Feasibility and Reproducibility of Two-Dimensional Wall Motion Tracking (WMT) in Fetal Echocardiography

Abstract

Objective The primary objective of this study was to determine the feasibility and reproducibility of 2-dimensional speckle tracking imaging based on the wall motion tracking (WMT) technique in fetal echocardiography. The secondary objective was to compare left and right ventricular global and segmental longitudinal peak strain values.

Methods A prospective cross-sectional study was performed. Global and segmental longitudinal peak strain values of the left ventricle (LV) and right ventricle (RV) were assessed prospectively. Based on apical 4-chamber views, cine loops were acquired and digitally stored. Strain analysis was performed offline. Intra- and interobserver variabilities were analyzed.

Results A total of 29 healthy fetuses with an echocardiogram performed between 19 and 37 weeks of gestation were included. Analysis was performed with a temporal resolution of 60 frames per second (fps). For both examiners, in all cases Cronbach’s alpha was>0.7. The interobserver variability showed a strong agreement in 50% of the segments (ICC 0.71–0.90). The global strain values for LV and RV were −16.34 and −14.65%, respectively. Segmental strain analysis revealed a basis to apex gradient with the lowest strain values in basal segments and the highest strain values in apical segments.

Conclusion The assessment of fetal myocardial deformation parameters by 2D WMT is technically feasible with good reproducibility.

Key words

fetal echocardiography - speckle tracking - cardiac function - wall motion tracking

• References

• 1 Sahn DJ, Lange LW, Allen HD et al. Quantitative real-time cross-sectional echocardiography in the developing normal human fetus and newborn. Circulation 1980; 62: 588-597
• 2 Allan LD, Joseph MC, Boyd EG et al. M-mode echocardiography in the developing human fetus. Br Heart J 1982; 47: 573-583
• 3 Sahn D, Kisslo J. Report of the Council on Scientific Affairs: ultrasonic imaging of the heart: report of the Ultrasonography Task Force. Arch Intern Med 1991; 151: 1288-1294
• 4 Deprest JA, Flake AW, Gratacos E et al. The making of fetal surgery. Prenat Diagn 2010; 30: 653-667
• 5 Comas M, Crispi F, Cruz-Martinez R et al. Usefulness of myocardial tissue Doppler vs conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction. Am J Obstet Gynecol 2010; 203: 45.e1-e7
• 6 Mäkikallio K, Räsänen J, Mäkikallio T et al. Human fetal cardiovascular profile score and neonatal outcome in intrauterine growth restriction. Ultrasound Obstet Gynecol 2008; 31: 48-54
• 7 Van Mieghem T, Klaritsch P, Doné E et al. Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2009; 200: 400 e1-e7
• 8 Mäkikallio K, McElhinney DB, Levine JC et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: Patient selection for fetal intervention. Circulation 2006; 113: 1401-1405
• 9 Axt-Fliedner R, Graupner O, Degenhardt J et al. Evaluation of right ventricular function in the fetus with hypoplastic left heart using tissue Doppler techniques. Ultrasound Obstet Gynecol 2015; 45: 670-677
• 10 Graupner O, Enzensberger C, Wieg L et al. Evaluation of right ventricular function in fetal hypoplastic left heartsyndrome by colour tissue Doppler imaging. Ultrasound Obstet Gynecol 2016; 47: 732-738
• 11 Di Salvo G, Russo MG, Paladini D et al. Quantification of regional left and rightventricular longitudinal function in 75 normal fetuses using ultrasound-based strain rate and strain imaging. Ultrasound Med Biol 2005; 31: 1159-1162
• 12 Di Salvo G, Russo MG, Paladini D et al. Two-dimensional strain to assess regional left and right ventricular longitudinal function in 100 normal foetuses. Eur J Echocardiogr 2008; 9: 754-756
• 13 Pena JL, da Silva MG, Faria SC et al. Quantification of regional left and right ventricular deformation indices in healthy neonates by using strain rate and strain imaging. J Am Soc Echocardiogr 2009; 22: 369-375
• 14 Lorch SM, Ludomirsky A, Singh GK. Maturational and growth-related changes inleft ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population. J Am Soc Echocardiogr 2008; 21: 1207-1215
• 15 Di Naro E, Cromi A, Ghezzi F et al. Myocardialdysfunction in fetuses exposed to intraamniotic infection: new insights fromtissue Doppler and strain imaging. Am J Obstet Gynecol 2010; 203: 459.e1-e7
• 16 Germanakis I, Matsui H, Gardiner HM. Myocardial strain abnormalities in fetal congenital heart disease assessed by speckle tracking echocardiography. Fetal Diagn Ther 2012; 32: 123-130
• 17 Barker PCA, Houle H, Li JS et al. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: Novel experience with velocity vector imaging. Echocardiography 2009; 26: 28-36
• 18 Amundsen BH, Helle-Valle T, Edvardsen T et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: Validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006; 47: 789-793
• 19 Ta-Shma A, Perles Z, Gavri S et al. Analysis of segmental and global function of the fetal heart using novel automatic functional imaging. J Am Soc Echocardiogr 2008; 21: 146-150
• 20 Younoszai AK, Saudek DE, Emery SP et al. Evaluation of myocardial mechanics in the fetus by velocity vector imaging. J Am Soc Echocardiogr 2008; 470-474
• 21 Pu DR, Zhou QC, Zhang M et al. Assessment of regional right ventricular longitudinal functions in fetus using velocity vector imaging technology. Prenat Diagn 2010; 30: 1057-1063
• 22 Matsui H, Germanakis I, Kulinskaya E et al. Temporal and spatial performance of vector velocity imaging in the human fetal heart. Ultrasound Obstet Gynecol 2011; 37: 150-157
• 23 Onugoren O, Gottschalk E, Dudenhausen JW et al. Assessment of long-axis ventricular function in the fetal heart with a tissue-tracking algorithm. J Perinat Med 2012; 40: 297-305
• 24 Ishii T, McElhinney DB, Harrild DM et al. Circumferential and longitudinal ventricular strain in the normal human fetus. J Am Soc Echocardiogr 2012; 25: 105-111
• 25 Willruth AM, Geipel AK, Berg CT et al. Comparison of global and regional right and left ventricular longitudinal peak systolic strain, strain rate and velocity in healthy fetuses using a novel feature tracking technique. J Perinat Med 2011; 39: 549-556
• 26 Kapusta L, Mainzer G, Weiner Z et al. Second trimester ultrasound: Reference values for two-dimensional speckle tracking-derived longitudinal strain, strain rate and time to peak deformation of the fetal heart. J Am Soc Echocardiogr 2012; 25: 1333-1341
• 27 Kapusta L, Mainzer G, Weiner Z et al. Changes in fetal left and right ventricular strain mechanics during normal pregnancy. J Am Soc Echocardiogr 2013; 26: 1193-1200
• 28 Barker PCA, Houle H, Li JS et al. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: Novel experience with velocity vector imaging. Echocardiography 2009; 26: 28-36
• 29 Willruth AM, Geipel AK, Fimmers R et al. Assessment of right ventricular global and regional longitudinal peak systolic strain, strain rate and velocity in healthy fetuses and impact of gestational age using a novel speckle/feature-tracking based algorithm. Ultrasound Obstet Gynecol 2011; 37: 143-149
• 30 Peng QH, Zhou QC, Zeng S et al. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging. Prenat Diagn 2009; 29: 1149-1155
• 31 Van Mieghem T, Giusca S, DeKoninck P et al. Prospective assessment of fetal cardiac function with speckle tracking in healthy fetuses and recipient fetuses of twin-to-twin transfusion syndrome. J Am Soc Echocardiogr 2010; 23: 301-308
• 32 Willruth AM, Geipel A, Berg C et al. Assessment of left ventricular global and regional longitudinal peak systolic strain, strain rate and velocity with feature tracking in healthy fetuses. Ultraschall Med 2012; 33: E293-E298
• 33 Koopman LP, Slorach C, Hui W et al. Comparison between different speckle tracking and color tissue doppler techniques to measure global and regional myocardial deformation in children. J Am Soc Echocardiogr 2010; 23: 919-928
• 34 Brooks PA, Khoo NS, Mackie AS et al. Right ventricular function in fetal hypoplastic left heart syndrome. J Am Soc Echocardiogr 2012; 25: 1068-1074
• 35 Brooks PA, Khoo NS, Hornberger LK. Systolic and diastolic function of the fetal single left ventricle. J Am Soc Echocardiogr 2014; 27: 972-977
• 36 Crispi F, Sepulveda-Swatson E, Cruz-Lemini M et al. Feasibility and reproducibility of a standard protocol for 2D speckle tracking and tissue doppler-based strain and strain rate analysis of the fetal heart. Fetal Diagn Ther 2012; 32: 96-108
• 37 Schubert U, Müller M, Norman M et al. Transition from fetal to neonatal life: Changes in cardiac function assessed by speckle-tracking echocardiography. Early Hum Dev 2013; 89: 803-808
• 38 Kim S-H, Miyakoshi K, Kadohira I et al. Comparison of the right and left ventricular performance during the fetal development using velocity vector imaging. Early Hum Dev 2013; 89: 675-681
• 39 Persico N, Fabietti I, Baffero GM et al. Fetal right ventricular contraction and relaxation times at 11-13 weeks’ gestation on speckle tracking imaging. Ultrasound Obstet Gynecol 2014; 43: 284-290
• 40 DeKoninck P, D’hooge J, Van Mieghem T et al. Speckle tracking echocardiography in fetuses diagnosed with congenital diaphragmatic hernia. Prenat Diagn 2014; 34: 1262-1267
• 41 Kawagishi T. Speckle tracking for assessment of cardiac motion and dyssynchrony. Echocardiography 2008; 25: 1167-1171
• 42 Fontana A, Zambon A, Cesana F et al. Tissue Doppler, triplane echocardiography, and speckle tracking echocardiography: different ways of measuring longitudinal myocardial velocity and deformation parameters. A comparative clinical study. Echocardiography 2012; 29: 428-437
• 43 Thomas G. Tissue Doppler echocardiography - a case of right tool, wrong use. Cardiovasc Ultrasound 2004; 2: 12
• 44 Marwick TH. Measurement of strain and strain rate by echocardiography: Ready for prime time?. J Am Coll Cardiol 2006; 47: 1313-1327
• 45 Forsey J, Friedberg MK, Mertens L. Speckle tracking echocardiography in pediatric and congenital heart disease. Echocardiography 2013; 30: 447-459
• 46 Biswas M, Sudhakar S, Nanda NC et al. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography 2013; 30: 88-105
• 47 Storaa C, Åberg P, Lind B et al. Effect of Angular Error on Tissue Doppler Velocities and Strain. Echocardiography 2003; 20: 581-587
• 48 Kim HK, Sohn DW, Lee SE et al. Assessment of Left Ventricular Rotation and Torsion with Two-dimensional Speckle Tracking Echocardiography. J Am Soc Echocardiogr 2007; 20: 45-53
• 49 Notomi Y, Lysyansky P, Setser RM et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardiol 2005; 45: 2034-2041
• 50 Takeuchi M, Nishikage T, Nakai H et al. The assessment of left ventricular twist in anterior wall myocardial infarction using two-dimensional speckle tracking imaging. J Am Soc Echocardiogr 2007; 20: 36-44
• 51 Ashraf M, Li XK, Young MT et al. Delineation of cardiac twist by a sonographically based 2-dimensional strain analysis method: an in vitro validation study. J Ultrasound Med 2006; 25: 1193-1198
• 52 Korinek J, Wang J, Sengupta PP et al. Two-dimensional strain – A Doppler-independent ultrasound method for quantitation of regional deformation: Validation in vitro and in vivo. J Am Soc Echocardiogr 2005; 18: 1247-1253
• 53 Singh GK, Cupps B, Pasque M et al. Accuracy and reproducibility of strain by speckle tracking in pediatric subjects with normal heart and single ventricular physiology: A two-dimensional speckle-tracking echocardiography and magnetic resonance imaging correlative Study. J Am Soc Echocardiogr 2010; 23: 1143-1152
• 54 Langeland S, D'hooge J, Wouters PF et al. Experimental validation of a new ultrasound method for the simultaneousassessment of radial and longitudinal myocardial deformation independent ofinsonation angle. Circulation 2005; 112: 2157-2162
• 55 Ishizu T, Seo Y, Enomoto Y et al. Experimental validation of left ventricular transmural strain gradient with echocardiographic two-dimensional speckle tracking imaging. Eur J Echocardiogr 2010; 11: 377-385
• 56 Marcus KA, Mavinkurve-Groothuis AMC, Barends M et al. Reference values for myocardial two-dimensional strain echocardiography in a healthy pediatric and young adult cohort. J Am Soc Echocardiogr 2011; 24: 625-636
• 57 Bussadori C, Moreo A, Di Donato M et al. A new 2D-based method for myocardial velocity strain and strain rate quantification in a normal adult and paediatric population: assessment of reference values. Cardiovasc Ultrasound 2009; 7: 8
• 58 Marwick TH, Leano RL, Brown J et al. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range. JACC Cardiovasc Imaging 2009; 2: 80-84
• 59 Bogaert J, Rademakers FE. Regional nonuniformity of normal adult human left ventricle. Am J Physiol Hear Circ Physiol 2001; 280: H610-H620
• 60 Leitman M, Lysiansky M, Lysyansky P et al. Circumferential and longitudinal strain in 3 myocardial layers in normal subjects and in patients with regional left ventricular dysfunction. J Am Soc Echocardiogr 2010; 23: 64-70
• 61 Saito K, Okura H, Watanabe N et al. Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two-dimensional approaches. J Am Soc Echocardiogr 2009; 22: 1025-1030
• 62 Enzensberger C, Degenhardt J, Tenzer A et al. First Experience with three-dimensional speckle tracking (3D wall motion tracking) in fetal echocardiography. Ultraschall Med 2014; 35: 566-572
• 63 De Isla LP, Balcones DV, Fernández-Golfín C et al. Three-dimensional-wall motion tracking: A new and faster tool for myocardial strain assessment: comparison with two-dimensional-wall motion Tracking. J Am Soc Echocardiogr 2009; 22: 325-330
• 64 D’Hooge J, Bijnens B, Jamal F et al. High frame rate myocardial integrated backscatter. does this change our understanding of this acoustic parameter? Eur J Echocardiogr 2000; 1: 32-41
• 65 Rychik J, Zeng S, Bebbington M et al. Speckle tracking-derived myocardial tissue deformation imaging in twin-twin transfusion syndrome: Differences in strain and strain rate between donor and recipient twins. Fetal Diagn Ther 2012; 32: 131-137
• 66 Rösner A, Barbosa D, Aarsæther E et al. The influence of frame rate on two-dimensional speckle-tracking strain measurements: a study on silico-simulated models and images recorded in patients. Eur Heart J Cardiovasc Imaging 2015; 16: 1137-1147
• 67 Smolich JJ, Walker AM, Campbell GR et al. Left and right ventricular myocardial morphometry in fetal, neonatal, and adult sheep. Am J Physiol 1989; 257 (1 Pt 2) H1-H9
• 68 Jonker SS, Zhang L, Louey S et al. Myocyte enlargement, differentiation, and proliferation kinetics in the fetal sheep heart. J Appl Physiol 2007; 102: 1130-1142
• 69 Voigt JU, Pedrizzetti G, Lysyansky P et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 1-11