Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum
ABSTRACT Objectives Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle‐tracking echocardiography (STE), an angle‐independent technique for assessing global and regional strain, may be a more sensit...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2019-04, Vol.53 (4), p.512-519 |
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| creator | Cohen, J. Binka, E. Woldu, K. Levasseur, S. Glickstein, J. Freud, L. R. Chelliah, A. Chiu, J. S. Shah, A. |
| description | ABSTRACT
Objectives
Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle‐tracking echocardiography (STE), an angle‐independent technique for assessing global and regional strain, may be a more sensitive way of determining ventricular systolic dysfunction compared with traditional 2D echocardiography. The aim of this study was to assess myocardial deformation in fetuses with PA/IVS compared with control fetuses and to determine if, in fetuses with PA/IVS, strain differs between those with and those without right ventricle‐dependent coronary circulation (RVDCC).
Methods
This was a retrospective analysis of fetuses with PA/IVS examined at two medical centers between June 2005 and October 2017. Left ventricular (LV) and right ventricular (RV) regional and global longitudinal strain (GLS) and strain rate were obtained using STE, and comparisons were made between fetuses with PA/IVS and gestational age (GA)‐matched controls. Postnatal outcome was assessed, including the presence of RVDCC.
Results
Fifty‐seven fetuses with PA/IVS and 57 controls were analyzed at a mean GA of 26.5 ± 5 weeks. LV‐GLS was significantly decreased in fetuses with PA/IVS compared with controls (−17.4 ± 1.7% vs −23.7 ± 2.0%, P |
| doi_str_mv | 10.1002/uog.19183 |
| format | Article |
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Objectives
Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle‐tracking echocardiography (STE), an angle‐independent technique for assessing global and regional strain, may be a more sensitive way of determining ventricular systolic dysfunction compared with traditional 2D echocardiography. The aim of this study was to assess myocardial deformation in fetuses with PA/IVS compared with control fetuses and to determine if, in fetuses with PA/IVS, strain differs between those with and those without right ventricle‐dependent coronary circulation (RVDCC).
Methods
This was a retrospective analysis of fetuses with PA/IVS examined at two medical centers between June 2005 and October 2017. Left ventricular (LV) and right ventricular (RV) regional and global longitudinal strain (GLS) and strain rate were obtained using STE, and comparisons were made between fetuses with PA/IVS and gestational age (GA)‐matched controls. Postnatal outcome was assessed, including the presence of RVDCC.
Results
Fifty‐seven fetuses with PA/IVS and 57 controls were analyzed at a mean GA of 26.5 ± 5 weeks. LV‐GLS was significantly decreased in fetuses with PA/IVS compared with controls (−17.4 ± 1.7% vs −23.7 ± 2.0%, P < 0.001). LV strain rate was also significantly decreased (−1.01 ± 0.21/s vs −1.42 ± 0.20/s, P < 0.001). Fetuses with PA/IVS had decreased strain in all segments. Similarly, RV strain was significantly decreased in fetuses with PA/IVS (−11.6 ± 3.8% vs −24.6 ± 2.5%, P < 0.0001). Thirty‐six patients had postnatal cardiac catheterization performed to define coronary anatomy; 10 fetuses had RVDCC. Fetuses with RVDCC had decreased LV strain compared with those without (−15.8 ± 1.2% vs −17.9 ± 1.7%, P = 0.009). RV strain was also decreased in fetuses with RVDCC vs those without (−7.0 ± 2.9% vs −12.1 ± 3.2%, P = 0.0004).
Conclusions
Fetuses with PA/IVS have decreased global and regional LV and RV strain compared with controls. The finding of decreased LV strain may be due to altered ventricular mechanics in the context of a hypertensive right ventricle and/or abnormal coronary perfusion. Moreover, fetuses that were found to have RVDCC postnatally had decreased LV and RV strain compared with those that did not. These results encourage further investigation to assess whether fetal ventricular strain could be a prenatal predictor of RVDCC. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.19183</identifier><identifier>PMID: 30043402</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Abnormalities ; Case-Control Studies ; Catheterization ; Coronary circulation ; Coronary Vessel Anomalies - complications ; Coronary Vessel Anomalies - diagnostic imaging ; Echocardiography ; fetal echocardiography ; Fetal Heart - diagnostic imaging ; Fetuses ; Gestational age ; global longitudinal strain ; Health care facilities ; Heart ; Heart Defects, Congenital - diagnostic imaging ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - physiopathology ; Humans ; Perfusion ; Pulmonary Atresia - diagnostic imaging ; Pulmonary Atresia - mortality ; Pulmonary Atresia - physiopathology ; pulmonary atresia with intact ventricular septum ; Regional analysis ; Retrospective Studies ; right ventricular dependent coronary circulation ; Septum ; speckle‐tracking echocardiography ; Strain rate ; Ventricle ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Right - diagnostic imaging</subject><ispartof>Ultrasound in obstetrics & gynecology, 2019-04, Vol.53 (4), p.512-519</ispartof><rights>Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3883-bb1d3cff030999629a441c4697bd5bd23b8a2a285eeffcbe46e321bc3ae964a03</citedby><cites>FETCH-LOGICAL-c3883-bb1d3cff030999629a441c4697bd5bd23b8a2a285eeffcbe46e321bc3ae964a03</cites><orcidid>0000-0002-7627-3094 ; 0000-0002-9940-2506</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.19183$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.19183$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,1430,27911,27912,45561,45562,46396,46820</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30043402$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cohen, J.</creatorcontrib><creatorcontrib>Binka, E.</creatorcontrib><creatorcontrib>Woldu, K.</creatorcontrib><creatorcontrib>Levasseur, S.</creatorcontrib><creatorcontrib>Glickstein, J.</creatorcontrib><creatorcontrib>Freud, L. R.</creatorcontrib><creatorcontrib>Chelliah, A.</creatorcontrib><creatorcontrib>Chiu, J. S.</creatorcontrib><creatorcontrib>Shah, A.</creatorcontrib><title>Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objectives
Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle‐tracking echocardiography (STE), an angle‐independent technique for assessing global and regional strain, may be a more sensitive way of determining ventricular systolic dysfunction compared with traditional 2D echocardiography. The aim of this study was to assess myocardial deformation in fetuses with PA/IVS compared with control fetuses and to determine if, in fetuses with PA/IVS, strain differs between those with and those without right ventricle‐dependent coronary circulation (RVDCC).
Methods
This was a retrospective analysis of fetuses with PA/IVS examined at two medical centers between June 2005 and October 2017. Left ventricular (LV) and right ventricular (RV) regional and global longitudinal strain (GLS) and strain rate were obtained using STE, and comparisons were made between fetuses with PA/IVS and gestational age (GA)‐matched controls. Postnatal outcome was assessed, including the presence of RVDCC.
Results
Fifty‐seven fetuses with PA/IVS and 57 controls were analyzed at a mean GA of 26.5 ± 5 weeks. LV‐GLS was significantly decreased in fetuses with PA/IVS compared with controls (−17.4 ± 1.7% vs −23.7 ± 2.0%, P < 0.001). LV strain rate was also significantly decreased (−1.01 ± 0.21/s vs −1.42 ± 0.20/s, P < 0.001). Fetuses with PA/IVS had decreased strain in all segments. Similarly, RV strain was significantly decreased in fetuses with PA/IVS (−11.6 ± 3.8% vs −24.6 ± 2.5%, P < 0.0001). Thirty‐six patients had postnatal cardiac catheterization performed to define coronary anatomy; 10 fetuses had RVDCC. Fetuses with RVDCC had decreased LV strain compared with those without (−15.8 ± 1.2% vs −17.9 ± 1.7%, P = 0.009). RV strain was also decreased in fetuses with RVDCC vs those without (−7.0 ± 2.9% vs −12.1 ± 3.2%, P = 0.0004).
Conclusions
Fetuses with PA/IVS have decreased global and regional LV and RV strain compared with controls. The finding of decreased LV strain may be due to altered ventricular mechanics in the context of a hypertensive right ventricle and/or abnormal coronary perfusion. Moreover, fetuses that were found to have RVDCC postnatally had decreased LV and RV strain compared with those that did not. These results encourage further investigation to assess whether fetal ventricular strain could be a prenatal predictor of RVDCC. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</description><subject>Abnormalities</subject><subject>Case-Control Studies</subject><subject>Catheterization</subject><subject>Coronary circulation</subject><subject>Coronary Vessel Anomalies - complications</subject><subject>Coronary Vessel Anomalies - diagnostic imaging</subject><subject>Echocardiography</subject><subject>fetal echocardiography</subject><subject>Fetal Heart - diagnostic imaging</subject><subject>Fetuses</subject><subject>Gestational age</subject><subject>global longitudinal strain</subject><subject>Health care facilities</subject><subject>Heart</subject><subject>Heart Defects, Congenital - diagnostic imaging</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Humans</subject><subject>Perfusion</subject><subject>Pulmonary Atresia - diagnostic imaging</subject><subject>Pulmonary Atresia - mortality</subject><subject>Pulmonary Atresia - physiopathology</subject><subject>pulmonary atresia with intact ventricular septum</subject><subject>Regional analysis</subject><subject>Retrospective Studies</subject><subject>right ventricular dependent coronary circulation</subject><subject>Septum</subject><subject>speckle‐tracking echocardiography</subject><subject>Strain rate</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Right - diagnostic imaging</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10MtOHDEQBVArIgoTkgU_gFpikywayo_xtJcIJSQSEZuwtsru6sSoH4MfoPn7mAywiJRVWaWjK9dl7JjDGQcQ52X5dcYN7-QbtuJKmxY2sD5gKzAa2o024pC9T-kOALSS-h07lABKKhArZn_sFo-xDzg2KUcMc4NuXuKEY8iBUlMXA-WS6vMx5N_NtozTMmPcNZgjpYANzn1VGX1uHmjOMfgyYmwSbXOZPrC3A46JPj7PI3b79cvPy2_t9c3V98uL69bLrpOtc7yXfhhAgjFGC4NKcV9P2bh-7XohXYcCRbcmGgbvSGmSgjsvkYxWCPKIfdrnbuNyXyhlO4XkaRxxpqUkK2CjheJaPtHTf-jdUuJcf2eFAK654kpV9XmvfFxSijTYbQxTvdtysE-t29q6_dt6tSfPicVN1L_Kl5orON-DxzDS7v9J9vbmah_5B2HZjSY</recordid><startdate>201904</startdate><enddate>201904</enddate><creator>Cohen, J.</creator><creator>Binka, E.</creator><creator>Woldu, K.</creator><creator>Levasseur, S.</creator><creator>Glickstein, J.</creator><creator>Freud, L. R.</creator><creator>Chelliah, A.</creator><creator>Chiu, J. S.</creator><creator>Shah, A.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7627-3094</orcidid><orcidid>https://orcid.org/0000-0002-9940-2506</orcidid></search><sort><creationdate>201904</creationdate><title>Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum</title><author>Cohen, J. ; Binka, E. ; Woldu, K. ; Levasseur, S. ; Glickstein, J. ; Freud, L. R. ; Chelliah, A. ; Chiu, J. S. ; Shah, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3883-bb1d3cff030999629a441c4697bd5bd23b8a2a285eeffcbe46e321bc3ae964a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abnormalities</topic><topic>Case-Control Studies</topic><topic>Catheterization</topic><topic>Coronary circulation</topic><topic>Coronary Vessel Anomalies - complications</topic><topic>Coronary Vessel Anomalies - diagnostic imaging</topic><topic>Echocardiography</topic><topic>fetal echocardiography</topic><topic>Fetal Heart - diagnostic imaging</topic><topic>Fetuses</topic><topic>Gestational age</topic><topic>global longitudinal strain</topic><topic>Health care facilities</topic><topic>Heart</topic><topic>Heart Defects, Congenital - diagnostic imaging</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Humans</topic><topic>Perfusion</topic><topic>Pulmonary Atresia - diagnostic imaging</topic><topic>Pulmonary Atresia - mortality</topic><topic>Pulmonary Atresia - physiopathology</topic><topic>pulmonary atresia with intact ventricular septum</topic><topic>Regional analysis</topic><topic>Retrospective Studies</topic><topic>right ventricular dependent coronary circulation</topic><topic>Septum</topic><topic>speckle‐tracking echocardiography</topic><topic>Strain rate</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Right - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cohen, J.</creatorcontrib><creatorcontrib>Binka, E.</creatorcontrib><creatorcontrib>Woldu, K.</creatorcontrib><creatorcontrib>Levasseur, S.</creatorcontrib><creatorcontrib>Glickstein, J.</creatorcontrib><creatorcontrib>Freud, L. R.</creatorcontrib><creatorcontrib>Chelliah, A.</creatorcontrib><creatorcontrib>Chiu, J. S.</creatorcontrib><creatorcontrib>Shah, A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cohen, J.</au><au>Binka, E.</au><au>Woldu, K.</au><au>Levasseur, S.</au><au>Glickstein, J.</au><au>Freud, L. R.</au><au>Chelliah, A.</au><au>Chiu, J. S.</au><au>Shah, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2019-04</date><risdate>2019</risdate><volume>53</volume><issue>4</issue><spage>512</spage><epage>519</epage><pages>512-519</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>ABSTRACT
Objectives
Global and regional myocardial deformation have not been well described in fetuses with pulmonary atresia and intact ventricular septum (PA/IVS). Speckle‐tracking echocardiography (STE), an angle‐independent technique for assessing global and regional strain, may be a more sensitive way of determining ventricular systolic dysfunction compared with traditional 2D echocardiography. The aim of this study was to assess myocardial deformation in fetuses with PA/IVS compared with control fetuses and to determine if, in fetuses with PA/IVS, strain differs between those with and those without right ventricle‐dependent coronary circulation (RVDCC).
Methods
This was a retrospective analysis of fetuses with PA/IVS examined at two medical centers between June 2005 and October 2017. Left ventricular (LV) and right ventricular (RV) regional and global longitudinal strain (GLS) and strain rate were obtained using STE, and comparisons were made between fetuses with PA/IVS and gestational age (GA)‐matched controls. Postnatal outcome was assessed, including the presence of RVDCC.
Results
Fifty‐seven fetuses with PA/IVS and 57 controls were analyzed at a mean GA of 26.5 ± 5 weeks. LV‐GLS was significantly decreased in fetuses with PA/IVS compared with controls (−17.4 ± 1.7% vs −23.7 ± 2.0%, P < 0.001). LV strain rate was also significantly decreased (−1.01 ± 0.21/s vs −1.42 ± 0.20/s, P < 0.001). Fetuses with PA/IVS had decreased strain in all segments. Similarly, RV strain was significantly decreased in fetuses with PA/IVS (−11.6 ± 3.8% vs −24.6 ± 2.5%, P < 0.0001). Thirty‐six patients had postnatal cardiac catheterization performed to define coronary anatomy; 10 fetuses had RVDCC. Fetuses with RVDCC had decreased LV strain compared with those without (−15.8 ± 1.2% vs −17.9 ± 1.7%, P = 0.009). RV strain was also decreased in fetuses with RVDCC vs those without (−7.0 ± 2.9% vs −12.1 ± 3.2%, P = 0.0004).
Conclusions
Fetuses with PA/IVS have decreased global and regional LV and RV strain compared with controls. The finding of decreased LV strain may be due to altered ventricular mechanics in the context of a hypertensive right ventricle and/or abnormal coronary perfusion. Moreover, fetuses that were found to have RVDCC postnatally had decreased LV and RV strain compared with those that did not. These results encourage further investigation to assess whether fetal ventricular strain could be a prenatal predictor of RVDCC. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30043402</pmid><doi>10.1002/uog.19183</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7627-3094</orcidid><orcidid>https://orcid.org/0000-0002-9940-2506</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Ultrasound in obstetrics & gynecology, 2019-04, Vol.53 (4), p.512-519 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Free Content |
| subjects | Abnormalities Case-Control Studies Catheterization Coronary circulation Coronary Vessel Anomalies - complications Coronary Vessel Anomalies - diagnostic imaging Echocardiography fetal echocardiography Fetal Heart - diagnostic imaging Fetuses Gestational age global longitudinal strain Health care facilities Heart Heart Defects, Congenital - diagnostic imaging Heart Defects, Congenital - mortality Heart Defects, Congenital - physiopathology Humans Perfusion Pulmonary Atresia - diagnostic imaging Pulmonary Atresia - mortality Pulmonary Atresia - physiopathology pulmonary atresia with intact ventricular septum Regional analysis Retrospective Studies right ventricular dependent coronary circulation Septum speckle‐tracking echocardiography Strain rate Ventricle Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Right - diagnostic imaging |
| title | Myocardial strain abnormalities in fetuses with pulmonary atresia and intact ventricular septum |
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