Fetal left and right ventricular strain parameters using speckle tracking in congenital heart diseases

• DOI: 10.1007/s10554-024-03094-y
• Publication Date: 2024-04-13T09:01:51Z
• Authors: Krista Young; Candace Hooton; M Bridget Zimmerman; Benjamin Reinking; Umang Gupta
• Keywords: Observer Variation; Transposition of Great Vessels; Heart Ventricles; Heart Septal Defects; Reproducibility of Results; Gestational Age; Myocardial Contraction; Ultrasonography, Prenatal; Ventricular Function, Left; Biomechanical Phenomena; Fetal Heart; 0302 clinical medicine; Predictive Value of Tests; Pregnancy; Image Interpretation, Computer-Assisted; Ventricular Function, Right; Humans; Female; Retrospective Studies

Abstract Background Assessment of fetal ventricular function is mostly subjective, and currently, for the objective assessment left ventricular shortening fraction is obtained. However, this by itself is not very reliable. Hence, more tools that can provide an objective assessment are needed to increase the confidence of functional assessment. Speckle tracking imaging can provide one such tool. Goal : In this study we sought to establish the normative value of global longitudinal and circumferential strain for our fetal patients and for two major forms of congenital heart diseases, namely atrioventricular canal defects (AVC) and uncorrected dextro-transposition of the great arteries (dTGA) to act as a benchmark. Methods The study was completed via a single center retrospective analysis on 72 fetal echocardiograms (26 normal, 15 dTGA, and 31 AVC). Tomtec Arena™ echocardiography analysis software was used for analysis. Results In normal fetuses, mean left ventricular (LV) global longitudinal strain (GLS) was − 22.6% (95% CI -24, -21.1) and mean right ventricular (RV) GLS was − 22.1% (95% CI -23.6, -20.6). In AVC patients LV GLS was-26.6% (95% CI -28,-25.3) and mean RV GLS was − 26.5% (95% CI -27.9,-25.2). In dTGA patients LV GLS was − 22.9% (95% CI of -24.8, -21) and RV GLS was − 21.3% (95% CI was − 23.4, -20.8). There was good intra-rater reliability though poor to fair inter-rater reliability. Conclusion Notwithstanding its current limitations, strain imaging can provide useful information that can increase confidence of cardiac functional assessment in fetal patients. However, to be reliable across the board, further automation and standardization is required.