Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

Hatém, Maria Amélia Bulhões; Zielinsky, Paulo; Hatem, Domingos; Nicoloso, Luiz Henrique Soares; Mânica, João Luiz; Piccoli, Antônio; Zanettini, Juliana Silveira; Oliveira, Vinicius; Scarpa, F; Petracco, Rafaella

doi:10.1017/s1047951108002138

Cited by 58 publications

(77 citation statements)

References 36 publications

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“…Tissue Doppler was able to detect both systolic and diastolic dysfunction than conventional Doppler in infants of diabetic mothers with hypertrophic cardiomyopathy when compared to the control group. This higher sensitivity of tissue Doppler over the conventional Doppler was previously reported in various studies [20,29,30]. We also found that Tei index was more sensitive than left or right ventricle fractional shortening in detecting impaired cardiac performance.…”

Section: /9supporting

confidence: 86%

Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

Al‐Biltagi¹,

Serag²,

Al-Asy³

et al. 2016

JPNC

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Objective: The objective was to evaluate the value of cord blood cardiac troponin-T levels and tissue Doppler echocardiography in evaluation of hypertrophic cardiomyopathy in infants of diabetic mothers. Methods:A prospective study involved 60 infants of diabetic mothers and 60 healthy neonates.Cord blood level of cardiac troponin-T was measured and conventional and tissue Doppler echocardiographies were performed for all infants. Results:Hypertrophic cardiomyopathy was present in 19 cases (31.6%) of infants of diabetic mothers. There were significant increase in the cord blood cardiac troponin-T levels (P<0.0001) and more significant systolic and diastolic dysfunction in infants of diabetic mothers than in control group. Infants of diabetic mothers with hypertrophic cardiomyopathy had significant increase in the cord blood cardiac troponin-T levels (P<0.0001) and more significant systolic and diastolic dysfunction than infants of diabetic mothers without hypertrophic cardiomyopathy. There was no significant correlation between infant's birth weight and cord blood cardiac troponin-T levels while there was significant correlation between maternal glycosylated hemoglobin and cord blood levels of cardiac troponin-T. There were significant negative correlation between cord blood levels of cardiac troponin-T and E/A ratio at mitral valve, E'/A' ratio and S wave at mitral annulus, E/A ratio tricuspid valve, E'/A' ratio and S wave at tricuspid annulus. There were positive correlations between cord blood cardiac troponin-T levels with septal/posterior wall, and Tie indices.Conclusion: cardiac troponin-T was a useful marker especially when combined with tissue Doppler echocardiography for evaluation of hypertrophic cardiomyopathy in infants of diabetic mothers. Keywords:

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Section: /9supporting

confidence: 86%

Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

Al‐Biltagi¹,

Serag²,

Al-Asy³

et al. 2016

JPNC

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“…96,300 In a prospective study in 25 growth restricted fetuses, TDI demonstrated both systolic and diastolic tissue velocity abnormalities compared with normal fetuses, whereas pulsed Doppler detected only an increase in left ventricular MPI with all other indexes, including E/A ratios, outflow tract velocities, and right ventricular MPI, being similar to those in controls. 301 TDI has also been applied to the assessment of diastolic dysfunction in fetuses of diabetic mothers and other complicated pregnancies 302,303 and in the presence of TTTS, 304 CHD, 305 heart failure, 306 and arrhythmias. 307 In summary, TDI evaluation of fetal cardiac function may be considered in clinical practice, although its usefulness has not been established and the technique currently remains a research tool.…”

Section: Tissue Doppler Imagingmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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“…Fetal cardiac dysfunction may be due to an intrinsic myocardial disease or to a secondary adaptive mechanism. The latter is particularly important because the heart seems to be a central organ in the fetal adaptive response to a variety of insults [5,6,7,8]. Consequently, assessment of fetal cardiac function may be helpful in the diagnosis or monitoring of several fetal conditions [4,5,6,7,8].…”

Section: Importance Of Fetal Cardiac Functionmentioning

confidence: 99%

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

2012

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Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.

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Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler

Abstract: Pulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.

Cited by 58 publications

References 36 publications

Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

Diagnosis and Treatment of Fetal Cardiac Disease

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

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