Using speckle‐tracking echocardiography to assess fetal myocardial deformation: are we there yet?

Charakida, Marietta; Simpson, John

doi:10.1002/uog.20233

Cited by 31 publications

(83 citation statements)

References 65 publications

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“…41 It also remains difficult to compare published studies due to differences in gestational age at which measurements were performed as well as the variations induced by some commercially available algorithms 11,14,26,[31][32][33]42 . Day et al 43 discuss the impact of some of these limitations on reference ranges. Additional confounders also include issues with vendor specific equipment as well as the difficulties associated with imaging using very high frame rates.…”

Section: Discussionmentioning

confidence: 99%

Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy

Lee-Tannock

Hay

Gooi

et al. 2020

J of Clinical Ultrasound

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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 four weeks from enrolment (18-28 weeks) until delivery. Strain and strain rate were measured at each examination using Velocity Vector Imaging (VVI). Changes in strain and strain rate as functions of gestational age were modelled using Bayesian mixed effects models.Results: A total of 406 assessments of global longitudinal strain and strain rate were performed 120 women. Global longitudinal strain and strain rate decreased with increasing gestational age 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 gestational age. 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.

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Section: Discussionmentioning

confidence: 99%

Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy

Lee-Tannock

Hay

Gooi

et al. 2020

J of Clinical Ultrasound

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“…2D speckle-tracking echocardiography uses an automated analysis to detect the endocardial border through the cardiac cycle, which can be advantageous to reduce the variability of manual tracing but requires specialized software to compute the measurements and calculate RV FAC. Although speckle-tracking technique is being progressively introduced into adult cardiology and postnatal pediatric practice, in fetal cardiology, there are still relatively few data [43][44][45][46][47] and more studies are needed to validate its clinical utility. Overall, prenatal assessment of RV FAC seems a feasibility and highly reproducible method using traditional 2D delineation or speckle tracking.…”

Section: Discussionmentioning

confidence: 99%

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

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Objectives: Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. Methods: Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area -ES area]/ED area) × 100. RV FAC intra-and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). Results: RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93-0.98], RV ES area 0.97 [0.94-0.98], and FAC 0.69 [0.44-0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10-90th centiles: 25-47%, respectively] to 29% at 41 weeks [10-90th centiles: 18-40%, Guirado et al. respectively]). The best models for RV areas and FAC were a second-degree polynomial. Conclusions: RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.

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“…In our study, even the case with mild disturbance of the cardiomyocyte network and endocardial fibrosis presented a corresponding mild reduction in myocardial wall deformation while, remarkably, standard LV function parameters according to the international criteria for fetal AS appeared normal. This emphasizes that speckle tracking echocardiography not only correlates greatly with myocardial histology but is also capable of identifying early structural alterations which are not detected by other ultrasound parameters [34]. The latter is especially of interest as Ishii et al demonstrated slightly higher strain values before prenatal valvuloplasty in fetal critical AS cases with biventricular outcome compared to cases with univentricular outcome, suggesting a pivot role of speckle tracking analysis in predicting ventricular outcome at an early stage [35].…”

Section: Discussionmentioning

confidence: 93%

Deficient Myocardial Organization and Pathological Fibrosis in Fetal Aortic Stenosis—Association of Prenatal Ultrasound with Postmortem Histology

Zwanenburg

DeRuiter

Wisse

et al. 2021

JCDD

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In fetal aortic stenosis (AS), it remains challenging to predict left ventricular development over the course of pregnancy. Myocardial organization, differentiation and fibrosis could be potential biomarkers relevant for biventricular outcome. We present four cases of fetal AS with varying degrees of severity and associate myocardial deformation on fetal ultrasound with postmortem histopathological characteristics. During routine fetal echocardiography, speckle tracking recordings of the cardiac four-chamber view were performed to assess myocardial strain as parameter for myocardial deformation. After pregnancy termination, postmortem cardiac specimens were examined using immunohistochemical labeling (IHC) of key markers for myocardial organization, differentiation and fibrosis and compared to normal fetal hearts. Two cases with critical AS presented extremely decreased left ventricular (LV) strain on fetal ultrasound. IHC showed overt endocardial fibro-elastosis, which correlated with pathological fibrosis patterns in the myocardium and extremely disturbed cardiomyocyte organization. The LV in severe AS showed mildly reduced myocardial strain and less severe disorganization of the cardiomyocytes. In conclusion, the degree of reduction in myocardial deformation corresponded with high extent to the amount of pathological fibrosis patterns and cardiomyocyte disorganization. Myocardial deformation on fetal ultrasound seems to hold promise as a potential biomarker for left ventricular structural damage in AS.

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Using speckle‐tracking echocardiography to assess fetal myocardial deformation: are we there yet?

Cited by 31 publications

References 65 publications

Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy

Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

Deficient Myocardial Organization and Pathological Fibrosis in Fetal Aortic Stenosis—Association of Prenatal Ultrasound with Postmortem Histology

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