Evaluation of cardiac function and systolic dyssynchrony of fetuses exposed to maternal autoimmune diseases using speckle tracking echocardiography

Abstract

Objectives To compare cardiac function and systolic dyssynchrony of fetuses not exposed to and those exposed to maternal autoimmune antibodies using two-dimensional speckle tracking echocardiography (2DSTE). Methods An observational study of 52 fetuses, 18 from mothers with autoimmune antibodies (anti-SSA/Ro60, anti-Ro52 or/and anti-SSB/La) and 34 from healthy mothers without antibodies, was conducted. Maternal baseline characteristics, fetoplacental Doppler parameters, and conventional echocardiographic data were prospectively collected. Systolic global and regional longitudinal strain of left and right ventricle (LV and RV) and the time to peak strain of regional myocardium were measured using 2DSTE. We also calculated the differences in time to peak strain between the LV free wall and RV free wall (two-chamber dyssynchrony, 2C-DYS) and the LV dyssynchrony between the septum and LV free wall (one-chamber dyssynchrony, 1C-DYS). Results There were no significant differences in conventional systolic and diastolic functional parameters for the LV and RV. No effect modification was demonstrated in a myocardial deformation analysis. However, 1C-DYS was significantly more prolonged in the maternal autoimmune disease group (19.50 [8.00 to 29.25] vs. 28.50 [13.50 to 39.25], P = 0.042). Conclusions LV systolic mechanical dyssynchrony in fetuses of mothers with autoimmune antibodies suggests in-utero subclinical damage of the cardiac conduction system. Key points• The left ventricular systolic dyssynchrony was significantly more prolonged in the maternal autoimmune disease (AD) fetuses.• Subclinical damage to the left ventricular conduction system of the fetal heart in maternal AD was observed.• Systolic and diastolic functional of the left and right ventricle were preserved in fetuses exposed to maternal autoimmune disease.

Quantitative evaluation of fetal ventricular function by speckle tracking echocardiography

“…Speckle tracking echocardiography (STE) technology can automatically track speckle motion and obtain myocardial deformation parameters such as longitudinal, radial, and circumferential strain and the rotation angle to evaluate myocardial function. Duan et al 1 showed that the parameters obtained by STE can reflect subclinical myocardial impairment and systolic dyssynchrony of fetuses exposed to maternal autoimmune disease. Furthermore, many studies have shown that the evaluation of fetal heart function by STE has important clinical value in the management and prognosis of gestational diabetes, twin-to-twin transfusion syndrome, and fetal congenital heart disease.…”

“…Speckle tracking echocardiography (STE) technology can automatically track speckle motion and obtain myocardial deformation parameters such as longitudinal, radial, and circumferential strain and the rotation angle to evaluate myocardial function. Duan et al 1 . showed that the parameters obtained by STE can reflect subclinical myocardial impairment and systolic dyssynchrony of fetuses exposed to maternal autoimmune disease.…”

Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography

“…Our previous study revealed that fetuses exposed to maternal AD with autoimmune antibodies (anti-SSA/Ro or/and anti-SSB/La) showed increased levels of LV dyssynchrony in comparison to fetuses of healthy pregnant women [ 39 ]. Recently, some studies have shown that there also seem to be potential targets of autoimmunity damage in the adult heart.…”

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®

“…Fetal echocardiography is crucial for indirect evaluation of fetal ventricular size and functional parameters since the fetal heart cannot be measured directly in utero [11]. A functional cardiac assessment provides early detection of subclinical cardiac dysfunction and detects intrauterine functional cardiac changes and might help to improve and predict perinatal outcomes, including prediction of subsequent cardiovascular risk based on fetal programming [8,12,13]. To record complex fetal myocardial function with its morphometry, encompassing longitudinal, radial, and circumferential deformation (strain), two-dimensional (2D) speckle-tracking echocardiography (STE) provides unique information of cardiac function using myocardial deformation imaging by tracking the endocardial border [2,10,[14][15][16].…”

“…2D-STE has become widely used to assess fetal cardiac function to detect cardiac dysfunction in numerous pathological intrauterine conditions by estimating early fetal cardiac adaptive changes in several pregnancy related complications, including CHD like coarctation of the aorta, aortic or pulmonal stenosis or hypoplastic left ventricle [19][20][21][22][23][30][31][32][33][34], fetal growth restriction (FGR) [17,35], gestational diabetes [36][37][38][39], twin-to-twin transfusion syndrome (TTTS) [40,41], pre-eclampsia [42], intrahepatic cholestasis of pregnancy (ICP) [43], fetal non-compaction cardiomyopathy (NCCM) [44,45] or autoimmune diseases [13].…”