Cardiac function evaluated by two-dimensional speckle tracking imaging in fetuses with congenital heart disease of ventricular afterload increase

Aims To study myocardial deformation in fetuses with ventricular afterload increase compared with gestational age-matched controls using speckle tracking echocardiography. Methods and results Eighty-nine fetuses were retrospectively selected from the pregnancy screen by echocardiography. There are 41 fetuses with gestational age-matched normal heart served as the control group, 25 fetuses with congenital heart disease (CHD) leading to left ventricular (LV) afterload increase as group LVA and 23 fetuses with CHD leading to right ventricular(RV) afterload increases as group RVA. LV and RV fractional shortening (FS) were measured by conventional methods. The longitudinal strain (LS) and strain rate (LSr) were analyzed by EchoPac software. Group LVA and RVA compared with control group, the LV FS was no significant difference, but LS and LSr values of LV were lower in fetuses with LVA compared to the control group (LS:-15.97(-12.50,-22.52)vs -27.53(-24.33,-29.16) %, p < .01; systolic strain rate (SRs):-1.34(-1.12,-2.16) vs -2.55(-2.28,-2.92) 1/sec, p < .01; early diastolic strain rate (SRe):1.70 +/- 0.57 vs 2.46 +/- 0.61 1/sec, p < 0.01; late diastolic strain rate (SRa):1.62 +/- 0.82 vs 2.39 +/- 0.81 1/sec, p < .01). LS and LSr values of LV or RV were lower in fetuses with RVA compared to the control group (LV: LS:-21.52 +/- 6.68 vs -26.79 +/- 3.22%, p < .01; SRs:-2.11 +/- 0.78 vs -2.56 +/- 0.43 1/sec; p = .02; RV: LS:-17.64 +/- 7.58 vs -26.38 +/- 3.97%, p < .01; SRs:-1.62 +/- 0.67 vs -2.37 +/- 0.44 1/sec; p < .01). Conclusion The results of this study showed that the ventricular LS, LSr, SRs, SRe, SRa values were lower in fetuses with LV or RV afterload increasing CHD estimated by speckle tracking imaging but LV and RV FS were normal,which indicated the strain imaging is feasible in evaluating cardiac function of fetus, and may be more sensitive.

Automated summary

This study aimed to investigate myocardial deformation in fetuses with ventricular afterload increase using speckle tracking echocardiography. The results showed that fetuses with afterload increase had lower longitudinal strain and strain rate in the left ventricle and right ventricle, but left and right ventricular fractional shortening were normal.