Longitudinal Behavior of Left-Ventricular Strain in Fetal Growth Restriction

Abstract

Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses.

Keywords: 2D speckle tracking; aCMQ-QLab; fetal echocardiography; fetal growth restriction; small for gestational age; strain.

Figure 1

Strain analysis with aCMQ-QLab by Philips. The software automatically delineated the left-ventricular myocardium, providing left-ventricle global longitudinal strain (red circle), as well as individual segment measurements; from left to right: basal segment of left-ventricle wall (LBA), middle segment of left-ventricle wall (ALM), apical segment of left-ventricle wall (AAL), basal interventricular septum (ISB), middle interventricular septum (ISM), and apical interventricular septum (AIS). L, left; R, right. Abbreviations differ from the manuscript, due to software language (Spanish).

Figure 2

Longitudinal behavior of strain parameters in FGR fetuses (red continuous line) compared to AGA fetuses (blue interrupted line). GLO, global longitudinal strain; BIS, basal interventricular septum; MIS, middle interventricular septum; AIS apical interventricular septum; BAL, basal segment of left-ventricle wall; MAL, middle segment of left-ventricle wall; AAL, apical segment of left-ventricle wall; EF, ejection fraction.