Prenatal speckle tracking echocardiography for fetal heart study in uncomplicated and complicated monochorionic diamond twin pregnancies
Authors:   Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation, Kosovtsova N.V. ,   first President of Russia B.N. Yeltsin Ural Federal University, Yekaterinburg, Russian Federation, Markova T.V. ,   Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation, Chumarnaya T.V. ,   first President of Russia B.N. Yeltsin Ural Federal University, Yekaterinburg, Russian Federation,   Institute of Immunology and Physiology of the Ural Branch of the RAS, Yekaterinburg, Russian Federation, Gusarova E.O. ,   Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation, Pavlichenko M.V. ,   Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation, Pospelova Ya.Yu. ,   Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation, Solov'eva O.E. ,   first President of Russia B.N. Yeltsin Ural Federal University, Yekaterinburg, Russian Federation,   Institute of Immunology and Physiology of the Ural Branch of the RAS, Yekaterinburg, Russian Federation
Published: October 2024

Aim: to compare left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) in uncomplicated monochorionic, diamniotic (MCDA) twin pregnancy with twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) of one fetus and uncomplicated singleton pregnancy. Patients and Methods: the study included 60 pregnant women divided into 2 groups. Group 1 included 25 women with an uncomplicated singleton pregnancy. Group 2 included 35 women with an MCDA twin pregnancy. Pregnancy was complicated with Quintero stage I-III TTTS in 10 women and sIUGR in 10 women. No MCDA twin pregnancy complications were reported in 15 women. Ventricular GLS (by speckle tracking echocardiography) and fetal ejection fraction were measured during the study. Results: significant differences in ventricular GLS were found between fetuses in singleton and uncomplicated MCDA twin pregnancies (for RV, -20.1±2.4 and -23.3±2.5, respectively, p=0.020; for LV, -20.9±2 and -24.5±2.3, respectively, p=0.005); donor and recipient fetuses in TTTS (for LV, -27. 2 [-29.5; -24.6] and -20.6 [-23.1; -17.6], respectively, p=0.005, for RV -26.7 [-30.9; -24.6] and -19.1 [-23.5; -17.9], respectively, p=0.005); recipient fetus before and after fetoscopic laser coagulation (FLC) of placental anastomoses; and twins with sIUGR. Thus, fetal ventricular GLS is greater in uncomplicated MCDA twin pregnancies than in singleton pregnancies. Hemodynamics improve after FLC of placental anastomoses in the recipient fetus in TTTS. sIUGR in MCDA twin pregnancy also affects cardiac function in twins, which requires further study. Conclusions: this paper discusses pilot data on the assessment of fetal cardiac function in MCDA twin pregnancy by speckle tracking echocardiography, which detects early changes in fetal myocardial function and reliably monitors changes in cardiac function over time. KEYWORDS: fetal echocardiography, monochorionic diamniotic twins, fetal surgery, speckle tracking echocardiography. FOR CITATION: Kosovtsova N.V., Markova T.V., Chumarnaya T.V., Gusarova E.O., Pavlichenko M.V., Pospelova Ya.Yu., Solov'eva O.E. Prenatal speckle tracking echocardiography for fetal heart study in uncomplicated and complicated monochorionic diamond twin pregnancies. Russian Journal of Woman and Child Health. 2024;7(3):192–198 (in Russ.). DOI: 10.32364/2618-8430-2024-7-3-1.