Assessment of fetal cardiomyopathy in early‐stage twin–twin transfusion syndrome: comparison between commonly reported cardiovascular assessment scores

Villa, Chet; Habli, Mounira; Votava‐Smith, Jodie K.; Cnota, James; Lim, Foong‐Yen; Divanović, Allison; Wang, Y.; Michelfelder, Erik C.

doi:10.1002/uog.13231

Cited by 23 publications

(15 citation statements)

References 20 publications

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“…This is in line with previous studies that have reported signs of systolic and diastolic dysfunction in recipient twins including TTTS stages I and II [13, 14, 20-22]. These echocardiographic findings can be in part due to an increased preload.…”

Section: Discussionsupporting

confidence: 81%

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

et al. 2018

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Objective: To evaluate left myocardial performance index (MPI) and time intervals in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser surgery. Methods: Fifty-one fetal pairs with TTTS and 47 uncomplicated monochorionic twin pairs were included. Left ventricular isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured using conventional Doppler. Results: Recipients showed prolonged ICT (46 ± 12 vs. 31 ± 8 vs. 30 ± 5 ms; p < 0.001) and IRT (51 ± 9 vs. 43 ± 8 vs. 43 ± 5 ms; p < 0.001) and higher MPI (0.57 ± 0.12 vs. 0.47 ± 0.09 vs. 0.44 ± 0.05; p < 0.001) than donors and controls. Donors showed shorter ET than recipients and controls (157 ± 12 vs. 169 ± 10 vs. 168 ± 10 ms; p < 0.001) and higher MPI than controls (0.47 ± 0.09 vs. 0.44 ± 0.05; p = 0.006). Preoperative MPI changes were observed in all TTTS stages. Time intervals partially improved after surgery. Conclusion: Donor and recipient twins had higher MPI due to different changes in the time intervals, possibly reflecting the state of hypovolemia in the donor and hypervolemia and pressure overload in the recipient.

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Section: Discussionsupporting

confidence: 81%

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

et al. 2018

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“…The increases in ICT and IRT but not ET can be interpreted as myocardial impairment of both contraction and relaxation with shortening of the diastolic filling time. Although several studies have evaluated cardiac dysfunction in recipients using Mod‐MPI, only a few reports have assessed its components, mainly focusing on the diastolic function . Divanović et al reported increased IRT in recipients, and this change was more significant in advanced‐stage TTTS .…”

Section: Discussionmentioning

confidence: 99%

Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome

et al. 2016

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“…Our results indicate that, similar to previously reported studies, [4][5][6][7][8] intra-observer variability and inter-observer variability are low and agreement is within acceptable limits for the majority of quantitative It is somewhat surprising that the Doppler MPI is so variable between testers, particularly given our center's substantial experience in the measurement of MPI in fetuses. [12][13][14][15] Studies have reported different ways to measure the variables necessary to calculate the MPI. 5,[16][17][18] We utilize the valve click method for MPI assessment, as it has previously been reported to lower variation.…”

Section: Discussionmentioning

confidence: 99%

“…ment. It is somewhat surprising that the Doppler MPI is so variable between testers, particularly given our center's substantial experience in the measurement of MPI in fetuses [12][13][14][15]. In comparison, the intra-observer percent mean difference and inter-observer percent mean difference were all <10% (with the exception of pulmonary vein VTI).…”

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confidence: 96%

Test–retest variability for quantitative two‐dimensional and Doppler measurements in the fetus

et al. 2018

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Objectives: Echocardiography is used to quantitatively characterize cardiovascular function in fetuses with cardiac abnormalities and inform decisions for fetal or perinatal interventions. It is clinically important to understand the reproducibility of these measures, particularly between testers. While studies have reported intraobserver variability and inter-observer variability, little is known about test-retest variability for these measures. We hypothesized that even in a high volume echocardiography laboratory, quantitative measurements will demonstrate higher test-retest variability compared with inter-observer variability and intra-observer variability of the same measurements.Methods: Prospective study of uncomplicated, singleton pregnancies to evaluate fetal measures of cardiovascular function obtained by echocardiography. One sonographer obtained predefined variables, and then, a second sonographer obtained the same variables 15 minutes after the first sonographer. Separate data acquisitions were obtained by the two sonographers to evaluate test-retest variability. Intraobserver variability and inter-observer variability were also evaluated. Results:Thirty fetuses between 17-and 36-week gestation were enrolled. Timebased variables had the best intra-observer agreement and inter-observer agreement (1.2%-7.4%), while 2D (7.5%-10%), M-mode (4.9%-10.1%), and velocity-time integral (VTI; 2.6%-13.8%) measurements had poorer agreement. For all variables, test-retest agreement was worse (3%-32.1%), particularly for measurement of myocardial performance index (MPI; 19.7%-21.1%), cardiac output estimation (27.2%-27.9%), and VTI-based indices (14.7%-32.1%). Conclusions:In a laboratory highly experienced in quantitative fetal echocardiography, intra-observer agreement and inter-observer agreement are good for most quantitative parameters. However, test-retest agreement is fair or poor for several variables, notably the MPI, cardiac output estimation, and VTI-based indices.Understanding how these measures vary between separate acquisitions is important for clinical interpretation and decision making. K E Y W O R D SDoppler, fetal echocardiography, fetus, test-retest variability | 143 ALLEN Et AL. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article.Graph S1. Uncertainty (precision) of measurement based on sample size.

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Assessment of fetal cardiomyopathy in early‐stage twin–twin transfusion syndrome: comparison between commonly reported cardiovascular assessment scores

Abstract: Objectives To assess the relationship between commonly reported fetal cardiomyopathy scoring systems in earlystage twin-twin transfusion syndrome (TTTS). Methods

Cited by 23 publications

References 20 publications

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome

Test–retest variability for quantitative two‐dimensional and Doppler measurements in the fetus

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