Clinical Investigation
Prospective Assessment of Fetal Cardiac Function With Speckle Tracking in Healthy Fetuses and Recipient Fetuses of Twin-to-Twin Transfusion Syndrome

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Background

The aim of this study was to assess speckle tracking–derived fetal cardiac function in a normal population and in recipient fetuses of twin-to-twin transfusion syndrome (TTTS).

Methods

A case-control study was conducted of 59 uncomplicated singleton pregnancies and 17 recipient fetuses of TTTS. Peak systolic strain, strain rate, velocity, and displacement were calculated, corrected for gestational age, and compared between patients with TTTS and controls.

Results

The feasibility of speckle tracking was 83% in controls but only 61% in patients with TTTS. Myocardial velocity and displacement increased over gestation, and regional differences were present within each wall and between walls. Strain and strain rate were stable within each wall but were higher in the right ventricle than in the left ventricle and septum. Right ventricular strain was decreased in patients with TTTS compared with controls (0.75 ± 0.34 vs 1.00 ± 0.37 multiples of the median, P = .04).

Conclusion

The feasibility of speckle tracking is low when imaging conditions are challenging, but it can identify right ventricular failure in selected patients with TTTS.

Section snippets

Study Population

We performed this prospective case-control study at the University Hospitals Leuven (Leuven, Belgium) after approval of the protocol by the hospital ethics committee for clinical studies. All mothers gave informed consent for this study.

As a control group, we recruited 59 women with uncomplicated singleton pregnancies attending our routine prenatal clinic at a gestational age between 16 and 36 weeks. They received additional ultrasound examinations for the sole purpose of measuring fetal

Control Fetuses

Fifty-nine controls were recruited for the study. The mean gestational age at ultrasound was 24.4 weeks (range, 16.9-36 weeks). Adequate cardiac 4-chamber view cine-loop clips could be obtained in 55 fetuses (93%), with frame rates ranging from 60 to 110 Hz. The fetal heart could not be visualized adequately in 2 cases because of fetal position and in 2 because of maternal obesity. Fifty-five fetuses theoretically yield 495 cardiac segments to track (3 segments per cardiac wall, 3 walls per

Discussion

Our findings show that even in uncomplicated pregnancies, speckle tracking is subject to the same technical limitations that compromise other grayscale methods for assessing ventricular function. Adequate imaging was possible in only 93% of the controls, with maternal obesity and suboptimal fetal position as leading factors for not acquiring appropriate images. Other limitations were related to the method such as; another 10% of examinations failed because the ventricular walls could not be

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