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Am J Perinatol
DOI: 10.1055/a-2090-5581
Original Article

Reference Ranges and Development Patterns of Fetal Myocardial Function Using Speckle Tracking Echocardiography in Healthy Fetuses at 17 to 24 Weeks of Gestation

Sanitra Anuwutnavin 
1   Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Kusol Russameecharoen
1   Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Pornpimol Ruangvutilert
1   Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Sommai Viboonchard
1   Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Mark Sklansky
2   Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
,
Greggory R. DeVore
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California
4   The Fetal Diagnostic Centers, Pasadena, California
› Author Affiliations Funding This study was supported by a grant from the Siriraj Research Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (grant no.: RO16232014).
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Abstract

Objective The purposes of the study were to develop reference ranges and maturation patterns of fetal cardiac function parameters measured by speckle tracking echocardiography (STE) using multiple biometric variables at 17 to 24 weeks' gestation among Thai fetuses and to compare with other previous reports.

Study Design The four-chamber view of the fetal heart in 79 healthy fetuses was suitably analyzed by STE to establish the best-fit regression model. The 95% reference intervals and Z-score equations of fetal cardiac function parameters were computed.

Results The fractional area change of both ventricles, left ventricular (LV) end-diastolic and end-systolic volumes, LV stroke volume, LV cardiac output (CO), and LV CO per kilogram were all increased according to gestational age (GA) and five fetal biometric measurements. However, the global longitudinal strain, basal-apical length fractional shortening (BAL-FS), BAL annular free wall and septal wall FS, BAL free wall and septal wall annular plane systolic excursions, 24-segment transverse width FS, as well as LV ejection fraction were all independent of GA or other somatic characteristics. There were varying development patterns between fetal right and left ventricles of these cardiac function indices across the gestation period.

Conclusion Our study created Z-score and corresponding centile calculators, 5th and 95th centile reference tables, and corresponding graphs and determined the normal evolution across gestation using multiple somatic growth and age variables between 17 and 24 gestational weeks. These nomograms serve as an essential prerequisite for quantitatively evaluating fetal cardiac contractility and allow for precisely detecting early changes in the fetal heart function.

Key Points

  • Most fetal cardiac function measurements were correlated with all the independent variables.

  • Fetal ventricular function parameters have their own characteristic maturation changes.

  • Racial variability may not occupy an important place for fetal myocardial function during these GA.

Keywords

nomograms - fetal cardiac function - 4-chamber view - speckle tracking analysis - echocardiography - 17 to 24 gestational weeks

Supplementary Material



Publication History

Received: 27 January 2023

Accepted: 04 May 2023

Accepted Manuscript online:
10 May 2023

Article published online:
22 June 2023

© 2023. Thieme. All rights reserved.

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