TY - JOUR
T1 - Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum
AU - Cohen, J.
AU - Binka, E.
AU - Woldu, K.
AU - Levasseur, S.
AU - Glickstein, J.
AU - Freud, L. R.
AU - Chelliah, A.
AU - Chiu, J. S.
AU - Shah, A.
N1 - Funding Information:
Funding for this work was provided by the Colin's Kids Foundation.
Funding Information:
Funding for this work was provided by the Colin’s Kids Foundation.
Publisher Copyright:
Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
PY - 2019/4
Y1 - 2019/4
N2 - Objectives: Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle-tracking echocardiography (STE), an angle-independent technique for assessing global and regional strain, may be a more sensitive way of determining ventricular systolic dysfunction compared with traditional 2D echocardiography. The aim of this study was to assess myocardial deformation in fetuses with PA/IVS compared with control fetuses and to determine if, in fetuses with PA/IVS, strain differs between those with and those without right ventricle-dependent coronary circulation (RVDCC). Methods: This was a retrospective analysis of fetuses with PA/IVS examined at two medical centers between June 2005 and October 2017. Left ventricular (LV) and right ventricular (RV) regional and global longitudinal strain (GLS) and strain rate were obtained using STE, and comparisons were made between fetuses with PA/IVS and gestational age (GA)-matched controls. Postnatal outcome was assessed, including the presence of RVDCC. Results: Fifty-seven fetuses with PA/IVS and 57 controls were analyzed at a mean GA of 26.5 ± 5 weeks. LV-GLS was significantly decreased in fetuses with PA/IVS compared with controls (−17.4 ± 1.7% vs −23.7 ± 2.0%, P < 0.001). LV strain rate was also significantly decreased (−1.01 ± 0.21/s vs −1.42 ± 0.20/s, P < 0.001). Fetuses with PA/IVS had decreased strain in all segments. Similarly, RV strain was significantly decreased in fetuses with PA/IVS (−11.6 ± 3.8% vs −24.6 ± 2.5%, P < 0.0001). Thirty-six patients had postnatal cardiac catheterization performed to define coronary anatomy; 10 fetuses had RVDCC. Fetuses with RVDCC had decreased LV strain compared with those without (−15.8 ± 1.2% vs −17.9 ± 1.7%, P = 0.009). RV strain was also decreased in fetuses with RVDCC vs those without (−7.0 ± 2.9% vs −12.1 ± 3.2%, P = 0.0004). Conclusions: Fetuses with PA/IVS have decreased global and regional LV and RV strain compared with controls. The finding of decreased LV strain may be due to altered ventricular mechanics in the context of a hypertensive right ventricle and/or abnormal coronary perfusion. Moreover, fetuses that were found to have RVDCC postnatally had decreased LV and RV strain compared with those that did not. These results encourage further investigation to assess whether fetal ventricular strain could be a prenatal predictor of RVDCC.
AB - Objectives: Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle-tracking echocardiography (STE), an angle-independent technique for assessing global and regional strain, may be a more sensitive way of determining ventricular systolic dysfunction compared with traditional 2D echocardiography. The aim of this study was to assess myocardial deformation in fetuses with PA/IVS compared with control fetuses and to determine if, in fetuses with PA/IVS, strain differs between those with and those without right ventricle-dependent coronary circulation (RVDCC). Methods: This was a retrospective analysis of fetuses with PA/IVS examined at two medical centers between June 2005 and October 2017. Left ventricular (LV) and right ventricular (RV) regional and global longitudinal strain (GLS) and strain rate were obtained using STE, and comparisons were made between fetuses with PA/IVS and gestational age (GA)-matched controls. Postnatal outcome was assessed, including the presence of RVDCC. Results: Fifty-seven fetuses with PA/IVS and 57 controls were analyzed at a mean GA of 26.5 ± 5 weeks. LV-GLS was significantly decreased in fetuses with PA/IVS compared with controls (−17.4 ± 1.7% vs −23.7 ± 2.0%, P < 0.001). LV strain rate was also significantly decreased (−1.01 ± 0.21/s vs −1.42 ± 0.20/s, P < 0.001). Fetuses with PA/IVS had decreased strain in all segments. Similarly, RV strain was significantly decreased in fetuses with PA/IVS (−11.6 ± 3.8% vs −24.6 ± 2.5%, P < 0.0001). Thirty-six patients had postnatal cardiac catheterization performed to define coronary anatomy; 10 fetuses had RVDCC. Fetuses with RVDCC had decreased LV strain compared with those without (−15.8 ± 1.2% vs −17.9 ± 1.7%, P = 0.009). RV strain was also decreased in fetuses with RVDCC vs those without (−7.0 ± 2.9% vs −12.1 ± 3.2%, P = 0.0004). Conclusions: Fetuses with PA/IVS have decreased global and regional LV and RV strain compared with controls. The finding of decreased LV strain may be due to altered ventricular mechanics in the context of a hypertensive right ventricle and/or abnormal coronary perfusion. Moreover, fetuses that were found to have RVDCC postnatally had decreased LV and RV strain compared with those that did not. These results encourage further investigation to assess whether fetal ventricular strain could be a prenatal predictor of RVDCC.
KW - fetal echocardiography
KW - global longitudinal strain
KW - pulmonary atresia with intact ventricular septum
KW - right ventricular dependent coronary circulation
KW - speckle-tracking echocardiography
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U2 - 10.1002/uog.19183
DO - 10.1002/uog.19183
M3 - Article
C2 - 30043402
AN - SCOPUS:85062782758
SN - 0960-7692
VL - 53
SP - 512
EP - 519
JO - Ultrasound in Obstetrics and Gynecology
JF - Ultrasound in Obstetrics and Gynecology
IS - 4
ER -