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.

cardiac - echocardiography - ultrasound 2D

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