Key result
Fetal atrioventricular canal defects are linked to ~19% higher LV GLS versus normal fetuses.
Why the study?
Fetal ventricular function assessment is mostly subjective and left ventricular shortening fraction alone is not reliable, creating a need for objective tools such as speckle tracking imaging.
Does speckle tracking echocardiography identify differences in fetal ventricular strain parameters between normal fetuses and those with congenital heart diseases (AVC and dTGA)?
Observational (n=72)
No
Does speckle tracking echocardiography identify differences in fetal ventricular strain parameters between normal fetuses and those with congenital heart diseases (AVC and dTGA)?
Absolute Event Rate: -26.9% vs -22.6%
p-value: p=0.0001
Fetal speckle tracking echocardiography demonstrates significantly higher global longitudinal and circumferential strain in atrioventricular canal defects compared to normal fetuses, providing potential benchmarks for functional assessment.
May inform fetal strain assessment in AVC; leaves open validation for outcome prediction or management.
Abstract Background Assessment of fetal ventricular function is mostly subjective, and currently, for the objective assessment left ventricular shortening fraction is obtained. However, this by itself is not very reliable. Hence, more tools that can provide an objective assessment are needed to increase the confidence of functional assessment. Speckle tracking imaging can provide one such tool. Goal : In this study we sought to establish the normative value of global longitudinal and circumferential strain for our fetal patients and for two major forms of congenital heart diseases, namely atrioventricular canal defects (AVC) and uncorrected dextro-transposition of the great arteries (dTGA) to act as a benchmark. Methods The study was completed via a single center retrospective analysis on 72 fetal echocardiograms (26 normal, 15 dTGA, and 31 AVC). Tomtec Arena™ echocardiography analysis software was used for analysis. Results In normal fetuses, mean left ventricular (LV) global longitudinal strain (GLS) was − 22.6% (95% CI -24, -21.1) and mean right ventricular (RV) GLS was − 22.1% (95% CI -23.6, -20.6). In AVC patients LV GLS was-26.6% (95% CI -28,-25.3) and mean RV GLS was − 26.5% (95% CI -27.9,-25.2). In dTGA patients LV GLS was − 22.9% (95% CI of -24.8, -21) and RV GLS was − 21.3% (95% CI was − 23.4, -20.8). There was good intra-rater reliability though poor to fair inter-rater reliability. Conclusion Notwithstanding its current limitations, strain imaging can provide useful information that can increase confidence of cardiac functional assessment in fetal patients. However, to be reliable across the board, further automation and standardization is required.
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Young et al. (2023) conducted an observational in Congenital heart diseases (Atrioventricular canal defects and dextro-transposition of the great arteries) (n=72). Atrioventricular canal defects (AVC) vs. Normal fetuses was evaluated on Left ventricular global longitudinal strain (LV GLS) (p=0.0001). Fetuses with atrioventricular canal defects demonstrated significantly higher left ventricular global longitudinal strain compared to normal fetuses (-26.9% vs -22.6%, p=0.0001).
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