Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile

DeVore, Greggory R.; Gumina, Diane L.; Hobbins, John C.

doi:10.1016/j.ajog.2019.05.042

Cited by 38 publications

(49 citation statements)

References 83 publications

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“…A limited number of studies concerning strain and strain rate in SGA fetuses using 2D‐STE have been performed to date 26‐29 . They suggest that strain and strain rate abnormalities can be identified at an early stage, independent of the umbilical and middle cerebral artery Doppler values 21,26‐28,30,31 .…”

Section: Introductionmentioning

confidence: 99%

“…25 A limited number of studies concerning strain and strain rate in SGA fetuses using 2D-STE have been performed to date. [26][27][28][29] They suggest that strain and strain rate abnormalities can be identified at an early stage, independent of the umbilical and middle cerebral artery Doppler values. 21,[26][27][28]30,31 Therefore, we hypothesize that fetal cardiac deformation values change early in the process of placental dysfunction in SGA fetuses.…”

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confidence: 99%

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Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses

et al. 2020

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Objectives: Small for gestational age (SGA) fetuses have an increased risk for adverse outcome. Placental insufficiency leads to changes in the circulation, with secondary adaptation of the fetal heart resulting in changed cardiac deformation. This deformation can be measured with 2D speckle tracking echocardiography (2D-STE). SGA is antenatally often undiagnosed. The measurement of deformation changes in the fetal heart might help in the prediction of SGA and identify fetuses in need of more intensive surveillance. Methods: In this longitudinal prospective cohort study, global longitudinal strain (GLS) and strain rate (GLSR), measured before 23 weeks gestational age were compared between SGA and appropriate for gestational age (AGA) fetuses, based on birthweight corrected for gestational age at birth. Results: The fetal heart rate was significantly increased in SGA; 158 beats per minute (146-163) vs 148 (134-156); P = 0.035 in AGA. Right ventricle GLS (RV-GLS) values were significantly increased in SGA; −15.87% (−11.69% to −20.55%) vs −20.24% (−16.29% to −24.28%); p = 0.024, respectively. Conclusion: RV-GLS values, measured with 2D-STE, were significantly increased in SGA, indicating systolic RV dysfunction before 23 weeks gestational age in fetuses who will become SGA later in pregnancy. A large longitudinal prospective cohort study is needed to confirm these findings. 1 | INTRODUCTION SGA is defined as an estimated fetal weight (EFW) below the 10th percentile. 1,2 The cause of SGA can either be constitutional, or due to fetal malformations, chromosomal abnormalities, infection or placental insufficiency. 3,4 Placental insufficiency is considered to be the main cause for SGA. 5-8 SGA fetuses have an increased risk for stillbirth, neurodevelopmental delay and metabolic disease later in life. 4,9,10 In addition to growth measurements, Doppler measurements of the umbilical and middle cerebral artery are performed to identify the SGA fetus endangered by placental insufficiency. 2 Despite this strategy however, 75% to 90% of at risk SGA fetuses remain antenatally unidentified, increasing their chance of stillbirth and adverse perinatal outcome. 11-15 Improved identification strategies for SGA are therefore needed. 2D-STE may be a promising new tool in the identification of SGA fetuses. 16-18 It was shown to be feasible and reproducible in the evaluation of the fetal heart. 16 Due to placental insufficiency, fetal hemodynamics change, leading to adaptive fetal myocardial changes. 19

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Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses

et al. 2020

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“…S peckle-tracking analysis of the fetal heart is a new diagnostic tool that allows the clinician to measure the size, shape, and contractility of the right ventricle (RV) and left ventricle (LV), as well as the function of the LV. [1][2][3][4][5][6][7][8][9][10][11][12][13] Currently, there are 2 approaches used for speckle-tracking analysis of the fetal heart. The first includes dedicated ultrasound machines in which the software for analysis is unique to the specific ultrasound manufacturer.…”

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confidence: 99%

“…The second approach is machine independent and only requires Digital Imaging and Communications in Medicine clips for analysis. [1][2][3][4][5][6][7][8][9][10][11][12][13]16,[19][20][21][22][23][24][25][26] Currently, TomTec (Unterschleissheim, Germany) is the most commonly used software for the latter analysis and is available as a stand-alone program as well as integrated into the Voluson Expert platform (GE Healthcare, Chicago, IL) for fetal analysis.…”

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Comparing the Non‐Quiver and Quiver Techniques for Identification of the Endocardial Borders Used for Speckle‐Tracking Analysis of the Ventricles of the Fetal Heart

DeVore

Satou

Sklansky

2020

J of Ultrasound Medicine

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This study compared the non-quiver with the quiver technique for identifying the end-systolic and end-diastolic endocardium of the fetal right ventricle (RV) and left ventricle (LV) used for speckle-tracking analysis. Bland-Altman and t test analyses showed no significant differences in measurements between the techniques for the RV and LV. The difference in the time required to perform the non-quiver analysis was significantly longer (P < .001) for the RV and LV than the quiver technique. The quiver technique allows the examiner to efficiently identify the endocardial borders of the fetal heart compared with the non-quiver method.

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“…Lastly, we have reported a number of cardiac measurements derived from speckle‐tracking analysis of the right and left ventricular endocardium that analyze ventricular size, shape and contractility. This analysis, a relatively new adaptation of speckle‐tracking assessment, enables the examiner to obtain numerous cardiac measurements from a single endocardial tracing of each ventricle, which takes less than 3 min, and is now commercially available on ultrasound platforms dedicated primarily to fetal evaluation.…”

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

DeVore

Satou

Sklansky

2019

Ultrasound in Obstet & Gyne

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Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile

Cited by 38 publications

References 83 publications

Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses

Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses

Comparing the Non‐Quiver and Quiver Techniques for Identification of the Endocardial Borders Used for Speckle‐Tracking Analysis of the Ventricles of the Fetal Heart

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

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