Speckle tracking – ein neues Ultraschallverfahren zur Beurteilung der fetalen Myokardfunktion

Zusammenfassung

Speckle tracking ist eine neue echokardiografische Technik, die quantitativ Informationen über 2-dimensionale globale und segmentale myokardiale Wandbewegung und Deformierungsparameter (Strain, Strain rate) liefert. Multiple Faktoren, wie fetale Bewegungen, hohe Herzfrequenz, nierdiger Blutdruck, kleine Herzgröße, physiologische fetale Herzbewegungen im Perikardbeutel, unterschiedliche kardiale Füllungszustände und myokardiale Reifungsprozesse während der Schwangerschaft sowie Polyhydramnie, maternale Adipositas und Pulsation der Aorta, können die Bildqualität stark beeinträchtigen und müssen bei der Analyse der fetalen kardialen Funktion stets berücksichtigt werden. Die alleinige Betrachtung der myokardialen Geschwindigkeiten enthält daher Artefakte, sodass sich die Bestimmung von Strain und Strain rate als quantitative objektivierbare Technik zur Einschätzung der globalen myokardialen Funktion und Kontraktilität etabliert hat. In der Erwachsenen-Kardiologie wird speckle tracking zunehmend zur erweiterten Herzfunktionsanalyse eingesetzt, wobei „longitudinal peak systolic Strain” der gebräuchlichste und best untersuchteste Deformierungsparameter zur Analyse der segmentalen und globalen Myokardkontraktilität bei Erwachsenen ist. Im Gegensatz zur Doppler-basierten Echokardiografie (TDI) ermöglicht speckle tracking (z. B. EchoPac^®; syngo^® velocity vector imaging, VVI) die Analyse der myokardialen Funktion unabhängig vom Insonationswinkel, was in der fetalen Echokardiografie von besonderem Vorteil ist. Zeitaufwand und Lernkurve zur Aufnahme optimaler hochauflösender Videosequenzen schränken den Einsatz der speckle tracking Technik in der täglichen Routine derzeit noch ein. Ob speckle tracking zukünftig eher als etablierte Verfahren subklinische myokardiale Dysfunktionen nachweisen oder zur besseren Diskriminierung zwischen gesunden und kardial erkrankten Feten beitragen kann, muss bei den unterschiedlichen fetalen Erkrankungen in Studien mit größerer Fallzahl untersucht werden.

Abstract

Speckle tracking is a new ultrasound tool to assess 2D ventricular global and segmental myocardial velocity and deformation (strain, strain rate). Multiple factors such as fetal motion, high heart rates, low blood pressure, small size of the heart, physiological cardiac translation, filling and maturational changes of myocardium, polyhydramnion, maternal obesity and aortic pulsation can degrade the image quality and result in artifacts and measurement errors which may have an impact on the final analysis. Therefore deformation indices such as strain and strain rate offer a quantitative technique for the estimation of global and segmental myocardial function and contractility. At present longitudinal peak systolic strain is the most commonly applied deformation parameter used to analyse segmental and global myocardial contractility in adults. When obtained using Doppler methods, these measurements are angle dependent, whereas speckle tracking techniques overcome the limitations of Doppler echocardiography which is a particular advantage in foetal echocardiography. Nevertheless, the time and training necessary to acquire high-quality video clips limit the implementation of speckle tracking into clinical routine. It is not yet clear whether this new technique will identify subclinical myocardial impairment earlier than with current techniques or allow for better discrimination between healthy fetuses and fetuses with congenital heart disease. The clinical use of speckle tracking will have to be demonstrated in larger groups of complicated pregnancies.

Schlüsselwörter

Speckle tracking - fetal - Strain - myokardiale Performance - Herzfunktion - Herzfehler - feto-fetales Transfusionssyndrom

Key words

speckle tracking - fetal - strain - myocardial performance - cardiac function - congenital heart defect - twin-twin transfusion syndrome

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