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Abnormalities in Cardiac Function, Anatomy, and Myocardial Strain in Coarctation of the Aorta
Guihong Chen1, Wei Xiang1, Yanhong Zhang1
1Department of Medical Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China.
Insights
Fetal coarctation of the aorta (CoA) significantly impacts cardiac function and myocardial strain. Speckle tracking echocardiography reveals decreased cardiac parameters and strain, aiding in differentiating CoA fetuses from normal controls.
Area of Science:
- Cardiology
- Fetal Medicine
- Medical Imaging
Background:
- Coarctation of the aorta (CoA) is a congenital heart defect.
- Prenatal diagnosis of CoA is crucial for timely intervention.
- Speckle tracking echocardiography (STE) offers advanced assessment of cardiac mechanics.
Purpose of the Study:
- To evaluate cardiac function and myocardial strain in fetuses with CoA using STE.
- To identify echocardiographic parameters indicative of CoA in utero.
Main Methods:
- Prospective enrollment of fetuses with and without CoA.
- Prenatal ultrasound scan with STE for CoA assessment.
- Comparison of echocardiographic parameters between CoA fetuses and normal controls.
Main Results:
- CoA fetuses showed significant decreases in aortic arch/isthmus diameters, left ventricle (LV) and right ventricle (RV) volumes, stroke volume, cardiac output, ejection fraction (EF), and fraction of area change (FAC).
- Myocardial strain, including LV and RV global longitudinal strain (EndoGLS) and LV circumferential strain, was significantly reduced in CoA fetuses.
- Global sphericity index (GSI) and end-diastolic diameter showed significant alterations in both LV and RV, with specific increases and decreases noted in different segments.
- Multivariate analysis identified LV apical end-diastolic diameter, LV endocardial GCS, LV FAC, and 4CV GSI as independent risk factors for CoA. ROC analysis demonstrated high predictive accuracy (AUC 0.973).
Conclusions:
- Fetal CoA is associated with significant reductions in cardiac function, anatomical dimensions, and myocardial strain (longitudinal and circumferential).
- Key parameters like LV end-diastolic diameter, fraction of shortening (FS), GSI, and STE-derived strain measures are significantly altered.
- These findings suggest that STE can effectively assist in differentiating fetuses with CoA from normal controls, potentially improving prenatal diagnosis.
Purpose:
To investigate the cardiac function and myocardial strain in fetuses with coarctation of the aorta (CoA) using speckle tracking echocardiography.
Materials And Methods:
Fetuses with and without CoA were prospectively enrolled to undergo a prenatal ultrasound scan for the presence of CoA. The ultrasound parameters were compared between CoA fetuses and normal controls.
Results:
Forty-five CoA fetuses and 336 normal fetuses matched (p > 0.05) in the gestational age, estimated body weight, and pregnant women's age were enrolled. The CoA fetuses had significant (p < 0.05) decreases in the diameters of the aortic arch and isthmus, the left ventricle (LV) stroke volume and its ratio to the estimated body weight, the LV cardiac output and its ratio to the estimated body weight, the LV EF, the LV end-diastolic and end-systolic volume, area, length and basal segment diameter, the right ventricle (RV) end-diastolic (ED) length, the 4CV global sphericity index (GSI), LV and RV fraction of area change (FAC), LV endocardial global longitudinal strain (EndoGLS) and circumferential strain, RV EndoGLS and free wall strain. In the CoA fetuses, significant (p < 0.05) decreases were detected in the fraction of shortening (FS) and FS Z-score in the LV middle and apical segments and in the RV middle segments, and in the FS Z-score in the RV basal segments. In the CoA fetuses, significant (p < 0.05) increases were detected in the GSI and GSI Z-score in the LV apical part, in the ED diameter and its Z-score in the RV basal and middle parts, whereas significant (p < 0.05) decreases in the GSI and GSI Z-score in all the RV basal, middle and apical parts and in the ED diameter and its Z-score in all the LV basal, middle and apical parts. The LV apical ED diameter (2.30 ± 1.13, OR 9.97, 95% CI 1.16-107.89), LV endocardial GCS (-0.30 ± 0.14, OR 0.74, 95% CI 0.55-0.95), LV FAC (-1.17 ± 0.45, OR 0.31, 95% CI 0.13-0.74), and 4CV GSI (-11.69 ± 5.60, OR 8.34e-6, 95% CI 4.51e-11-0.22) were significant (p < 0.05) independent risk factors. The ROC curve analysis of the multivariate regression model for predicting CoA presence revealed an AUC of 0.973, a sensitivity value of 0.977, and a specificity of 0.888.
Conclusion:
The cardiac function, anatomical parameters, longitudinal and circumferential strain, FS and GSI, LV end-diastolic diameter, and their Z-scores significantly decrease in CoA fetuses, which may assist in differentiating CoA fetuses from normal controls.
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