Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI)

Abstract

Introduction: The long-term outcome of patients with HLHS (hypoplastic left heart syndrome) is mainly determined by right ventricular function. Our study examines, whether there are differences in segmental right ventricular myocardial displacement and tissue velocities of fetuses with HLHS compared to healthy fetuses during gestation.Materials and methods: A prospective study was conducted including 20 fetuses with HLHS and 20 gestational age matched controls. c-TDI (colour tissue Doppler imaging) derived systolic and diastolic velocities as well as myocardial displacement were assessed in three different locations of the right ventricle (RV). A ROI (region of interest) was placed in the basal, middle and apical part of the myocardium. Possible changes of c-TDI indices in the course of pregnancy and between the three different segments were investigated in both groups.Results: HLHS fetuses showed significantly lower e' velocities measured in the basal and middle part of the RV compared to healthy controls (p < 0.05). Basal displacement showed significantly lower values in HLHS fetuses compared to controls. In control fetuses but not in HLHS fetuses there was a significant increase of basal diastolic velocities and displacement in the course of pregnancy. According to myocardial velocities and displacement values there was a significant decrease from the base of the fetal heart to the apex pointed in both groups.Conclusions: An altered right ventricular myocardial function in HLHS fetuses within different myocardial segments could be demonstrated. An apicobasal gradient with higher velocity and displacement values in the basal part of RV myocardium could be found in both groups. The technique may be of value in the prenatal assessment of myocardial function, however its role as a monitoring tool and outcome predictor needs to be defined.

Role of ultrasound in morphologic and functional assessment of fetal heart

“…In line with our findings, Al Subhi et al [6] perspective's analysis discovered that HLH fetus had greater E and A velocities (p =0.01). However, a prospective investigation by Graupner et al [11] indicated that compared to healthy fetus, the group with Hypoplastic Lt heart syndrome had significantly lower E′ velocities (p= 0.017) and E′/A′ ratios (p= 0.012) when right ventricular function was examined. A lower E/A ratio shows that atrial contraction is what drives the process of ventricular filling rather than the negative pressure experienced during relaxation.…”

Fetal echocardiography in the 3rd trimester of pregnancy as an essential element of modern prenatal diagnostics and perinatal care – recommendations of Polish Society of Prenatal Cardiology 2020

“…The tissue Doppler technique (TDI) measures the speed of movement of the annuli of the atrioventricular valves during the heart cycle. The assessment of these velocities is an early and sensitive measure of systolic-diastolic dysfunction [10,[11][12][13][14].…”

“…The speckle tracking technique allows the evaluation of myocardial deformation during systole and diastole (parameters such as "strain" and "strain rate" can be measured). Abnormal deformation of the heart muscle is an early symptom of its dysfunction [10,[11][12][13][14].…”