Speckle‐Tracking Analysis in Fetuses With Tetralogy of Fallot: Evaluation of Right and Left Ventricular Contractility and Left Ventricular Function

DeVore, Greggory R.; Afshar, Yalda; Harake, Danielle; Satou, Gary; Sklansky, Mark

doi:10.1002/jum.15987

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…This finding indicates the additive value of considering strain parameters of both, LV and RV, in the evaluation of fetal cardiac function. Using echocardiography, recent studies suggested that myocardial strain reflects the changing physiology in fetuses with CHD [ 23 – 25 ], e.g., altered strain parameters were observed in fetuses with tetralogy of Fallot [ 26 ]. In fetuses with transposition of the great arteries, echocardiographic strain measures predicted urgent postnatal intervention [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Myocardial strain assessment in the human fetus by cardiac MRI using Doppler ultrasound gating and feature tracking

Dargahpour Barough,

Tavares de Sousa,

Hergert

et al. 2024

Eur Radiol

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Objectives Assessment of myocardial strain by feature tracking magnetic resonance imaging (FT-MRI) in human fetuses with and without congenital heart disease (CHD) using cardiac Doppler ultrasound (DUS) gating. Methods A total of 43 human fetuses (gestational age 28–41 weeks) underwent dynamic cardiac MRI at 3 T. Cine balanced steady-state free-precession imaging was performed using fetal cardiac DUS gating. FT-MRI was analyzed using dedicated post-processing software. Endo- and epicardial contours were manually delineated from fetal cardiac 4-chamber views, followed by automated propagation to calculate global longitudinal strain (GLS) of the left (LV) and right ventricle (RV), LV radial strain, and LV strain rate. Results Strain assessment was successful in 38/43 fetuses (88%); 23 of them had postnatally confirmed diagnosis of CHD (e.g., coarctation, transposition of great arteries) and 15 were heart healthy. Five fetuses were excluded due to reduced image quality. In fetuses with CHD compared to healthy controls, median LV GLS (− 13.2% vs. − 18.9%; p < 0.007), RV GLS (− 7.9% vs. − 16.2%; p < 0.006), and LV strain rate (1.4 s−1 vs. 1.6 s−1; p < 0.003) were significantly higher (i.e., less negative). LV radial strain was without a statistically significant difference (20.7% vs. 22.6%; p = 0.1). Bivariate discriminant analysis for LV GLS and RV GLS revealed a sensitivity of 67% and specificity of 93% to differentiate between fetuses with CHD and healthy fetuses. Conclusion Myocardial strain was successfully assessed in the human fetus, performing dynamic fetal cardiac MRI with DUS gating. Our study indicates that strain parameters may allow for differentiation between fetuses with and without CHD. Clinical relevance statement Myocardial strain analysis by cardiac MRI with Doppler ultrasound gating and feature tracking may provide a new diagnostic approach for evaluation of fetal cardiac function in congenital heart disease. Key Points • MRI myocardial strain analysis has not been performed in human fetuses so far. • Myocardial strain was assessed in human fetuses using cardiac MRI with Doppler ultrasound gating. • MRI myocardial strain may provide a new diagnostic approach to evaluate fetal cardiac function.

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Section: Discussionmentioning

confidence: 99%

Myocardial strain assessment in the human fetus by cardiac MRI using Doppler ultrasound gating and feature tracking

Dargahpour Barough,

Tavares de Sousa,

Hergert

et al. 2024

Eur Radiol

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“…6 (2) The measurements can be obtained using the area and distance measurement tools available on all ultrasound machines and do not require speckle tracking analysis to perform as they have a high correlation for the LV area (0.96), RV area (0.98), LV length (0.97) RV length (0.97) LV midchamber width (0.95), and RV Base width (0.93) when compared to speckle tracking measurements. 10,24 (3) The measurements take less than 1 minute to perform once the end-diastolic image of the 4-chamber view is obtained. Supplement 3 is a video of the measurements from a fetus at 20 weeks and 1 day that took 48 seconds to complete the measurement sequence.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical benefits of measuring the 4CV and ventricles, as described in the current study, are the following: (1) The measurements would be compatible with the guidelines outlined for the Standard Ultrasound Examination endorsed by AIUM, ACOG, ARC, SMFM, and SRU 6 . (2) The measurements can be obtained using the area and distance measurement tools available on all ultrasound machines and do not require speckle tracking analysis to perform as they have a high correlation for the LV area (0.96), RV area (0.98), LV length (0.97) RV length (0.97) LV mid‐chamber width (0.95), and RV Base width (0.93) when compared to speckle tracking measurements 10,24 . (3) The measurements take less than 1 minute to perform once the end‐diastolic image of the 4‐chamber view is obtained.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities of the Width of the Four‐Chamber View and the Area, Length, and Width of the Ventricles to Identify Fetuses at High‐Risk for D‐Transposition of the Great Arteries and Tetralogy of Fallot

DeVore

Cuneo

Sklansky

et al. 2022

J of Ultrasound Medicine

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Objectives The prenatal detection of D‐Transposition of the great arteries (D‐TGA) and tetralogy of Fallot (TOF) has been reported to be less than 50% to as high as 77% when adding the outflow tracts to the four‐chamber screening protocol. Because many examiners still struggle with the outflow tract examination, this study evaluated whether changes in the size and shape of the heart in the 4CV as well as the ventricles occurred in fetuses with D‐TGA and TOF could be used to screen for these malformations. Methods Forty‐four fetuses with the pre‐and post‐natal diagnosis of D‐TGA and 44 with TOF were evaluated between 19 and 36 weeks of gestation in which the 4CV was imaged. Measurements of the end‐diastolic width, length, area, and global sphericity index were measured for the four‐chamber view and the right and left ventricles. Using z‐score computed values, logistic regression was performed between the 88 study and 200 control fetuses using the hierarchical forward selection protocol. Results Logistic regression identified 10 variables that correctly classified 83/88 of fetuses with TOF and TGA, for a sensitivity of 94%. Six of 200 normal controls were incorrectly classified for a false‐positive rate of 3%. The area under the receiver operator classification curve was 98.1%. The true positive rate for D‐TGA was 93.2%, with a false‐negative rate to 6.8%. The true positive rate for TOF was 95.5%, with a false negative rate of 4.5%. Conclusions Measurements of the 4CV and of the RV and LV may help identify fetuses at risk for D‐TGA or TOF.

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Fetal Speckle Tracking Echocardiography Measured Global Longitudinal Strain and Strain Rate in Congenital Heart Disease: A Systematic Review and Meta‐Analysis

van den Wildenberg,

van Beynum,

Havermans

et al. 2024

Prenatal Diagnosis

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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.

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Speckle‐Tracking Analysis in Fetuses With Tetralogy of Fallot: Evaluation of Right and Left Ventricular Contractility and Left Ventricular Function

Cited by 7 publications

References 14 publications

Myocardial strain assessment in the human fetus by cardiac MRI using Doppler ultrasound gating and feature tracking

Myocardial strain assessment in the human fetus by cardiac MRI using Doppler ultrasound gating and feature tracking

Abnormalities of the Width of the Four‐Chamber View and the Area, Length, and Width of the Ventricles to Identify Fetuses at High‐Risk for D‐Transposition of the Great Arteries and Tetralogy of Fallot

Fetal Speckle Tracking Echocardiography Measured Global Longitudinal Strain and Strain Rate in Congenital Heart Disease: A Systematic Review and Meta‐Analysis

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