Key result
Fetal CMR feature tracking showed reduced LV global longitudinal strain in fetuses with HLHS (-6.2% vs -18.6%; p<0.001) and RV-dominant AVSD (-7.7% vs -18.6%; p=0.003) compared to controls.
Why the study?
Cardiovascular magnetic resonance is an emerging modality for assessing fetal heart anatomy and function in CHD, but myocardial strain using fetal CMR feature tracking across different CHD subtypes required evaluation.
Does fetal cardiovascular magnetic resonance feature tracking reveal differences in myocardial strain between normal fetuses and those with various subtypes of congenital heart disease?
Observational (n=60)
Does fetal cardiovascular magnetic resonance feature tracking reveal differences in myocardial strain between normal fetuses and those with various subtypes of congenital heart disease?
Fetal CMR feature tracking is feasible and identifies distinct myocardial strain differences across various congenital heart disease subtypes, which may aid in clinical decision-making and prognostication.
May support fetal CHD risk stratification; leaves open whether strain alters prenatal management or outcomes.
BACKGROUND: Cardiovascular magnetic resonance (CMR) is an emerging imaging modality for assessing the anatomy and function of the fetal heart in congenital heart disease (CHD). This study aimed to evaluate myocardial strain using fetal CMR feature tracking (FT) in different subtypes of CHD. METHODS: Fetal CMR FT analysis was retrospectively performed on four-chamber cine images acquired with Doppler ultrasound gating at 3T. Left ventricular (LV) global longitudinal strain (GLS), LV global radial strain (GRS), LV global longitudinal systolic strain rate, and right ventricular (RV) GLS were quantified using dedicated software optimized for fetal strain analysis. Analysis was performed in normal fetuses and different CHD subtypes (d-transposition of the great arteries [dTGA], hypoplastic left heart syndrome [HLHS], coarctation of the aorta [CoA], tetralogy of Fallot [TOF], RV-dominant atrioventricular septal defect [AVSD], and critical pulmonary stenosis or atresia [PS/PA]). Analysis of variance with Tukey post-hoc test was used for group comparisons. RESULTS: A total of 60 fetuses were analyzed (8/60 (13%) without CHD, 52/60 (87%) with CHD). Myocardial strain was successfully assessed in 113/120 ventricles (94%). Compared to controls, LV GLS was significantly reduced in fetuses with HLHS (-18.6±2.7% vs -6.2±5.6%; p<0.001) and RV-dominant AVSD (-18.6±2.7% vs -7.7±5.0%; p = 0.003) and higher in fetuses with CoA (-18.6±2.7% vs -25.0±4.3%; p = 0.038). LV GRS was significantly reduced in fetuses with HLHS (25.7±7.5% vs 11.4±9.7%; p = 0.024). Compared to controls, RV GRS was significantly reduced in fetuses with PS/PA (-16.1±2.8% vs -8.3±4.2%; p = 0.007). Across all strain parameters, no significant differences were present between controls and fetuses diagnosed with dTGA and TOF. CONCLUSION: Fetal myocardial strain assessment with CMR FT in CHD is feasible. Distinct differences are present between various types of CHD, suggesting potential implications for clinical decision-making and prognostication in fetal CHD.
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Vollbrecht et al. (2024) conducted an observational in Congenital heart disease (n=60). Fetal CMR feature tracking (FT) vs. Normal fetuses was evaluated on Myocardial strain (LV GLS, LV GRS, RV GLS). Fetal CMR feature tracking showed reduced LV global longitudinal strain in fetuses with HLHS (-6.2% vs -18.6%; p<0.001) and RV-dominant AVSD (-7.7% vs -18.6%; p=0.003) compared to controls.
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