Fetal growth restriction is associated with increased mechanical dyssynchrony and right-ventricular remodeling: a 2D speckle-tracking analysis

OBJECTIVES: This study aimed to evaluate predefined two-dimensional speckle-tracking parameters (2D-STE) to distinguish between growth-restricted fetuses (FGR) and healthy controls (FC) and to identify novel parameters using an exploratory approach. METHODS: The study comprised 112 fetuses, 56 in the FGR cohort and 56 gestational-age-matched healthy fetuses in the FC cohort. We analyzed global longitudinal strain (GLS), as well as segmental strain, displacement, and velocity using 2D Cardiac Performance Analysis software. Dyssynchrony (DYS) was calculated as the difference in time to peak of GLS or segmental parameters inter- and intraventricular. We also measured changes in ventricular length, diameter and area. Additionally, we tested a prototype software with a tracked M-mode approach, which measured annular displacement. RESULTS: Dyssynchrony parameters were generally higher in the FGR cohort than in the FC cohort. Particularly the GLS-DYS was noticeably higher in the FGR cohort than in the FC cohort (median 19.85 vs. 8.40 ms; p<0.001). Also strain-dyssynchrony, displacement- and velocity-dyssynchrony were increased. FGR fetuses showed right ventricular alterations with lower RV-GLS and reduced longitudinal shortening and area change (25.58 vs. 22.06; p=0.040; 0.75 vs. 0.78; p=0.015; 0.58 vs. 0.67; p=0.024), while LV-GLS and LV-geometry did not differ noticeably. The prototype software did not sufficiently discriminate between groups. CONCLUSIONS: FGR was associated with higher cardiac dyssynchrony and altered right-ventricular function and geometry. GLS-based dyssynchrony may complement Doppler for risk stratification and monitoring in suspected placental insufficiency. These results should be considered in the context of the limited sample size. Prospective studies with larger cohorts should validate these parameters and establish standardized reference values.