Adaptation of Left Ventricular Function and Myocardial Microstructure in Fetuses with Right Ventricular Hypoplasia

Jing Ma; Yuman Li; Haiyan Cao; Yaping Yuan; Shizhen Chen; Liu Hong; Li Zhang; Xin Zhou; Mingxing Xie

doi:10.1016/j.cjca.2024.12.020

Adaptation of Left Ventricular Function and Myocardial Microstructure in Fetuses with Right Ventricular Hypoplasia

Can J Cardiol. 2024 Dec 18:S0828-282X(24)01317-5. doi: 10.1016/j.cjca.2024.12.020. Online ahead of print.

Authors

Jing Ma¹, Yuman Li¹, Haiyan Cao¹, Yaping Yuan², Shizhen Chen³, Liu Hong¹, Li Zhang¹, Xin Zhou⁴, Mingxing Xie⁵

Affiliations

¹ Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
² State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences - Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China; University of Chinese Academy of Sciences, Beijing 100049, China.
³ State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences - Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China; Optics Valley Laboratory, Hubei 430074, China; University of Chinese Academy of Sciences, Beijing 100049, China.
⁴ State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences - Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China; Optics Valley Laboratory, Hubei 430074, China; University of Chinese Academy of Sciences, Beijing 100049, China. Electronic address: [email protected].
⁵ Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China. Electronic address: [email protected].

PMID: 39706362
DOI: 10.1016/j.cjca.2024.12.020

Abstract

Background: This study aimed to evaluate changes in left ventricular (LV) function and myocardial microstructure in fetuses with right ventricular hypoplasia (RVH) using two-dimensional speckle tracking echocardiography (2D-STE), diffusion tensor cardiovascular magnetic resonance imaging (DT-CMR) and proteomics analysis.

Methods: 51 singleton fetuses diagnosed with RVH and 51 normal fetuses were retrospectively included. LV global longitudinal strain (GLS) and global circumferential strain (GCS) were acquired by 2D-STE. Fraction anisotropy (FA), mean diffusivity (MD) and helix angle were measured using DT-CMR in four fetal specimens with RVH and three normal fetal specimens. Bioinformatics analysis was performed for differentially expressed proteins between RVH and normal specimens.

Results: In RVH fetuses, LVGLS and regional longitudinal strain were significantly lower than in controls (p<0.001), whereas LV sphericity index and LVGCS were increased. In RVH fetuses, FA was higher in middle and apical segments than in normal fetuses (p<0.001). LV MD was reduced in all the segments (p<0.001). Circumferentially oriented myocytes and left-handed oriented myocytes were increased, but right-handed orientated myocytes were decreased (p<0.001). Using proteomics, 95 myocardial proteins differed with upregulation of 66 and downregulation in RVH, hearts including myocardial contractile fibrillar proteins and cell membrane protein complexes.

Conclusions: In fetal RVH, the left ventricle demonstrates altered function with reduced longitudinal but augmented circumferential strain which may support its need to augment its preload and consequent cardiac output. Decreased right-handed and increased circumferentially oriented myocytes may contribute to this adaptation. The left ventricle in fetal RVH also demonstrates a differential expression of various myocardial proteins.

Keywords: Diffusion Tensor Cardiovascular Magnetic Resonance Imaging; Fetal Echocardiography; Proteomics Analysis; Right Ventricular Hypoplasia; Two-Dimensional Speckle Tracking Echocardiography.