Assessment of Fetal Global and Regional Ventricular Function in Congenital Heart Disease Using a Novel Feature Tracking Technique

Zusammenfassung

Ziel: Studienziel war, die globale und regionale longitudinale ventrikuläre Herzmuskelfunktion bei Feten mit angeborenen Herzfehlern zu beurteilen und diese mittels „Feature-tracking“-Technik erhaltenen Messwerte mit Referenzwerten gesunder Feten zu vergleichen. Material und Methoden: Bei 17 Feten mit angeborenen Herzfehlern (10 mit Linksherzobstruktion, 5 mit Fallot’scher Tetralogie und 2 mit Double outlet right ventricle [DORV]) konnten globale und segmentale longitudinale maximale systolische Strain, Strain rate und Geschwindigkeitsmesswerte des LV- und RV-Myokards mittels neuer „Feature-tracking“-Technik beurteilt und in einem zweiten Schritt mit 24 gesunden Kontroll-Feten (21. – 36. Schwangerschaftswoche) verglichen werden. Ergebnisse: Globale longitudinale maximale systolische Strain-Messwerte bei Feten mit Fallot’scher Tetralogie oder DORV waren im Vergleich zu den Kontroll-Feten in beiden Ventrikeln leicht erhöht (RV: p = 0,055; LV: p = 0,063). Die entsprechende RV Strain rate wies in dieser Untergruppe tendenziell etwas höhere Werte auf (p = 0,09). Die globalen LV-Geschwindigkeitsmessungen bei Feten mit Fallot’scher Tetralogie oder DORV wiesen eher niedrigere Werte auf (p = 0,054). Feten mit Linksherzobstruktion wiesen hingegen keinen signifikanten Unterschied bei Strain, Strain rate und Geschwindigkeitsmessungen im Vergleich zur Kontrollgruppe auf. Schlussfolgerung: Die globale longitudinale maximale systolische Ventrikelfunktion zeigte in der Subgruppe der Feten mit Fallot’scher Tetralogie oder DORV beidseits geringgradig höhere Strain-Werte und rechtsseitig höhere Strain-rate-Werte im Vergleich zu den gesunden Kontroll-Feten. Ob diese neue winkelunabhängige Technik geeignet ist, zwischen gesunden und erkrankten Feten zu unterscheiden, muss durch weitere Studien überprüft werden.

Abstract

Purpose: The aim of this study was to assess global and regional longitudinal peak systolic ventricular function in fetuses with congenital heart disease (CHD) and compare measurements derived from feature tracking with reference values of healthy fetuses with a matching gestational age. Materials and Methods: Global and segmental longitudinal peak systolic strain (LPSS), strain rate and velocity values of the left (LV) ventricular myocardium and right (RV) ventricular myocardium were assessed by a novel feature tracking technique in 17 fetuses with congenital heart disease (10 fetuses with left heart obstruction (LHO), 5 fetuses with tetralogy of Fallot (TOF) and 2 fetuses with double outlet right ventricle (DORV)) and were compared in a second step with 24 matched healthy fetuses (gestational age range 21 – 36 weeks of gestation). Results: The global LPSS of both ventricles was slightly elevated in fetuses with TOF or DORV compared with controls (RV: p = 0.055; LV: p = 0.063). The RV strain rate presented a trend toward higher values (p = 0.09). Corresponding global LV velocity values of fetuses with TOF or DORV revealed a tendency to decrease compared to healthy controls (p = 0.054). In contrast, all measurements of fetuses with LHO did not show any statistical difference regarding deformation parameters or velocity compared to healthy controls. Conclusion: Global longitudinal peak systolic measurements in fetuses with congenital heart disease revealed slightly higher strain (RV/LV) and strain rate (RV) values in the subgroup of fetuses with TOF or DORV compared to healthy controls. Whether the application of this new angle-independent technique is suitable for discriminating between healthy and diseased fetuses has to be verified in further investigations.

Key words

cardiac - echocardiography - ultrasound 2D

References

• 1 Harada K, Tsuda A, Orino T et al. Tissue Doppler imaging in the normal fetus.  Int J Cardiol. 1999;  71 227-234
• 2 Stefani L, Toncelli L, Gianassi M et al. Two-dimensional tracking and TDI are consistent methods for evaluating myocardial longitudinal peak strain in left and right ventricle basal segments in athletes.  Cardiovasc Ultrasound. 2007;  5 7
• 3 Barker P C, Houle H, Li J S et al. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging.  Echocardiography. 2009;  26 28-36
• 4 Van Mieghem T, Giusca S, DeKoninck P et al. Prospective assessment of fetal cardiac function with speckle tracking in healthy fetuses and recipient fetuses of twin-to-twin transfusion syndrome.  J Am Soc Echocardiogr. 2010;  23 301-308
• 5 Thomas G. Tissue Doppler echocardiography – a case of right tool, wrong use.  Cardiovasc Ultrasound. 2004;  2 12
• 6 Marwick T H. Measurement of strain and strain rate by echocardiography: ready for prime time?.  J Am Coll Cardiol. 2006;  47 1313-1327
• 7 Younoszai A K, Saudek D E, Emery S P et al. Evaluation of myocardial mechanics in the fetus by velocity vector imaging.  J Am Soc Echocardiogr. 2008;  21 470-474
• 8 Pirat B, Khoury D S, Hartley C J et al. A novel feature-tracking echocardiographic method for the quantitation of regional myocardial function: validation in an animal model of ischemia-reperfusion.  J Am Coll Cardiol. 2008;  51 651-659
• 9 Peng Q H, Zhou Q C, Zeng S et al. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging.  Prenat Diagn. 2009;  29 1149-1155
• 10 Willruth A M, Geipel A K, Fimmers R et al. Assessment of right ventricular global and regional longitudinal peak systolic strain, strain rate and velocity in healthy fetuses and impact of gestational age using a novel speckle/feature-tracking based algorithm.  Ultrasound Obstet Gynecol. 2011;  37 143-149
• 11 Willruth A M, Geipel A, Berg C et al. Assessment of Left Ventricular Global and Regional Longitudinal Peak Systolic Strain, Strain Rate and Velocity with Feature Tracking in Healthy Fetuses.  Ultraschall in Med. 2011 DOI: 10.1055/s-0029-1246029
• 12 Yagel S, Cohen S M, Achiron R. Examination of the fetal heart by five short-axis views: a proposed screening method for comprehensive cardiac evaluation.  Ultrasound Obstet Gynecol. 2001;  17 367-369
• 13 Berg C, Gembruch U, Geipel A. Outflow tract sectional planes in two-dimensional fetal echocardiography – part I.  Ultraschall in Med. 2009;  30 128-144 ; quiz 145 – 149
• 14 Berg C, Gembruch U, Geipel A. Outflow tract views in two-dimensional fetal echocardiography – part ii.  Ultraschall in Med. 2009;  30 230-251
• 15 D’hooge J, Bijnens B, Jamal F et al. High frame rate myocardial integrated backscatter. Does this change our understanding of this acoustic parameter?.  Eur J Echocardiogr. 2000;  1 32-41
• 16 Perles Z, Nir A, Gavri S et al. Assessment of fetal myocardial performance using myocardial deformation analysis.  Am J Cardiol. 2007;  99 993-996
• 17 Struijk P C, Mathews V J, Loupas T et al. Blood pressure estimation in the human fetal descending aorta.  Ultrasound Obstet Gynecol. 2008;  32 673-681
• 18 Gardiner H M. Response of the fetal heart to changes in load: from hyperplasia to heart failure.  Heart. 2005;  91 871-873
• 19 Gardiner H M, Pasquini L, Wolfenden J et al. Increased periconceptual maternal glycated haemoglobin in diabetic mothers reduces fetal long axis cardiac function.  Heart. 2006;  92 1125-1130
• 20 Vannan M A, Pedrizzetti G, Li P et al. Effect of cardiac resynchronization therapy on longitudinal and circumferential left ventricular mechanics by velocity vector imaging: description and initial clinical application of a novel method using high-frame rate B-mode echocardiographic images.  Echocardiography. 2005;  22 826-830
• 21 D’hooge J, Heimdal A, Jamal F et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations.  Eur J Echocardiogr. 2000;  1 154-170
• 22 Gilman G, Khandheria B K, Hagen M E et al. Strain rate and strain: a step-by-step approach to image and data acquisition.  J Am Soc Echocardiogr. 2004;  17 1011-1020
• 23 Falkensammer C B, Paul J, Huhta J C. Fetal congestive heart failure: correlation of Tei-index and Cardiovascular-score.  J Perinat Med. 2001;  29 390-398
• 24 Pacileo G, Calabro P, Limongelli G et al. Left ventricular remodeling, mechanics, and tissue characterization in congenital aortic stenosis.  J Am Soc Echocardiogr. 2003;  16 214-220
• 25 Kiraly P, Kapusta L, Thijssen J M et al. Left ventricular myocardial function in congenital valvar aortic stenosis assessed by ultrasound tissue-velocity and strain-rate techniques.  Ultrasound Med Biol. 2003;  29 615-620
• 26 Eidem B W, McMahon C J, Ayres N A et al. Impact of chronic left ventricular preload and afterload on Doppler tissue imaging velocities: a study in congenital heart disease.  J Am Soc Echocardiogr. 2005;  18 830-838
• 27 Giusca S, Jurcut R, Ginghina C et al. The right ventricle: anatomy, physiology and functional assessment.  Acta Cardiol. 2010;  65 67-77
• 28 Sheehan F, Redington A. The right ventricle: anatomy, physiology and clinical imaging.  Heart. 2008;  94 1510-1515