interventricular septum was examined at 12 weeks' postnatal age. The correlations between myocardial strain rates and gestational age as well as fetal left ventricular mass were analyzed, and the performance of myocardial strain rates in predicting a complete membranous ventricular septum was deducted. Strain rate absolute values in the membranous ventricular septum all increased across gestation. They all significantly correlated with gestational age and left ventricular mass. At 24 weeks during pregnancy, the areas under the receiver operating characteristics curve (AUC) for SRe and SRa were all > 0.72 (p < 0.05) in predicting a complete membranous ventricular septum, while the AUC for SRs was only 0.55. The sensitivity, specificity and accuracy of the cut off value (> 1.53 s-1) for SRe was 62.5, 85.7 and 73.3%, respectively, and the sensitivity, specificity and accuracy of the cut off value (> 1.51 s-1) for SRa was 75.2, 71.9 and 73.8%, respectively. The changes of myocardial strain rates in the membranous ventricular septum across gestation maybe can be used to predict a complete membranous ventricular septum after delivery.
Collapse
Affiliation(s)
- Li-Juan Zhang
- Department of Ultrasound, Pukou Hospital (The Fourth Affiliated Hospital with Nanjing Medical University), 18 Puyuan Road, Pukou District, Nanjing, 210031, Jiangsu Province, People's Republic of China
| | - Ke-Qi Chen
- Department of Ultrasound, Yancheng Institute of Clinical Medicine (The First People's Hospital of Yancheng), Xuzhou Medical University, 166 west Yulong Road, Yancheng, 224005, Jiangsu Province, People's Republic of China
| | - Yun-Yan Shi
- Department of Ultrasound, Yancheng Institute of Clinical Medicine (The First People's Hospital of Yancheng), Xuzhou Medical University, 166 west Yulong Road, Yancheng, 224005, Jiangsu Province, People's Republic of China
| | - Xiao-Zhi Zheng
- Department of Ultrasound, Yancheng Institute of Clinical Medicine (The First People's Hospital of Yancheng), Xuzhou Medical University, 166 west Yulong Road, Yancheng, 224005, Jiangsu Province, People's Republic of China.
| |
Collapse
|
23
|
Graupner O, Enzensberger C, Wieg L, Wolter A, Yerebakan C, Khalil M, Axt-Fliedner R. Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI). PRENATAL CARDIOLOGY 2017. [DOI: 10.1515/pcard-2017-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: The long-term outcome of patients with HLHS (hypoplastic left heart syndrome) is mainly determined by right ventricular function. Our study examines, whether there are differences in segmental right ventricular myocardial displacement and tissue velocities of fetuses with HLHS compared to healthy fetuses during gestation. Materials and methods: A prospective study was conducted including 20 fetuses with HLHS and 20 gestational age matched controls. c-TDI (colour tissue Doppler imaging) derived systolic and diastolic velocities as well as myocardial displacement were assessed in three different locations of the right ventricle (RV). A ROI (region of interest) was placed in the basal, middle and apical part of the myocardium. Possible changes of c-TDI indices in the course of pregnancy and between the three different segments were investigated in both groups. Results: HLHS fetuses showed significantly lower e' velocities measured in the basal and middle part of the RV compared to healthy controls (p < 0.05). Basal displacement showed significantly lower values in HLHS fetuses compared to controls. In control fetuses but not in HLHS fetuses there was a significant increase of basal diastolic velocities and displacement in the course of pregnancy. According to myocardial velocities and displacement values there was a significant decrease from the base of the fetal heart to the apex pointed in both groups. Conclusions: An altered right ventricular myocardial function in HLHS fetuses within different myocardial segments could be demonstrated. An apicobasal gradient with higher velocity and displacement values in the basal part of RV myocardium could be found in both groups. The technique may be of value in the prenatal assessment of myocardial function, however its role as a monitoring tool and outcome predictor needs to be defined.
Collapse
Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich , Germany
| | - Christian Enzensberger
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University and UKGM, Giessen , Germany
| | - Larissa Wieg
- Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich , Germany
| | - Aline Wolter
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University and UKGM, Giessen , Germany
| | - Can Yerebakan
- NCardiovascular Surgery, Children’s National Heart Institute, George Washington University Medical Center, Washington , DC, USA
| | - Markus Khalil
- Department of Paediatric Cardiology, Justus-Liebig-University and UKGM, Giessen , Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University and UKGM, Giessen , Germany
| |
Collapse
|
24
|
Li L, Craft M, Hsu HH, Zhang M, Klas B, Danford DA, Kutty S. Left Ventricular Rotational and Twist Mechanics in the Human Fetal Heart. J Am Soc Echocardiogr 2017; 30:773-780.e1. [DOI: 10.1016/j.echo.2017.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Indexed: 10/19/2022]
|
25
|
Enzensberger C, Achterberg F, Graupner O, Wolter A, Herrmann J, Axt-Fliedner R. Wall-motion tracking in fetal echocardiography-Influence of frame rate on longitudinal strain analysis assessed by two-dimensional speckle tracking. Echocardiography 2017; 34:898-905. [DOI: 10.1111/echo.13542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Christian Enzensberger
- Division of Prenatal Medicine; Department of OB/GYN; University Hospital UKGM; Justus-Liebig University; Giessen Germany
| | - Friederike Achterberg
- Division of Prenatal Medicine; Department of OB/GYN; University Hospital UKGM; Justus-Liebig University; Giessen Germany
| | - Oliver Graupner
- Department of OB/GYN; University Hospital, Technical University; Munich Germany
| | - Aline Wolter
- Division of Prenatal Medicine; Department of OB/GYN; University Hospital UKGM; Justus-Liebig University; Giessen Germany
| | | | - Roland Axt-Fliedner
- Division of Prenatal Medicine; Department of OB/GYN; University Hospital UKGM; Justus-Liebig University; Giessen Germany
| |
Collapse
|
26
|
Enzensberger C, Achterberg F, Degenhardt J, Wolter A, Graupner O, Herrmann J, Axt-Fliedner R. Feasibility and Reproducibility of Two-Dimensional Wall Motion Tracking (WMT) in Fetal Echocardiography. Ultrasound Int Open 2017; 3:E26-E33. [PMID: 28210715 DOI: 10.1055/s-0042-124501] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective The primary objective of this study was to determine the feasibility and reproducibility of 2-dimensional speckle tracking imaging based on the wall motion tracking (WMT) technique in fetal echocardiography. The secondary objective was to compare left and right ventricular global and segmental longitudinal peak strain values. Methods A prospective cross-sectional study was performed. Global and segmental longitudinal peak strain values of the left ventricle (LV) and right ventricle (RV) were assessed prospectively. Based on apical 4-chamber views, cine loops were acquired and digitally stored. Strain analysis was performed offline. Intra- and interobserver variabilities were analyzed. Results A total of 29 healthy fetuses with an echocardiogram performed between 19 and 37 weeks of gestation were included. Analysis was performed with a temporal resolution of 60 frames per second (fps). For both examiners, in all cases Cronbach's alpha was>0.7. The interobserver variability showed a strong agreement in 50% of the segments (ICC 0.71-0.90). The global strain values for LV and RV were -16.34 and -14.65%, respectively. Segmental strain analysis revealed a basis to apex gradient with the lowest strain values in basal segments and the highest strain values in apical segments. Conclusion The assessment of fetal myocardial deformation parameters by 2D WMT is technically feasible with good reproducibility.
Collapse
Affiliation(s)
- Christian Enzensberger
- Division of Prenatal Medicine, Department of OB&GYN, University Hospital UKGM, Justus-Liebig-University, Giessen, Germany
| | - Friederike Achterberg
- Division of Prenatal Medicine, Department of OB&GYN, University Hospital UKGM, Justus-Liebig-University, Giessen, Germany
| | - Jan Degenhardt
- Division of Prenatal Medicine, Department of OB&GYN, University Hospital UKGM, Justus-Liebig-University, Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine, Department of OB&GYN, University Hospital UKGM, Justus-Liebig-University, Giessen, Germany
| | - Oliver Graupner
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Herrmann
- Statistical Consulting Service Giessen, Statistikberatung, Giessen, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Department of OB&GYN, University Hospital UKGM, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
27
|
DeVore GR, Polanco B, Satou G, Sklansky M. Two-Dimensional Speckle Tracking of the Fetal Heart: A Practical Step-by-Step Approach for the Fetal Sonologist. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1765-1781. [PMID: 27353066 DOI: 10.7863/ultra.15.08060] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/13/2015] [Indexed: 06/06/2023]
Abstract
Various approaches to 2-dimensional speckle tracking have been used to evaluate left ventricular function and deformation in the fetus, child, and adult. In 2015, because of differences in imaging devices and analytical programs, the cardiology community published a consensus document proposing standards for pediatric/adult deformation imaging using 2-dimensional speckle tracking. The understanding and application of deformation imaging in the fetus have been limited by a lack of uniform software, terminology, techniques, and display. This article provides a practical, step-by-step approach for deformation analysis of the fetal heart using offline software that is independent of specific ultrasound vendors.
Collapse
Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California USA. Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Bardo Polanco
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| |
Collapse
|
28
|
Ingul CB, Lorås L, Tegnander E, Eik-Nes SH, Brantberg A. Maternal obesity affects fetal myocardial function as early as in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:433-442. [PMID: 25761057 DOI: 10.1002/uog.14841] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/14/2015] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate cardiac function from 14 weeks' gestation in fetuses of obese pregnant women (FOW). Animal studies have shown that maternal obesity induces fibrosis in fetal myocardium. We hypothesized that fetal cardiac function would be impaired among FOW. METHODS A case-control study with longitudinal follow-up was performed at Trondheim University Hospital, Norway. In total, 80 pregnant women were included and the final population comprised 52 obese and 24 of normal weight (mean body mass index before pregnancy, 34.8 ± 4.1 vs 21.0 ± 2.2 kg/m(2) ; P < 0.001). The main outcome measures were global strain rate (GSR) and strain by tissue Doppler imaging, tissue Doppler velocities (TDVs) and interventricular septal thickness assessed by fetal echocardiography at gestational ages of 14, 20 and 32 weeks. RESULTS In FOW, fetal left ventricle (LV) and right ventricle (RV) GSR and strain were significantly lower than in fetuses of normal-weight pregnant women: LV GSR was 33.3% lower at 14 weeks, 22.4% lower at 20 weeks and 22.8% lower at 32 weeks of gestation (P < 0.001) with no difference in fetal heart rate. Systolic and late diastolic TDVs for LV were significantly lower from 20 weeks' gestation and remained lower throughout pregnancy. Fetal interventricular septum was 26.6% (P < 0.001) thicker in late pregnancy in FOW compared with normal-weight pregnancies. CONCLUSIONS At 14 weeks of gestation, we detected fetal myocardial dysfunction with reduced LV and RV GSR and strain in FOW compared with fetuses of women with normal weight. Our finding is alarming considering the high prevalence of obesity and may partly explain the predisposition of offspring to cardiovascular disease later in life.
Collapse
Affiliation(s)
- C B Ingul
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Lorås
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E Tegnander
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - S H Eik-Nes
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
29
|
Maskatia SA, Pignatelli RH, Ayres NA, Altman CA, Sangi-Haghpeykar H, Lee W. Longitudinal Changes and Interobserver Variability of Systolic Myocardial Deformation Values in a Prospective Cohort of Healthy Fetuses across Gestation and after Delivery. J Am Soc Echocardiogr 2016; 29:341-9. [PMID: 26797677 DOI: 10.1016/j.echo.2015.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Normative data for fetal myocardial deformation values have not been comprehensively described in a longitudinal cohort. The effect of gestational age on these values and on interobserver variability require further investigation. METHODS Sixty gravid women were prospectively enrolled before 20 weeks' gestation. The following measures were obtained by two blinded observers at five time points across gestation and also at 4 to 8 weeks' postnatal age: global circumferential strain and strain rate, global longitudinal left ventricular strain and strain rate, global longitudinal right ventricular strain and strain rate, and left and right ventricular myocardial performance indices. Optimal myocardial visualization and frame rate (≥100 frames/sec) were ensured. RESULTS For gestational age groups ≥24 weeks, intraclass correlation coefficients between observers were >0.70 for all measures and >0.85 for the majority of measures of myocardial deformation. At 20 to 21 weeks' gestation, intraclass correlation coefficients were 0.35 to 0.52 for longitudinal measures and 0.74 to 0.82 for circumferential measures. Myocardial performance index intraclass correlation coefficients were <0.80 at all time points and <0.70 for most time points. Global longitudinal left ventricular strain and global circumferential strain values remained stable across gestational age groups. Global longitudinal right ventricular strain values remained stable across gestation and increased after birth. Global circumferential strain rate, global longitudinal left ventricular strain rate, and global longitudinal right ventricular strain rate decreased from 20 to 21 weeks' gestation to the remainder of gestation and then remained stable until delivery. Upon delivery, global circumferential strain rate and global longitudinal left ventricular strain rate decreased, and global longitudinal right ventricular strain rate increased. CONCLUSIONS Interobserver variability of fetal strain and strain rate measured at ≥24 weeks' gestation was lower in comparison with values obtained at 20 to 21 weeks' gestation and lower in comparison with left ventricular and right ventricular myocardial performance indices using the described protocol. Gestational changes in fetal myocardial deformation values likely reflect changes in preload and/or afterload on the fetal heart.
Collapse
Affiliation(s)
- Shiraz Arif Maskatia
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Ricardo H Pignatelli
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Nancy A Ayres
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carolyn A Altman
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Haleh Sangi-Haghpeykar
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Wesley Lee
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
30
|
Liu M, Yu J, Fu X, Wan W. Quantitative Assessment of Cardiac Function in Fetuses of Women with Maternal Gestational Thyroid Dysfunction Using VVI Echocardiography. Med Sci Monit 2015; 21:2956-68. [PMID: 26427319 PMCID: PMC4596453 DOI: 10.12659/msm.894381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to investigate the clinical value of velocity vector imaging (VVI) in assessing heart function in fetuses of pregnant women with thyroid dysfunction. The inter-observer and intra-observer variability was assessed for all VVI parameters observed. Material/Methods The participants were enrolled from singleton pregnant women with gestational ages ranging 24+0 to 40+1 weeks who visited the Department of Obstetrics and Gynecology at the Affiliated Hospital of Qingdao University, China, for prenatal care from July 2011 to February 2014. Digital 2-dimensional (2D) dynamic 4-chamber images of the heart were collected. A total of qualified 226 images from 125 fetuses of pregnant women with normal thyroid (control group), 64 fetuses of pregnant women with hypothyroidism (hypothyroidism group), and 37 fetuses of pregnant women with hyperthyroidism (hyperthyroidism group) were interrogated offline using VVI software. The echocardiographic parameters including the myocardium peak systolic velocity (Vs), peak diastolic velocity (Vd), peak systolic strain (S), peak systolic strain rate (SRs), peak diastolic strain rate (SRd) of RV and LV, were obtained from the velocity curves of 2D myocardial motion. The heart rate was measured using a virtual M-mode algorithm built into the software. Results The study found that the longitudinal Vs and Vd of both ventricles in the control group gradually decreased from basal segments to apical segments and significantly increased over the gestation. S, SRs, and SRd of both ventricles remained stable after middle gestation. Compared with the control group, the hypothyroidism and hyperthyroidism groups exhibited significantly reduced S, SRs, and SRd, even for fetuses at 24-weeks gestation. There were no significant differences in global Vs and global Vd between the control group and the hyperthyroidism or hypothyroidism groups. Conclusions The thyroid dysfunction of pregnant women may damage fetal heart function, and VVI could be a sensitive technique to measure the variation of fetal heart function.
Collapse
Affiliation(s)
- Meixin Liu
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| | - Jing Yu
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| | - Xiuxiu Fu
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| | - Wei Wan
- The Affiliated Hospital of Qingdao University, Qingdao, Shinan, China (mainland)
| |
Collapse
|
31
|
Abstract
BACKGROUND The functionally single fetal right ventricle demonstrates reduced longitudinal relative to circumferential contraction velocities and deformation, a pattern similar to the normal fetal left ventricle. Altered diastolic properties are also present, with greater reliance on atrial contraction for right ventricular filling. It is unknown whether the functionally single left ventricle (SLV) demonstrates similar altered deformation patterns and diastolic properties. METHODS Echocardiograms from 29 fetuses with SLVs were retrospectively compared with those from 48 controls with appropriately grown left ventricles. Ventricular function was assessed using Velocity Vector Imaging velocity, tissue deformation, two-dimensional, and Doppler flow parameters. RESULTS Fetuses with functionally SLVs showed no difference in peak global left ventricular longitudinal velocity or displacement or strain, while global radial displacement was increased (P < .001). The ratio of longitudinal to circumferential deformation was also no different from that in controls. The SLVs showed increased diameters (P < .001) with normal lengths. Mitral inflow peak E-wave (P < .05) and A-wave (P < .0001) velocities were increased, with a reduced E/A ratio (P < .001). A-wave inflow fraction was also increased (P < .05), with no change in A duration. Although ejection time was no different, inflow duration was increased (P < .01) and there was a trend toward reduction of the Tei index (P = .07). CONCLUSIONS The functionally single fetal left ventricle shows comparable changes to the single right ventricle, with a more spherical morphology and greater reliance on atrial contraction for ventricular filling than in controls. However, in contrast to the single right ventricle, the SLV had a normal longitudinal to circumferential deformation ratio with enhanced early diastolic filling.
Collapse
|
32
|
Mahajan A, Henry A, Meriki N, Hernandez-Andrade E, Crispi F, Wu L, Welsh AW. The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research. Fetal Diagn Ther 2015; 38:1-13. [DOI: 10.1159/000363181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.
Collapse
|
33
|
Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 732] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
Collapse
|
34
|
Saini AP, Ural S, Pauliks LB. Quantitation of Fetal Heart Function With Tissue Doppler Velocity Imaging-Reference Values for Color Tissue Doppler Velocities and Comparison With Pulsed Wave Tissue Doppler Velocities. Artif Organs 2013; 38:87-91. [DOI: 10.1111/aor.12187] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ashish P. Saini
- Department of Pediatrics; Division of Pediatric Cardiology; Penn State Hershey College of Medicine; Hershey PA USA
| | - Serdar Ural
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine; Penn State Hershey College of Medicine; Hershey PA USA
| | - Linda B. Pauliks
- Department of Pediatrics; Division of Pediatric Cardiology; Penn State Hershey College of Medicine; Hershey PA USA
| |
Collapse
|
35
|
Kapusta L, Mainzer G, Weiner Z, Deutsch L, Khoury A, Haddad S, Lorber A. Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy. J Am Soc Echocardiogr 2013; 26:1193-1200. [DOI: 10.1016/j.echo.2013.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Indexed: 11/26/2022]
|
36
|
Schubert U, Müller M, Norman M, Abdul-Khaliq H. Transition from fetal to neonatal life: changes in cardiac function assessed by speckle-tracking echocardiography. Early Hum Dev 2013; 89:803-8. [PMID: 23948155 DOI: 10.1016/j.earlhumdev.2013.06.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/07/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Assessment of cardiac function by speckle-tracking (2D-S) echocardiography in the transitional period from fetal to neonatal life in a healthy population. METHODS Ultrasound assessment of cardiac function of 30 healthy fetuses at the gestational age of 28 weeks, and follow-up after birth using 2-D strain derived novel parameters such as longitudinal strain (S), strain rate (SR), tissue velocities, MPI- and E/E'-index, E/A- and E'/A'-rate of both right (RV) and left ventricles (LV) and interventricular septum (IVS) and comparison to conventionally measured cardiac stroke volume (SV), cardiac output (CO) and ejection fraction (EF). RESULTS Ultrasound 2D-S performance and analysis were technically feasible and reproducible in all 30 fetuses and in the neonatal period. In fetuses, tissue velocities and SR measurements were homogenous for all regions of interest in both ventricles, and strain increased from apex to base and was significantly higher in the RV compared to LV. All calculated indices were almost identical for RV and LV. After birth, strain and strain rate exhibited significantly lower values, and systolic tissue velocities were higher in comparison to fetal values in both chambers and in all regions of interest. CONCLUSION Speckle-tracking echocardiography is a feasible and reproducible technique in analyzing both fetal and newborn cardiac functions. Therefore, it might be useful in clinical routine examinations and give new insights in transitional physiology.
Collapse
Affiliation(s)
- Ulf Schubert
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
37
|
Kapusta L, Mainzer G, Weiner Z, Deutsch L, Khoury A, Haddad S, Lorber A. Second trimester ultrasound: reference values for two-dimensional speckle tracking-derived longitudinal strain, strain rate and time to peak deformation of the fetal heart. J Am Soc Echocardiogr 2013. [PMID: 23200418 DOI: 10.1016/j.echo.2012.09.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data on myocardial deformation during the internationally widely used second-trimester screening are scarce and confusing. Reference values of time to peak strain are missing. The aims of this study were to assess reference values derived from two-dimensional speckle-tracking echocardiography for global and regional longitudinal right ventricular (RV) and left ventricular (LV) strain, strain rate, and time to peak global strain and to determine the influence of heart rate and gender on these strain parameters. METHODS Seventy-five healthy fetuses were enrolled during second-trimester ultrasound (20-24 weeks). Clips with high frame rates (mean, 132 frames/sec) and two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses. RESULTS There were no statistically significant differences in global strain and strain rate between both ventricles (P = .679 and P = .734, respectively) or among the RV, septal, and LV free walls. Regional measurements, modeled also as an interaction of wall and segment (basal mid and apical), showed only a small, statistically significant difference between the basal RV and LV free walls. Strain and strain rate values were independent of heart rate. The mean time to peak LV global strain adjusted for heart rate was statistically significantly shorter than the RV value (P < .0001]). Strain, strain rate, and time to peak global strain were not found to be associated with gender. CONCLUSIONS The establishment of second-trimester two-dimensional speckle-tracking echocardiographic reference values for global and regional strain, strain rate, and time to peak global strain in a healthy fetal cohort is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.
Collapse
Affiliation(s)
- Livia Kapusta
- Children's Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
38
|
Taylor-Clarke MC, Matsui H, Roughton M, Wimalasundera RC, Gardiner HM. Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2013; 208:462.e1-6. [PMID: 23474428 DOI: 10.1016/j.ajog.2013.02.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/21/2013] [Accepted: 02/28/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to investigate whether vector velocity imaging (VVI), a non-Doppler speckle tracking ultrasound technology, is feasible in twin pregnancies and can aid management of twin-twin transfusion syndrome (TTTS). STUDY DESIGN Twenty-seven women pregnant with monochorionic diamniotic twins affected by TTTS and 28 monochorionic pregnancies that did not develop TTTS were included in a prospective case-control study at a fetal medicine center. Fetal echocardiograms were recorded with dummy electrocardiography to retain original frame rates when exported for offline speckle tracking analysis using Syngo-VVI software (Siemens Corp, Munich, Germany). Right and left ventricular (LV) free wall Lagrangian strain was measured from the original coordinates. Within-twin pair ventricular strain differences including relationship to Quintero staging and response to laser therapy for TTTS were analyzed by Wilcoxon signed-rank test. RESULTS The VVI strain measurements could be analyzed in 182 of 200 TTTS and 96 of 112 non-TTTS control ventricles. Within-pair strain was concordant in non-TTTS controls. Recipient LV strain was reduced at all Quintero stages compared with donors (P < .01). Recipient right ventricular strain was reduced only in stages 3 and 4 (P < .01). Strain improved at a median of 2 weeks following successful laser therapy. Intertwin differences in strain were independent of weight discordance. CONCLUSION Recipient LV strain is reduced in stages 1 and 2 TTTS. Within-pair strain discordance may distinguish early TTTS from growth discordance and guide timing of and management following treatment.
Collapse
|
39
|
King G, Almuntaser I, Murphy RT, La Gerche A, Mahoney N, Bennet K, Clarke J, Brown A. Reduced right ventricular myocardial strain in the elite athlete may not be a consequence of myocardial damage. "Cream masquerades as skimmed milk". Echocardiography 2013; 30:929-35. [PMID: 23488623 DOI: 10.1111/echo.12153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Latest research shows that the lower resting values of right ventricular (RV) myocardial % strain may represent a physiologic change rather than subclinical myocardial damage. Therefore, we assessed load-independent changes to the RV as a consequence of high intensity training by measuring the Isovolumic acceleration (IVA) of the free wall of the RV in conjunction with NT pro-BNP measured by an electrochemiluminescence assay. METHODS Seventeen controls (mean age 27 ± 4), 24 soccer footballers (mean age 24 ± 4), and 18 elite rowers (mean age 22 ± 4) were studied. Left ventricular (LV) and RV % strain were measured using two-dimensional (2D) speckle based automated functional imaging (AFI) software. RV free wall IVA was measured using pulsed-wave tissue Doppler at the lateral tricuspid annulus. Standard 2D echo were used to measured RV parameters including the Tei index (systolic and diastolic function) and the total annular plane systolic excursion (TAPSE) of the RV annulus. NT pro-BNP was measured by an electrochemiluminescence assay. RESULTS The RV diameter was increased in the footballers and elite rowers compared with controls (P < 0.001). RV wall size was greater in the elite rowers compared with controls and footballers (P = 0.002). The peak IVA of the RV was higher in the rowers, compared with the footballers and to controls (P < 0.001). The mean LV and RV % myocardial strain were lower in the elite athletes and the footballers compared with controls (P < 0.001). There was no difference in RV Tei index, levels of BNP, and TAPSE across all subjects. CONCLUSIONS This study showed a significant increase in IVA of the RV of athletes despite reduced myocardial % strain and normal levels in NT-proBNP. This suggests that the decrease in % strain is not a consequence of myocardial damage, but may represents a part of the physiological response to endurance exercise. Therefore, a reduced IVA in a remodeled RV could herald a pathological response.
Collapse
Affiliation(s)
- Gerard King
- Eagle Lodge Medical Centre, Limerick, Ireland; Department of Cardiology (CREST), St. James's Hospital, Dublin, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Functional Imaging in Fetal Echocardiography: A Review of Conventional and Novel Approaches. Cardiovasc Eng Technol 2013; 4:276-285. [DOI: 10.1007/s13239-013-0132-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/05/2013] [Indexed: 02/06/2023]
|
41
|
Truong UT, Sun HY, Tacy TA. Myocardial deformation in the fetal single ventricle. J Am Soc Echocardiogr 2012; 26:57-63. [PMID: 23140844 DOI: 10.1016/j.echo.2012.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In postnatal life, patients with single ventricle (SV) with morphologic right ventricles have a worse prognosis than those with morphologic left ventricles. The aim of this study was to test the hypotheses that (1) the SV in fetuses with SV has decreased longitudinal strain compared with fetuses with normal cardiac anatomy, and (2) fetuses with SV right ventricular (RV) morphology have decreased strain compared with those with SV left ventricular (LV) morphology. METHODS Fetal echocardiograms with SV RV and SV LV morphology were retrospectively compiled. Postprocessing analysis of the dominant ventricle was done using syngo Velocity Vector Imaging version 2.0. Peak global longitudinal strain (GLS) and global longitudinal strain rate (GL SR) were generated. Both the right and left ventricles were analyzed in fetuses with normal cardiac anatomy for comparison. RESULTS Fifty-four fetuses with SV (18 with LV morphology and 36 with RV morphology) were included in the study and compared with 54 controls matched for gestational age. Global longitudinal strain and GL SR were compared between fetuses with SV and normal fetuses and among SV subsets. When all four categories were compared (normal left ventricle, normal right ventricle, SV left ventricle, and SV right ventricle), there was no difference in GLS (P = .49) or in GL SR (P = .32) between any of the categories. CONCLUSIONS Comparable GLS and GL SR values between fetal SV of LV or RV morphology, as well as normal fetal left and right ventricles, reflect in utero preservation of systolic function of the SV heart.
Collapse
Affiliation(s)
- Uyen T Truong
- Division of Pediatric Cardiology, Children's Hospital Colorado, The University of Colorado Medical Center, Aurora, Colorado, USA
| | | | | |
Collapse
|
42
|
Abstract
BACKGROUND The systemic right ventricle in palliated hypoplastic left heart syndrome (HLHS) has relatively reduced longitudinal compared with circumferential deformation, a pattern of contraction more akin to the normal left ventricle, which presumably improves right ventricular (RV) pumping efficiency. The aim of this study was to test the hypothesis that these changes in the RV contraction pattern in infants with HLHS are present prenatally. METHODS Echocardiograms from 48 fetuses with HLHS were retrospectively compared with those from appropriately grown RV and left ventricular controls. Ventricular function was assessed using Velocity Vector Imaging velocity, tissue deformation, two-dimensional echocardiography, and Doppler flow parameters. RESULTS Fetuses with HLHS demonstrated reduced peak global RV longitudinal velocity (P < .01), strain (P < .001), and displacement (P < .05), while radial displacement was increased (P < .001) compared with the normal fetal right ventricle. Mean RV diameter was increased in HLHS (P < .001), but length was unchanged. The ratio of longitudinal to circumferential deformation was reduced in HLHS compared with the normal right ventricle (P < .001) and equivalent to the normal left ventricle. Tricuspid inflow peak A-wave velocity (P < .01), A-wave duration, A-wave inflow fraction, RV Tei index (P < .05 for all), and inferior vena cava A-wave reversal (P < .0001) were increased in HLHS. CONCLUSIONS The fetal right ventricle in HLHS becomes more spherical because of increased RV diameter. It has relatively reduced longitudinal compared with circumferential deformation and an increased reliance on atrial contraction for ventricular filling. These findings are similar to postnatal changes observed in the systemic right ventricle in palliated congenital heart disease, suggesting that ventricular remodeling is initiated in fetal life.
Collapse
|
43
|
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. [DOI: 10.1159/000334413] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 10/11/2011] [Indexed: 11/19/2022]
|
44
|
Germanakis I, Gardiner H. Assessment of Fetal Myocardial Deformation Using Speckle Tracking Techniques. Fetal Diagn Ther 2012; 32:39-46. [DOI: 10.1159/000330378] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/07/2011] [Indexed: 11/19/2022]
|
45
|
Germanakis I, Pepes S, Sifakis S, Gardiner H. Fetal Longitudinal Myocardial Function Assessment by Anatomic M-Mode. Fetal Diagn Ther 2012; 32:65-71. [DOI: 10.1159/000330790] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 07/06/2011] [Indexed: 11/19/2022]
|
46
|
Crispi F, Sepulveda-Swatson E, Cruz-Lemini M, Rojas-Benavente J, Garcia-Posada R, Dominguez JM, Sitges M, Bijnens B, Gratacós E. Feasibility and Reproducibility of a Standard Protocol for 2D Speckle Tracking and Tissue Doppler-Based Strain and Strain Rate Analysis of the Fetal Heart. Fetal Diagn Ther 2012; 32:96-108. [DOI: 10.1159/000337329] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 02/09/2012] [Indexed: 11/19/2022]
|
47
|
Rychik J, Zeng S, Bebbington M, Szwast A, Quartermain M, Natarajan S, Johnson M, Tian Z. Speckle Tracking-Derived Myocardial Tissue Deformation Imaging in Twin-Twin Transfusion Syndrome: Differences in Strain and Strain Rate between Donor and Recipient Twins. Fetal Diagn Ther 2012; 32:131-7. [DOI: 10.1159/000335403] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
48
|
Ishii T, McElhinney DB, Harrild DM, Marcus EN, Sahn DJ, Truong U, Tworetzky W. Circumferential and longitudinal ventricular strain in the normal human fetus. J Am Soc Echocardiogr 2011; 25:105-11. [PMID: 22033231 DOI: 10.1016/j.echo.2011.09.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Echocardiography with speckle tracking is a novel, angle-independent technique for assessing global and regional cardiac function. Normal data on longitudinal strain have been reported for human fetuses. The aim of this study was to define circumferential left ventricular (LV) strain in a normal fetal population. METHODS Singleton fetuses between 17 and 42 weeks in gestational age with no adverse maternal health issues or fetal abnormalities were studied. Regional and averaged cardiac strain were measured using syngo Velocity Vector Imaging software. RESULTS Data from 81 fetuses were analyzed (mean gestational age, 29.2 ± 5.7 weeks). Overall, average midventricular circumferential strain was 18.7 ± 3.3%, LV longitudinal strain was 15.2 ± 2.7%, and right ventricular longitudinal strain was 16.0 ± 3.3%, with no correlation with gestational age. CONCLUSION This is the first study to report normal fetal LV circumferential strain. These data may be useful as a reference for assessing fetal cardiac function. The retrospective study design and relatively low frame rates used in this study were important limitations.
Collapse
Affiliation(s)
- Tetsuko Ishii
- Department of Cardiology, Children's Hospital Boston, and Harvard Medical School, Boston, Massachusetts 02115, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Willruth AM, Geipel AK, Berg CT, Fimmers R, Gembruch UG. Comparison of global and regional right and left ventricular longitudinal peak systolic strain, strain rate and velocity in healthy fetuses using a novel feature tracking technique. J Perinat Med 2011; 39:549-56. [PMID: 21749284 DOI: 10.1515/jpm.2011.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To compare the feature tracking derived measurements of the right (RV) and left ventricular (LV) myocardium in healthy fetuses and evaluate the correlation with advancing pregnancy. METHODS Global and segmental longitudinal peak systolic strain, strain rate and velocity of the RV and LV myocardium were assessed with feature tracking technique in 150 healthy fetuses (13-39, median 22 weeks). RESULTS RV global and free wall strain and strain rate values were significantly higher than those in the LV segments (P<0.001 and P<0.001). In all segments on both ventricles longitudinal peak systolic velocity measurements exhibited a significant base to apex gradient (P<0.001) and increased with advancing pregnancy (P<0.001). LV global strain and strain rate values remained constant throughout gestation, whereas RV measurements decreased (P<0.05). With advancing pregnancy the difference between RV and LV global longitudinal velocity increased significantly, whereas the difference of strain and strain rate decreased significantly. CONCLUSION RV deformation parameters and velocity values are significantly higher compared to LV values. LV deformation parameters are stable throughout gestation, whereas RV measurements decrease significantly. The difference between global RV and LV myocardial values were significant throughout gestation, velocity values increased, whereas deformation parameters decreased.
Collapse
Affiliation(s)
- Arne M Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
| | | | | | | | | |
Collapse
|
50
|
Matsui H, Germanakis I, Kulinskaya E, Gardiner HM. Temporal and spatial performance of vector velocity imaging in the human fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:150-157. [PMID: 20814875 DOI: 10.1002/uog.8815] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To assess the spatial and temporal performance of fetal myocardial speckle tracking, using high-frame-rate (HFR) storing and Lagrangian strain analysis. METHODS Dummy electrocardiographic signaling permitted DICOM HFR in 124 normal fetuses and paired low-frame-rate (LFR) video storing at 25 Hz in 93 of them. Vector velocity imaging (VVI) tracking co-ordinates were used to compare time and spatial domain measures. We compared tracking success, Lagrangian strain, peak diastolic velocity and positive strain rate values in HFR vs. LFR video storing. Further comparisons within an HFR subset included Lagrangian vs. natural strain, VVI vs. M-mode annular displacement, and VVI vs. pulsed-wave tissue Doppler imaging (TDI) peak velocities. RESULTS HFR (average 79.4 Hz) tracking was more successful than LFR (86 vs. 76%, P = 0.024). Lagrangian and natural HFR strain correlated highly (left ventricle (LV): r = 0.883, P < 0.001; right ventricle (RV): r = 0.792, P < 0.001) but natural strain gave 20% lower values, suggesting reduced reliability of measurement. Lagrangian HFR strain was similar in LV and RV and decreased with gestation (P = 0.015 and P < 0.001, respectively). LV Lagrangian LFR strain was significantly lower than the values for the RV (P < 0.001) and those using paired LV-HFR recordings (P = 0.007). Annular displacement methods correlated highly (LV = 1.046, r = 0.90, P < 0.001; RV = 1.170, r = 0.88, P < 0.001). Early diastolic waves were visible in 95% of TDI, but in only 26% of HFR and 0% of LFR recordings, and HFR-VVI velocities were significantly lower than those for TDI (P < 0.001). CONCLUSIONS Doppler estimation of velocities remains superior to VVI but image gating and use of original co-ordinates should improve offline VVI assessment of fetal myocardial function.
Collapse
Affiliation(s)
- H Matsui
- Department of Reproductive Biology, Imperial College at Queen Charlotte's and Chelsea Hospital, London, UK
| | | | | | | |
Collapse
|