Longitudinal Behavior of Left-Ventricular Strain in Fetal Growth Restriction

Abstract

Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses.

Fetal Left Ventricle Function Evaluated by Two-Dimensional Speckle-Tracking Echocardiography across Clinical Stages of Severity in Growth-Restricted Fetuses

“…Differences in longitudinal strain in FGR have been previously reported [ 14 , 16 ], even in the absence of Doppler abnormalities [ 8 ], highlighting poorer ventricle contractility in FGR when compared to adequate for gestational age fetuses (AGA) and demonstrating a subclinical cardiac dysfunction in these fetuses, similarly to that described by other studies [ 4 , 19 ]. Previously published studies have also demonstrated the efficacy of different echocardiographic tools [ 4 , 5 , 8 , 20 , 21 ] in assessing cardiac dysfunction associated with FGR.…”

“…Previously published studies have also demonstrated the efficacy of different echocardiographic tools [ 4 , 5 , 8 , 20 , 21 ] in assessing cardiac dysfunction associated with FGR. Due to the technical limitations these tools have, recent studies focused their interest on the evaluation of fetal ventricular strain by 2D-STE [ 11 , 13 , 14 , 22 , 23 ]. In this context, speckle-tracking has emerged as promising solution, offering a semi-automated analysis that reduces intra- and interobserver variability [ 11 , 13 ].…”

“…Cardiac strain, measured through 2D-STE, represents deformation of myocardial tissue during the cardiac cycle and provides valuable insights into myocardial performance, enabling a comprehensive assessment of regional and global myocardial function. In the context of FGR, the evaluation of longitudinal endocardial deformation has the potential to detect early signs of cardiac dysfunction [ 14 ], due to longitudinal endocardial myofibers being more vulnerable to ischemia [ 15 ]. While several studies have investigated cardiac function and strain in FGR fetuses, the existing literature remains limited and fragmented [ 8 , 16 ].…”