The assessment of the fetal heart function using two-dimensional speckle tracking with a high frame rate

Ohira, Akiko; Hayata, Keiji; Mishima, Shiro; Tani, Kazuhide; Maki, Jota; Mitsui, Takashi; Eto, Eriko; Masuyama, Hisashi

doi:10.1016/j.earlhumdev.2020.105160

Cited by 9 publications

(21 citation statements)

References 14 publications

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“…In human fetuses, RV global longitudinal strain shows less deformation with advancing gestational age. 18 This is proposed to reflect increased RV afterload, that is, fetal blood pressure that increases with advancing gestation. In the present study, fetal MAP decreased during hypoxemia; thus, the effect of reduced afterload on RV global longitudinal strain should have been the opposite.…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

Nifedipine disturbs fetal cardiac function during hypoxemia in a chronic sheep model at near term gestation

Alanne

Bhide

Lantto

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: Nifedipine is a widely used drug in pregnancies complicated by maternal hypertensive disorders that can be associated with placental insufficiency and fetal hypoxemia. The evidence regarding fetal myocardial responses to nifedipine in hypoxemia is limited. OBJECTIVE: We hypothesized that nifedipine would not impair fetal sheep cardiac function under hypoxemic environment. In particular, we investigated the effects of nifedipine on fetal ventricular functional parameters and cardiac output. STUDY DESIGN: A total of 21 chronically instrumented fetal sheep at 122 to 134 gestational days (term, 145 days) were included in this study. Fetal cardiac function was evaluated by measuring global longitudinal strain, indices describing ventricular systolic and diastolic function, and cardiac outputs using two-dimensional speckle tracking and tissue and spectral pulsed-wave Doppler echocardiography. Fetal carotid artery blood pressure and blood gas values were invasively monitored. After baseline data collection, fetal hypoxemia was induced by maternal hyperoxygenation. After hypoxemia phase data collection, 9 fetuses received nifedipine infusion, and 12 fetuses received saline infusion. Data were collected 30 and 120 minutes after the infusion was started. After 120 minutes of data collection, maternal and fetal oxygenation were normalized, and normoxemia phase data were collected, while infusion was continued. RESULTS: Hypoxemia decreased fetal carotid artery mean arterial pressure from 40 (8) mm Hg to 35 (8) mm Hg (P<.007), and left ventricular global longitudinal strain showed less deformation than at baseline (P¼.001). Under hypoxemia, nifedipine caused a reduction in right ventricular global longitudinal strain (P<.05), a decrease in right ventricular isovolumic relaxation velocity and its deceleration (P<.01) indicating diastolic dysfunction, and a drop in right ventricular cardiac output (P<.05). Nifedipine did not alter fetal left ventricular functional parameters or cardiac output. When normoxemia was restored, fetal right ventricular functional parameters and cardiac output returned to baseline level. CONCLUSION: In hypoxemic fetus, nifedipine impaired right ventricular function and reduced its cardiac output. The detrimental effects of nifedipine on fetal right ventricular function were abolished, when normoxemia was restored. Our findings suggest that in a hypoxemic environment nifedipine triggers detrimental effects on fetal right ventricular function.

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Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

Nifedipine disturbs fetal cardiac function during hypoxemia in a chronic sheep model at near term gestation

Alanne

Bhide

Lantto

et al. 2021

American Journal of Obstetrics and Gynecology

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“…Of these, three studies showed an increase in LV‐GLS and RV‐GLS values throughout gestation 38,44,52 , similar to the current study. Other studies reported stable strain values in both ventricles 13,39,40,42,43,48,51,53,54 , increased LV‐GLS values only 37 or increased RV‐GLS values only 36,45,47,49 . The discrepancies among studies can be explained by the differences in ultrasound device and speckle‐tracking software used.…”

Section: Discussionmentioning

confidence: 97%

Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

Oostrum

Vet

Clur

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives Two‐dimensional speckle‐tracking echocardiography (2D‐STE) is a promising technique which allows assessment of fetal cardiac function, and can be used in the evaluation of cardiac and non‐cardiac diseases in pregnancy. However, reliable fetal reference values for deformation parameters measured using 2D‐STE are needed before it can be introduced into clinical practice. This study aimed to obtain reference values for fetal global longitudinal strain (GLS) and GLS rate (GLSR) measured using 2D‐STE and compare right and left ventricular values. Methods This was a prospective longitudinal cohort study of uncomplicated pregnancies that underwent echocardiography every 4 weeks from inclusion at 18–21 weeks until delivery to obtain four‐chamber loops of the fetal heart. Left and right ventricular GLS and GLSR were measured using 2D‐STE at each examination. Using Bayesian mixed‐effects models, reference values with lower and upper 5% prediction limits were calculated according to gestational age. Right and left ventricular GLS values according to gestational age were compared using the Wilcoxon signed‐rank test. Results A total of 592 left ventricular and 566 right ventricular GLS and GLSR measurements were obtained from 124 women with uncomplicated pregnancy and non‐anomalous, appropriately grown fetuses. Reference values were obtained for both fetal ventricles according to gestational week. GLS and GLSR values of both ventricles increased (i.e. became less negative) significantly during pregnancy. Right ventricular GLS values were significantly higher (i.e. less negative) than the respective left ventricular values at every gestational week. Conclusions Reference values were obtained for fetal GLS and GLSR measured using 2D‐STE. GLS and GLSR values increased significantly for both ventricles from the second trimester until delivery. GLS values were significantly higher for the right ventricle compared with the left ventricle. Future studies are needed to assess whether the obtained reference values are helpful in clinical practice in the assessment of pregnancy complications, such as fetal growth restriction or cardiac anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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“…Compared with conventional echocardiography, STE technology can more sensitively evaluate the mechanics and proving that the assessment of fetal myocardial strain is feasible and repeatable. 3,10,11 The global longitudinal strain parameters of the fetal heart obtained from the fetal four-chamber view are reportedly the most reliable deformation parameters that reflect fetal heart function. 12 Therefore, in this study, the four-chamber view of the fetus was selected for aCMQ to obtain longitudinal strain-related parameters and explore their clinical value.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with conventional echocardiography, STE technology can more sensitively evaluate the changes in cardiac function in adults and children by acquiring myocardial deformation parameters 8,9 . With the development of ultrasound imaging technology, focus has moved to the analysis of fetal myocardial mechanics and proving that the assessment of fetal myocardial strain is feasible and repeatable 3,10,11 …”

Section: Discussionmentioning

confidence: 99%

“…10,[21][22][23] According to a fetal myocardial development hypothesis,24 the growth of the heart is the result of cardiomyocyte hypertrophy, and the number of cardiomyocytes per unit volume of the ventricle is constant. Because longitudinal strain is the relative change in the length of the myocardial segment relative to its original length, it is likely to remain stable from the moment a stable number of cardiomyocytes is obtained.…”

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confidence: 99%

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Quantitative evaluation of fetal ventricular function by speckle tracking echocardiography

et al. 2021

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Methods:The study included 59 patients with normal fetal heart structure, blood flow, and heart rhythm (fetal abnormality-negative group) and 50 patients with abnormal fetal heart structure, blood flow, and/or heart rhythm (fetal abnormality-positive group). Automated Cardiac Motion Quantification (aCMQ) was performed in both groups to obtain left and right ventricular endocardial global longitudinal strain (GLSendo), mid-myocardial global longitudinal strain (GLSmid), and epicardial global longitudinal strain (GLSepi). Parameters between the two groups were compared and correlation analyses performed. A deformation analysis was performed by two trained observers, and reproducibility was assessed. Results:The fetal left ventricular and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively) decreased in a gradient from the endocardium to the epicardium. LV-GLS and RV-GLS of all myocardial layers were lower in the fetal abnormality-positive than -negative group (all P < 0.05). Correlation analysis showed that neither LV-GLS nor RV-GLS was significantly correlated with gestational age in the fetal abnormality-negative group (all P > 0.05), whereas left ventricular GLSendo, GLSmid, and GLSepi were negatively correlated with gestational age in the fetal abnormality-positive group (r = −.39 to −.44, all P < 0.05). Repeatability testing showed that the inter-observer and intra-observer intra-class correlation coefficients for LV-GLS and RV-GLS in each myocardial layer were >.75 (all P < 0.001). Conclusions:As a new speckle tracking echocardiography tool, aCMQ has feasibility and repeatability in evaluating myocardial deformation of the fetal ventricle. This technique might provide helpful information on ventricular myocardial deformation in fetal hearts with abnormal structure or rhythm for clinical guidance in pregnancy.

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The assessment of the fetal heart function using two-dimensional speckle tracking with a high frame rate

Cited by 9 publications

References 14 publications

Nifedipine disturbs fetal cardiac function during hypoxemia in a chronic sheep model at near term gestation

Nifedipine disturbs fetal cardiac function during hypoxemia in a chronic sheep model at near term gestation

Fetal myocardial deformation measured with two‐dimensional speckle‐tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses

Quantitative evaluation of fetal ventricular function by speckle tracking echocardiography

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