Review of speckle tracking analysis to measure the size, shape, and contractility of the fetal heart in fetuses with congenital heart defects

Ventricular Free Wall and Septal Wall Displacement of the Fetal Heart: A Quantitative and Qualitative Assessment

OBJECTIVE

The purpose of this study was to measure the systolic displacement of the free and septal walls of the right (RV) and left (LV) ventricles using speckle tracking analysis in normal fetuses and those with cardiac abnormalities.

METHODS

Two-hundred fetuses between 20 and 40 weeks of gestation were examined in which the 4-chamber view (4CV) of the fetal heart was imaged. Speckle tracking analysis of the RV and LV was used to measure the length of displacement between end-diastole and end-systole for each of 24 segments located on the free and septal walls from the base to the apex of each ventricle. The mean displacement length was computed for the base (segments 1-8), mid-chamber (segments 9-16), and the apex (segments 17-24) of the RV and LV free walls (RVfw, LVfw) and septal walls (RVsw, LVsw). Fractional polynomial regression analysis was used to compute the mean equation for the base, mid-chamber, and apex displacement lengths for the RV and LV free walls and septal walls using gestational age as the independent variable. The Kruskal-Wallis test with a Bonferroni correction was used to compare the mean values from the base, mid-chamber, and apex segments between the RVfw versus RVsw, LVfw versus LVsw, RVfw versus LVfw, and RVsw versus LVsw. In addition, the ultrasound program provided a graphic of the systolic segment length of the RV and LV free walls and septal walls. Four examples of cardiac pathology were used to illustrate abnormal free and septal wall segment displacement.

RESULTS

The mean segment end-systolic displacement lengths for the RVfw (base and mid-chamber), and LVfw (base, mid-chamber, and apex) increased with gestational age. However, The RVsw and LVsw segment lengths did not increase or increased minimally as a function of gestational age. The displacement lengths for the RVfw versus RVsw and LVfw versus LVsw were greater for the free wall than the septal wall for the base, mid-chamber, and apex. When comparing the RV with the LV, the segment lengths for the RVfw were significantly greater than the LVfw for the base. The segment lengths were significantly greater for the LVsw than the RVsw for the base, mid-chamber, and apex. The LVsw segments moved inward toward the LV chamber for the mid-chamber and apex. For the RVsw, the segment lengths moved between both the RV and LV chamber during systole. Four pathological cases graphically illustrated abnormal movement of the RVfw, LVfw, RVsw, and LVsw.

CONCLUSION

Speckle tracking analysis enabled quantitation of the systolic ventricular free wall and septal wall segment displacement as well as a graphical display of displacement that can be used to identify pathological changes when abnormal cardiac function is present.

Left ventricular longitudinal strain in the follow-up of arterial switch operation: a fingerprint of the patient's history

BACKGROUND

Left ventricular function after arterial switch operation for d-transposition of the great arteries is notoriously compromised because of abnormal coronary artery anatomy or altered loading conditions. We sought to longitudinally investigate the performance of the left ventricle in a cohort of d-transposition of the great artery patients after arterial switch operation, by using advanced echocardiographic deformation imaging and grouping patients according to pre- and post-surgery variables, labelled as risk factors.

METHODS

Longitudinal single-centre study involving 53 d-transposition of the great artery patients (81.1% male) after arterial switch operation, the latter being performed as unique surgical procedure in 39 patients (76.5%). Median follow-up was 59 months [23.5-72].

RESULTS

Selected patients were split into two groups according to risk factors. Fifteen patients (30.6%) were grouped into high-risk class (<3 risk factors). Echocardiographic variables such as tricuspid annular plane systolic excursion, ejection fraction, and global longitudinal strain were compared between the two groups. Only global longitudinal strain reached statistical significance (-17.56 ± 2.26 versus -19.82 ± 1.97 %; p < 0.001). To discriminate high- versus low-risk patients, a receiver operating characteristic (ROC) curve identified a global longitudinal strain cut-off value of -17.75% (sensitivity 57.1%, specificity 97%, AUC 80%).

CONCLUSIONS

Several neonatal and post-surgical variables might conditionate long-term follow-up of d-transposition of the great artery patients after arterial switch operation, and global longitudinal strain best conveys the overall risk profile of these patients.

Reproducibility Challenges in Fetal Cardiac Function Analysis with 2D Speckle-Tracking Echocardiography: Insights from FetalHQ

Background/Objectives: Functional assessment of the fetal heart remains a significant challenge in contemporary perinatology due to the absence of a universally accepted gold standard for such evaluations. The aim of this study was to evaluate the reproducibility of parameters derived from two-dimensional speckle-tracking echocardiography (2D STE) using the FetalHQ software. Methods: We enrolled 87 pregnant women between 19 and 23 weeks of gestation who were undergoing mid-trimester screening at the Provincial Hospital Complex in Kielce. Two independent operators acquired 5 s cine-loops of four-chamber views (4CVs) according to a standardized protocol. Reproducibility was assessed by examining intra- and interobserver variability using the intraclass correlation coefficient (ICC) for several cardiac parameters, including the global sphericity index (GSI), global longitudinal strain (GLS), stroke volume (SV), and fractional area change (FAC). Results: Reproducibility varied substantially across the assessed parameters. The highest intraobserver reproducibility was observed for the 4CV GSI (ICC > 0.9). Moderate intraobserver reproducibility (ICCs ranging from 0.5 to 0.75) was noted for left ventricular (LV) parameters, such as end-diastolic area, end-systolic area, end-diastolic volume, and end-systolic volume. Interobserver variability demonstrated higher ICC values, with excellent reproducibility (ICC > 0.9) for the 4CV GSI and LV volume measurements. Good reproducibility (ICCs between 0.75 and 0.9) was observed for specific left ventricular segmental strain indices, whereas other parameters showed moderate to poor reproducibility (ICC < 0.5). Conclusions: Two-dimensional speckle-tracking echocardiography (2D STE) using FetalHQ exhibits variable reproducibility, which is influenced by the choice of parameters, operator experience, and technical factors. This method holds potential for fetal cardiac assessment; however, additional research is required to improve its predictive accuracy and streamline the evaluation process for routine clinical application.

Assessing Fetal Heart Morphology and Function in Fetuses With Right Ventricular Outflow Obstruction by Fetal Heart Quantitative Technique

OBJECTIVES

To investigate the clinical utility of the fetal heart quantification (Fetal HQ) technique in the assessment of morphological and functional changes in fetuses with right ventricular outflow obstruction (RVOTO).

METHODS

This study included 53 fetuses with RVOTO and 30 age-matched normal controls. The RVOTO fetuses were divided into 2 groups based on the occurrence of other cardiovascular malformations: the simple pulmonary stenosis (PS group) and the conotruncal defects (CTD group). Size, shape, and contractility parameters of the fetal heart in 4-chamber view (4CV), left ventricle, and right ventricle (LV and RV) detected by fetal HQ.

RESULTS

Fetuses with RVOTO exhibited an increased 4CV-width, with normal 4CV-Length. The end-diastolic diameter (ED) of the LV segments 1-22 was significantly greater in RVOTO fetuses. The sphericity index (SI) of the LV 24-segment was significantly smaller in the CTD and PS groups. Global longitudinal strain (GLS) and fractional area change (FAC) of the LV and RV were reduced in RVOTO fetuses.

CONCLUSION

Our results suggested that the characteristic changes in the morphology and function of the RVOTO fetal heart could be detected early by the HQ technique, which has clinical utility in analyzing the morphology of the RVOTO fetal heart in a quantitative manner.

Second trimester echocardiography

Fetal echocardiography involves a comprehensive cardiac assessment aiming to make a complete structural examination of the heart as well as to detect signs of cardiovascular adaptation to different insults. For the former, this assessment entails expert's evaluation of the anatomy of the heart including additional views beyond the five axial views used in cardiac screening examinations and always complemented with colour and pulsed Doppler. Echocardiography may accurately diagnose most congenital heart defects in fetal life, which enables adjusting the perinatal management. For the latter, echocardiography encompasses cardiac morphometric assessment to identify signs of cardiac remodeling indicative of cardiac adaptation in structure, shape, and size in response to underlying diseases, and cardiac functional assessment to detect signs of systolic and/or diastolic dysfunction. The most used parameters to study the systolic function (stroke volume, cardiac output, ejection fraction, fractional shortening, and mitral and tricuspid annular plane systolic excursion), diastolic function (characteristics of flow in the precordial veins and through the atrioventricular valves) and global myocardial function (myocardial performance index) will be discussed in this review.

Pathogenesis and Surgical Treatment of Dextro-Transposition of the Great Arteries (D-TGA): Part II

Dextro-transposition of the great arteries (D-TGA) is the second most common cyanotic heart disease, accounting for 5-7% of all congenital heart defects (CHDs). It is characterized by ventriculoarterial (VA) connection discordance, atrioventricular (AV) concordance, and a parallel relationship with D-TGA. As a result, the pulmonary and systemic circulations are separated [the morphological right ventricle (RV) is connected to the aorta and the morphological left ventricle (LV) is connected to the pulmonary artery]. This anomaly is included in the group of developmental disorders of embryonic heart conotruncal irregularities, and their pathogenesis is multifactorial. The anomaly's development is influenced by genetic, epigenetic, and environmental factors. It can occur either as an isolated anomaly, or in association with other cardiac defects. The typical concomitant cardiac anomalies that may occur in patients with D-TGA include ventriculoseptal defects, patent ductus arteriosus, left ventricular outflow tract obstruction (LVOTO), mitral and tricuspid valve abnormalities, and coronary artery variations. Correction of the defect during infancy is the preferred treatment for D-TGA. Balloon atrial septostomy (BAS) is necessary prior to the operation. The recommended surgical correction methods include arterial switch operation (ASO) and atrial switch operation (AtrSR), as well as the Rastelli and Nikaidoh procedures. The most common postoperative complications include coronary artery stenosis, neoaortic root dilation, neoaortic insufficiency and neopulmonic stenosis, right ventricular (RV) outflow tract obstruction (RVOTO), left ventricular (LV) dysfunction, arrhythmias, and heart failure. Early diagnosis and treatment of D-TGA is paramount to the prognosis of the patient. Improved surgical techniques have made it possible for patients with D-TGA to survive into adulthood.