Myocardial deformation in fetuses with coarctation of the aorta: a case–control study

• Published in: Ultrasound in obstetrics & gynecology 2017-05, Vol.49 (5), p.623-629
• Main Authors: Miranda, J. O., Hunter, L., Tibby, S., Sharland, G., Miller, O., Simpson, J. M.
• Format: Article
• Language: English
• Subjects: Age; Aorta; Aortic Coarctation - diagnostic imaging; Aortic Coarctation - pathology; Cardiovascular disease; Case-Control Studies; coarctation of the aorta; congenital heart disease; Coronary vessels; Deformation; Echocardiography; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - pathology; fetal heart; Fetuses; Gestational Age; Heart; Heart diseases; Heart Ventricles - abnormalities; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Humans; Mitral valve; Pregnancy; Pregnancy Outcome; Retrospective Studies; speckle tracking; strain; Strain rate; Ultrasonography, Prenatal; Ultrasound; Ventricle
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.15939

ABSTRACT Objective To study myocardial deformation by speckle tracking echocardiography in fetuses with coarctation of the aorta (CoA) compared with gestational age‐matched normal controls. Methods This was a retrospective study of 12 fetuses with postnatally confirmed CoA and 12 gestational age‐matched controls seen at a tertiary fetal cardiology unit between January 2013 and July 2014. Two‐dimensional speckle tracking in standard grayscale four‐chamber view of the fetal heart was performed to assess left and right myocardial deformation. Global longitudinal strain, strain rate and velocities, and regional longitudinal strain were analyzed and compared with controls. Results Median gestational age at echocardiography was 25 + 4 weeks. Fetuses with CoA presented with a narrower, but not shorter, left ventricle when compared with controls (mitral valve diastolic diameter, 5.90 vs 8.50 mm; P = 0.002; left ventricular diastolic length, 16.50 vs 18.50 mm; P = 0.05). Global longitudinal systolic strain (P = 0.004), systolic strain rate (P = 0.01) and diastolic strain rate (P = 0.004) of the left ventricle were significantly lower in fetuses with CoA compared with controls. Similar findings were observed for longitudinal systolic (P = 0.03) and diastolic (P = 0.01) velocities of the left ventricle. Right ventricular parameters were not different between groups. Conclusions Fetuses with CoA have lower left ventricular longitudinal systolic strain, systolic strain rate and diastolic strain rate when compared with gestational age‐matched control fetuses. These differences in deformation might explain, at least in part, the cardiac asymmetry observed in fetuses with CoA. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Linked Comment: Ultrasound Obstet Gynecol 2017; 49: 565–565