Helical structure of the ventricular myocardium. A narrative review of cardiac mechanics

Antùnez-Montes, Omar Yassef; Kočica, Mladen J.; Olavarría, Alberto Sosa; Corno, Antonio F.; Millán, Rocío Aceves; Rosales, Carlos Ixcamparij; Aparicio, Héctor Eduardo Sánchez

doi:10.1111/echo.15515

Cited by 5 publications

(4 citation statements)

References 61 publications

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“…4,8,25,73 The helical structure of the ventricular myocardium with its threedimensional (3D) deformation requires to detect speckles in all dimensions. 81 In addition, 2D-STE excludes the right ventricular outflow tract. 11 Theoretically, holistic, spatial concepts might offer an important contribution in measuring more realistic volumetric parameters.…”

Section: Resultsmentioning

confidence: 99%

“…Cardiac mechanics is complex due to special geometry with myocardial three‐directional motion including longitudinal, radial, and circumferential contraction 4,8,25,73 . The helical structure of the ventricular myocardium with its three‐dimensional (3D) deformation requires to detect speckles in all dimensions 81 . In addition, 2D‐STE excludes the right ventricular outflow tract 11 .…”

Section: Discussionmentioning

confidence: 99%

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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®

Scharf,

Dracopoulos,

Gembicki

et al. 2024

Echocardiography

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BackgroundPrenatal 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.MethodsA 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.ResultsThe 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.ConclusionsBetween 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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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®

Scharf,

Dracopoulos,

Gembicki

et al. 2024

Echocardiography

View full text Add to dashboard Cite

show abstract

“…Cardiac mechanics is complex due to special geometry with myocardial three-directional motion including longitudinal, radial, and circumferential contraction [4,8,25,73]. The heli-cal structure of the ventricular myocardium with its three-dimensional (3D) deformation requires to detect speckles in all dimensions [81]. In addition, 2D-STE excludes the right ventricular outflow tract [11].…”

Section: Discussionmentioning

confidence: 99%

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®

Scharf,

Dracopoulos,

Gembicki

et al. 2024

Preprint

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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, USA). 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/m . 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 were 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 -0.49 mm ± 1.54 mm to -0.10 mm ± 1.28 mm, that for FS from -0.33 pp ± 11.82 pp to 3.91 pp ± 15.56 pp and that for SI from -0.38 ± 0.68 to -0.15 ± 0.45. 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.

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“…Interestingly, blocking the function of CDH2 with an antibody led to randomized heart looping in the chicken embryo ( 22 ), a process relying on muscle fiber alignment in crossing direction, similar to the process we identified to underlie the formation of hUC helices. CDH2 and the association with abnormal heart development are linked to the helical appearance and spatial distribution of overlapping superficial and deep myocardial fibers of the ventricular heart with concentric contraction of the myocardium ( 66 , 67 ). The up-regulation of CDH2 in hypercoiled hUCs may give an increased muscle fiber alignment, contributing to and maintaining the increased coiling.…”

Section: Discussionmentioning

confidence: 99%

Twisting the theory on the origin of human umbilical cord coiling featuring monozygotic twins

Todtenhaupt,

Kuipers,

Dijkstra

et al. 2024

Life Sci. Alliance

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The human umbilical cord (hUC) is the lifeline that connects the fetus to the mother. Hypercoiling of the hUC is associated with pre- and perinatal morbidity and mortality. We investigated the origin of hUC hypercoiling using state-of-the-art imaging and omics approaches. Macroscopic inspection of the hUC revealed the helices to originate from the arteries rather than other components of the hUC. Digital reconstruction of the hUC arteries showed the dynamic alignment of two layers of muscle fibers in the tunica media aligning in opposing directions. We observed that genetically identical twins can be discordant for hUC coiling, excluding genetic, many environmental, and parental origins of hUC coiling. Comparing the transcriptomic and DNA methylation profile of the hUC arteries of four twin pairs with discordant cord coiling, we detected 28 differentially expressed genes, but no differentially methylated CpGs. These genes play a role in vascular development, cell–cell interaction, and axis formation and may account for the increased number of hUC helices. When combined, our results provide a novel framework to understand the origin of hUC helices in fetal development.

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Helical structure of the ventricular myocardium. A narrative review of cardiac mechanics

Cited by 5 publications

References 61 publications

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®

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®

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®

Twisting the theory on the origin of human umbilical cord coiling featuring monozygotic twins

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