Characterization of Ventricular Myocardial Performance in the Fetus by Tissue Doppler Imaging

Abstract

Background: Clinically useful indices of fetal cardiac function have not been fully delineated for tissue Doppler imaging (TDI). Methods and Results:In the present study, 56 pregnancies between the 17 th and 38 th weeks of gestation included 38 normal fetuses, 6 cases of hydrops fetalis (HF), and 12 of intrauterine growth retardation (IUGR). Peak velocity in early diastole (E) was measured by pulsed-wave Doppler and the peak annular velocities in systole (Sa) and early diastole (Ea) were measured by TDI. The ratio between flow velocity and annular velocity in early diastole (E/Ea) and the ratio of the Sa of right ventricle to that of the left ventricle (RVSa/LVSa) were estimated. In all fetuses with HF, LVSa was <2 cm/s and LVE/Ea was >13. RVSa/LVSa in the HF group was significantly higher than that in the normal group, and RVSa/LVSa in the IUGR group was significantly lower than that in the normal group. Conclusions: A combination of low LVSa and high LVE/Ea shows reduced global myocardial performance of the LV, and would be one of the useful indices for quantitative assessment in high-risk pregnancies. Changes in the RVSa/LVSa ratio may reflect afterload changes in both ventricles and compensatory cardiovascular mechanisms occurring during the process of placental insufficiency and heart failure. (Circ J 2009; 73: 943 -947)

Impact of Gestational Hypertension on Left Ventricular Function and Geometric Pattern

“…28 This evidence explains the finding of longitudinal functional deterioration as a result of early subendocardial lesions in GH patients; and the present findings regarding the presence of longitudinal dysfunction are consistent with other studies that have shown the progressive nature of longitudinal deterioration in patients with diastolic heart failure, even in patients with transient hypertension, 29 indicating that reduced global myocardial performance of the left ventricle would be one of the useful indices for quantitative assessment in high-risk pregnancies. 30 The present study shows that the BP of GHW decreased after delivery, as happens usually, and that RWT and Tei index returned to normal but remained higher compared to NPW at the time of follow-up echocardiography. Pregnancy followed by delivery may decrease arterial stiffness.…”

Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

“…Fetal cardiac function is mainly dependent on the right ventricle. It has been suggested that almost 2 thirds of the total cardiac output is handled by the right ventricle; therefore, a continuous deterioration of the DV might suggest abnormal cardiac function mainly in the right ventricle, thus increasing the risk of fetal demise [26,27]. Evaluation of the RA and FA did not show differences when compared with normally grown fetuses.…”

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

“…However, more recent studies using myocardial imaging techniques have demonstrated that systolic annular peak velocities are decreased from the very early stages of FGR, long before atrial flow in the DV becomes abnormal [43,74]. Additionally, fetuses with early FGR show signs of impaired relaxation (diastolic dysfunction) from the early stages of deterioration [6], as measured by increased pulsatility in precordial veins (particularly DV) [6,32,75], higher E/A ratios [6,32,74,76,77,78], increased IRT [6,43,79], reduced diastolic annular peak velocities [43,80], and increased cord blood levels of ANP and BNP [6,81]. This decrease in longitudinal motion and impaired relaxation may be a fetal adaptive mechanism to the chronic hypoxia and volume/pressure overload of placental insufficiency.…”