The transverse four-chamber view for the assessment of atrial tissue deformation in the fetus

PLoS One. 2018 Jul 2;13(7):e0199581. doi: 10.1371/journal.pone.0199581. eCollection 2018.


Aims: To determine if atrial tissue deformation (peak strain, PS) and time to peak strain (TTPS) can be assessed in the fetus, with identification of best echocardiographic plane.

Materials and methods: Pulsed-wave tissue Doppler study of a longitudinal and a transverse four-chamber view (FCV) in each of 20 healthy fetuses. Determination of PS and TTPS in regions of interest (ROI), viz., lateral walls of the right and left atria (RA, LA); comparison of values depending on section plane, with results-based discussion of the physiology of fetal atrial deformation and of possible clinical uses.

Results: PS and TTPS could be determined on transverse FCV in 91% of subjects and in 61% on longitudinal FCV. Transverse PS and TTPS were significantly higher than longitudinal (p = 0.0001). Transverse PS was significantly higher in RA than in LA (26.9% vs. 17.3%, p = 0.034), and transverse TTPS was significantly shorter in RA than in LA (p = 0.034).

Conclusion: Atrial radial PS and TTPS determinations are possible in the fetus. The transverse FCV is best suited for these. The highest PS values and shortest TTPS values are found in ROI representing the RA. Our findings may contribute to detailed intrauterine assessment of atrial and ventricular myocardial function.

MeSH terms

  • Atrial Function, Left
  • Echocardiography
  • Fetal Heart / diagnostic imaging*
  • Fetal Heart / pathology*
  • Heart Atria / diagnostic imaging*
  • Heart Atria / pathology*
  • Heart Atria / physiopathology
  • Heart Function Tests
  • Humans

Grants and funding

The authors received no specific funding for this work.