Abstract
Introduction: Twin pregnancies are associated with an increased risk of perinatal morbidity and mortality. Pregnancy complications related to twins, such as fetal growth restriction, and twin-to-twin transfusion syndrome (TTTS), are associated with hemodynamic changes in the fetal heart. Two-dimensional speckle tracking echocardiography (2D STE) is a tool to evaluate fetal cardiac function. This paper aims to review the literature regarding global longitudinal strain (rate) and peak systolic strain (rate) assessed with 2D STE in twin pregnancies. Feasibility, frame rate, and angle of the fetal heart at the time of measurement were selected as secondary outcomes. Methods: The databases Medline, Embase, Scopus, and Web of Science were searched. Results: Seven articles met the inclusion criteria and selected all monochorionic diamniotic (MCDA) twins with TTTS as the study population. The global longitudinal strain in the right and left ventricle and the peak systolic strain in the right ventricle of the recipient MCDA twin are significantly decreased compared to the donor MCDA twin. 2D STE assessment was shown feasible and reproducible in MCDA pregnancies. Large heterogeneity in technical characteristics between the articles induces inconsistent results. Conclusion: Although feasible, the knowledge of 2D STE is very limited in twin pregnancy. Prospective studies are needed to evaluate the 2D STE assessment in uncomplicated twin pregnancies considering its possible additive value in the diagnostics of pregnancy-related pathologies.
Journal Section:
Prenatal Diagnosis
Plain Language Summary
Monitoring twin pregnancies is more complex than managing singleton pregnancies due to differing growth patterns in the third trimester and twin-specific complications. Additional tools for detecting early signs of complications could be beneficial for managing twin pregnancies. Speckle tracking echocardiography, a relatively new software, calculates deformation parameters of the fetal heart, providing insights into the overall function of the fetal heart, placental health, and potential fetal growth. This systematic review examined various databases for studies on the use of this software in twin pregnancies. Seven articles met the inclusion criteria, but all focused on a single type of twin pregnancy with the same condition. The software was found to be feasible and reproducible in the study population. However, significant differences in technical characteristics among the articles led to inconsistent results. Therefore, prospective clinical trials are needed to evaluate this software across all types of twin pregnancies, establish reference values for healthy twin pregnancies, and explore its potential value in diagnosing pregnancy-related complications.
Journal Section:
Prenatal Diagnosis
References
1.
Elliott
JP
. High-order multiple gestations
. Semin Perinatol
. 2005
;29
(5
):305
–11
. 2.
Hack
KEA
, Derks
JB
, Elias
SG
, Franx
A
, Roos
EJ
, Voerman
SK
, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study
. BJOG Int J Obstet Gynaecol
. 2008
;115
(1
):58
–67
. 3.
Fisk
NM
, Duncombe
GJ
, Sullivan
MHF
. The basic and clinical science of twin-twin transfusion syndrome
. Placenta
. 2009
;30
(5
):379
–90
. 4.
Vasciaveo
L
, Zanzarelli
E
, D’Antonio
F
. Fetal cardiac function evaluation: a review
. J Clin Ultrasound
. 2023
;51
(2
):215
–24
. 5.
Cruz‐Lemini
M
, Crispi
F
, Valenzuela-Alcaraz
B
, Figueras
F
, Sitges
M
, Gómez
O
, et al. Value of annular M‐mode displacement vs tissue Doppler velocities to assess cardiac function in intrauterine growth restriction
. Ultrasound Obstet Gynecol
. 2013
;42
(2
):175
–81
. 6.
van Oostrum
NHM
, van der Woude
DAA
, Clur
SAB
, Oei
SG
, van Laar
JOEH
. Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses
. Prenat Diagn
. 2020
;40
(12
):1525
–31
. 7.
Biswas
M
, Sudhakar
S
, Nanda
NC
, Buckberg
G
, Pradhan
M
, Roomi
AU
, et al. Two‐ and three‐dimensional speckle tracking echocardiography: clinical applications and future directions
. Echocardiography
. 2013
;30
(1
):88
–105
. 8.
Blessberger
H
, Binder
T
. NON-invasive imaging: two dimensional speckle tracking echocardiography: basic principles
. Heart
. 2010
;96
(9
):716
–22
. 9.
Amedro
P
, Bredy
C
, Guillaumont
S
, De La Villeon
G
, Gamon
L
, Lavastre
K
, et al. Speckle tracking echocardiography in healthy children: comparison between the QLAB by Philips and the EchoPAC by General Electric
. Int J Cardiovasc Imaging
. 2019
;35
(5
):799
–809
. 10.
Vianna-Pinton
R
, Moreno
CA
, Baxter
CM
, Lee
KS
, Tsang
TSM
, Appleton
CP
. Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects
. J Am Soc Echocardiogr
. 2009
;22
(3
):299
–305
. 11.
Cameli
M
, Caputo
M
, Mondillo
S
, Ballo
P
, Palmerini
E
, Lisi
M
, et al. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking
. Cardiovasc Ultrasound
. 2009
;7
(1
):6
. 12.
van Oostrum
NHM
, de Vet
CM
, Clur
SB
, van der Woude
DAA
, van den Heuvel
ER
, Oei
SG
, et al. Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses
. Ultrasound Obstet Gynecol
. 2022
;59
(5
):651
–9
. 13.
Van Oostrum
NHM
, De Vet
CM
, Van Der Woude
DAA
, Kemps
HMC
, Oei
SG
, Van Laar
JOEH
. Fetal strain and strain rate during pregnancy measured with speckle tracking echocardiography: a systematic review
. Eur J Obstet Gynecol Reprod Biol
. 2020
;250
:178
–87
. 14.
Clavero Adell
M
, Ayerza Casas
A
, Jiménez Montañés
L
, Palanca Arias
D
, López Ramón
M
, Alcalá Nalvaiz
JT
, et al. Evolution of strain and strain rate values throughout gestation in healthy fetuses
. Int J Cardiovasc Imaging
. 2020
;36
(1
):59
–66
. 15.
Di Salvo
G
, Russo
MG
, Paladini
D
, Felicetti
M
, Castaldi
B
, Tartaglione
A
, et al. Two-dimensional strain to assess regional left and right ventricular longitudinal function in 100 normal foetuses
. Eur J Echocardiogr
. 2008
;9
(6
):754
–6
. 16.
Wohlmuth
C
, Osei
FA
, Moise
KJ
, Johnson
A
, Papanna
R
, Bebbington
M
, et al. Aortic distensibility as a surrogate for intertwin pulse pressure differences in monochorionic pregnancies with and without twin-twin transfusion syndrome
. Ultrasound Obstet Gynecol
. 2016
;48
(2
):193
–9
. 17.
Barker
PCA
, Houle
H
, Li
JS
, Miller
S
, Herlong
JR
, Camitta
MGW
. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging
. Echocardiography
. 2009
;26
(1
):28
–36
. 18.
Germanakis
I
, Gardiner
H
. Assessment of fetal myocardial deformation using speckle tracking techniques
. Fetal Diagn Ther
. 2012
;32
(1–2
):39
–46
. 19.
Barker
PCA
, Houle
H
, Li
JS
, Miller
S
, Herlong
JR
, Camitta
MGW
. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging
. Echocardiography
. 2009
;26
(1
):28
–36
. 20.
Peixoto
AB
, Bravo-Valenzuela
NJ
, Rocha
LA
, Araujo Júnior
E
. Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update
. Radiol Bras
. 2021
;54
(2
):99
–106
. 21.
Zanardini
C
, Prefumo
F
, Fichera
A
, Botteri
E
, Frusca
T
. Fetal cardiac parameters for prediction of twin‐to‐twin transfusion syndrome
. Ultrasound Obstet Gynecol
. 2014
;44
(4
):434
–40
. 22.
Page
MJ
, McKenzie
JE
, Bossuyt
PM
, Boutron
I
, Hoffmann
TC
, Mulrow
CD
, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews
. BMJ
. 2021
;372
:n71
. 23.
Ouzzani
M
, Hammady
H
, Fedorowicz
Z
, Ahmed
E
. Rayyan: a web and mobile app for systematic reviews
.24.
Joanna Briggs Institute
. Checklist for systematic reviews and research syntheses
. 2017
. [Online]. Available from: https://joannabriggs.org/ebp/critical_appraisal_tools (accessed: Jul 07, 2023).25.
Higgins
JPT
. Cochrane handbook for systematic reviews of interventions
. Cochrane
; 2023
. [Online]. Available from: www.training.cochrane.org/handbook (accessed: Dec 08, 2023).26.
Granholm
A
, Alhazzani
W
, Møller
MH
. Use of the GRADE approach in systematic reviews and guidelines
. Br J Anaesth
. 2019
;123
(5
):554
–9
. 27.
Higgins
JPT
, Thompson
SG
, Deeks
JJ
, Altman
DG
. Measuring inconsistency in meta-analyses
. BMJ
. 2003
;327
(7414
):557
–60
. 28.
Gavaghan
DJ
, Moore
AR
, McQuay
HJ
. An evaluation of homogeneity tests in meta-analyses in pain using simulations of individual patient data
. Pain
. 2000
;85
(3
):415
–24
. 29.
Egger
M
, Davey Smith
G
, Schneider
M
, Minder
C
. Bias in meta-analysis detected by a simple, graphical test
. BMJ
. 1997
;315
(7109
):629
–34
. 30.
Lin
L
, Chu
H
. Quantifying publication bias in meta‐analysis
. Biometrics
. 2018
;74
(3
):785
–94
. 31.
Zhao
S
, Deng
Y-B
, Chen
X-L
, Liu
R
. Assessment of right ventricular function in recipient twin of twin to twin transfusion syndrome with speckle tracking echocardiography
. Ultrasound Med Biol
. 2012
;38
(9
):1502
–7
. 32.
Willruth
A
, Geipel
A
, Berg
C
, Fimmers
R
, Gembruch
U
. Assessment of cardiac function in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome before and after fetoscopic laser photocoagulation using Speckle tracking
. Ultraschall Med
. 2013
;34
(2
):162
–8
. 33.
Wohlmuth
C
, Agarwal
A
, Stevens
B
, Johnson
A
, Moise
KJ
Jr, Papanna
R
, et al. Fetal ventricular strain in uncomplicated and selective growth‐restricted monochorionic diamniotic twin pregnancies and cardiovascular response in pre‐twin–twin transfusion syndrome
. Ultrasound Obstet Gynecol
. 2020
;56
(5
):694
–704
. 34.
Taylor-Clarke
MC
, Matsui
H
, Roughton
M
, Wimalasundera
RC
, Gardiner
HM
. Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome
. Am J Obstet Gynecol
. 2013
;208
(6
):462.e1
–4626
. 35.
Rychik
J
, Zeng
S
, Bebbington
M
, Szwast
A
, Quartermain
M
, Natarajan
S
, 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
(1–2
):131
–7
. 36.
Van Mieghem
T
, Giusca
S
, DeKoninck
P
, Gucciardo
L
, Doné
E
, Hindryckx
A
, 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
(3
):301
–8
. 37.
Harbison
AL
, Pruetz
JD
, Ma
S
, Sklansky
MS
, Chmait
RH
, DeVore
GR
. Evaluation of cardiac function in the recipient twin in successfully treated twin-to-twin transfusion syndrome using a novel fetal speckle-tracking analysis
. Prenat Diagn
. 2021
;41
(1
):136
–44
. 38.
Couck
I
, Lewi
L
. The placenta in twin-to-twin transfusion syndrome and twin anemia polycythemia sequence
. Twin Res Hum Genet
. 2016
;19
(3
):184
–90
. 39.
Miller
JL
. Twin to twin transfusion syndrome
. Transl Pediatr
. 2021
;10
(5
):1518
–29
. 40.
Wohlmuth
C
, Gardiner
HM
, Diehl
W
, Hecher
K
. Fetal cardiovascular hemodynamics in twin–twin transfusion syndrome
. Acta Obstet Gynecol Scand
. 2016
;95
(6
):664
–71
. 41.
Manovel
A
, Dawson
D
, Smith
B
, Nihoyannopoulos
P
. Assessment of left ventricular function by different speckle-tracking software
. Eur J Echocardiogr
. 2010
;11
(5
):417
–21
. 42.
van Oostrum
NHM
, Derks
K
, van der Woude
DAA
, Clur
SA
, Oei
SG
, van Laar
JOEH
. Two-dimensional speckle tracking echocardiography in fetal growth restriction: a systematic review
. Eur J Obstet Gynecol Reprod Biol
. 2020
;254
:87
–94
. 43.
Patey
O
, Carvalho
JS
, Thilaganathan
B
. Intervendor discordance of fetal and neonatal myocardial tissue Doppler and speckle-tracking measurements
. J Am Soc Echocardiogr
. 2019
;32
(10
):1339
–49.e23
. 44.
Koopman
LP
, Slorach
C
, Hui
W
, Manlhiot
C
, McCrindle
BW
, Friedberg
MK
, 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
(9
):919
–28
. 45.
DeVore
GR
, Polanco
B
, Satou
G
, Sklansky
M
. Two-dimensional speckle tracking of the fetal heart: a practical step-by-step approach for the fetal sonologist
. J Ultrasound Med
. 2016
;35
(8
):1765
–81
. 46.
Haeger
C
, Hammer
K
, Braun
J
, Oelmeier
K
, Köster
HA
, Möllers
M
, et al. Importance of frame rate for the measurement of strain and synchrony in fetuses using speckle tracking echocardiography
. J Perinat Med
. 2022
;50
(2
):176
–84
. 47.
Semmler
J
, Day
TG
, Georgiopoulos
G
, Garcia-Gonzalez
C
, Aguilera
J
, Vigneswaran
TV
, et al. Fetal speckle-tracking: impact of angle of insonation and frame rate on global longitudinal strain
. J Am Soc Echocardiogr
. 2020
;33
(9
):1141
–6.e2
. 48.
Nichting
TJ
, de Vet
CM
, van der Ven
M
, van der Woude
DAA
, Regis
M
, van Sloun
RJG
, et al. The impact of angles of insonation on left and right ventricular global longitudinal strain estimation in fetal speckle tracking echocardiography
. PLoS One
. 2023
;18
(7
):e0287003
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