Longitudinal Behavior of Left-Ventricular Strain in Fetal Growth Restriction

Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses.

Automated summary

This study aimed to evaluate the association between fetal growth restriction (FGR) and cardiac left-ventricle (LV) dysfunction. The global and segmental LV longitudinal strain was measured using 2D speckle tracking echocardiography (2D-STE) software, and the differences in cardiac function were compared between FGR and appropriate-for-gestational-age (AGA) fetuses. The study found that FGR fetuses had lower LV strain values, indicating subclinical cardiac dysfunction. The findings provide more insights into fetal cardiac function in cases of placental dysfunction and highlight the potential use of 2D-STE in monitoring the cardiac function of these fetuses.