Evaluation of systolic and diastolic ventricular performance of the right ventricle in fetuses with ductal constriction using the Doppler Tei index

Mori, Yoshiki; Rice, Mary J.; McDonald, Robert W.; Reller, Mark D.; Wanitkun, Suthep; Harada, Kenji; Sahn, David J.

doi:10.1016/s0002-9149(01)02056-2

Cited by 69 publications

(49 citation statements)

References 26 publications

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“…241,242 An abnormal MPI has been demonstrated in many fetal cardiac abnormalities associated with altered function, including myocardial pathology in TTTS recipient twin, ductus arteriosus constriction, and Ebstein anomaly. 168,242,243 Ventricular function assessment with pulsed Doppler can be useful as part of the expanded fetal cardiac examination for fetuses at risk for or with myocardial dysfunction.…”

Section: Cardiac Function Assessmentmentioning

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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Section: Cardiac Function Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

View full text Add to dashboard Cite

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“…This index has been studied in normal fetuses 22,24 and in pathological conditions such as intrauterine ductus arteriosus constriction 25 and fetal hydrops. 26 The present study shows that early in the evolution of TTTS, the MPI of the recipient twin is systematically higher than that of the donor, which remains within normal range.…”

Section: Discussionmentioning

confidence: 99%

Early Intertwin Differences in Myocardial Performance During the Twin-to-Twin Transfusion Syndrome

et al. 2004

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Background-In the twin-to-twin transfusion syndrome (TTTS), pressure rather than volume overload is increasingly considered as a key factor in the pathogenesis of the cardiomyopathy of the recipient twin. If this is the case, cardiac dysfunction should be among the first signs observed with TTTS. The objective of this study was to determine whether intertwin differences in myocardial function are modified early in the course of TTTS and whether they can help to differentiate this condition from intrauterine growth restriction (IUGR). Methods and Results-Eight variables were analyzed on the first fetal echocardiography on 21 pairs of twins with TTTS and 11 with IUGR. No difference was found between the 2 groups for the cardiothoracic ratio, pulsatility indices in the umbilical and middle cerebral arteries, and peak velocity of the middle cerebral artery. Significant difference was found for ventricular septal thickness, but with no association with the conditions under study. With TTTS, left ventricular shortening fraction was consistently greater in the donor twins, and myocardial performance indices (MPIs) were elevated in the recipient twins. This increase in MPI was caused by a lengthening of the isovolumic periods compared with those of the donor twin: left ventricular and right ventricular isovolumic periods 0.105Ϯ0.047 and 0.097Ϯ0.026 seconds, respectively, for the recipient twins versus 0.0561Ϯ0.46 and 0.065Ϯ0.03 seconds, respectively, for the donor twins (PϽ0.001). These changes in the isovolumic periods were mainly due to significant prolongation of isovolumic relaxation times. A change in left ventricular MPI Ն0.09 combined with a change in right ventricular MPI Ն0.05 would identify a TTTS with a sensitivity of 75% and a false-positive rate of 9%. Conclusions-The observed diastolic function impairment goes along with the pressure-overload pathogenic concept proposed in TTTS. Assessment of intertwin difference in MPI is a valuable tool for early differential diagnosis between TTTS and isolated IUGR.

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“…An increased IRT is generally accompanied by a reduced ET, with the ICT the most stable MPI parameter [4]. The MPI has been used to demonstrate fetal cardiac dysfunction in a number of pathologies including maternal diabetes [11,12,13,14,15,16], TTTS [7,17,18,19,20,21,22], congenital heart malformations [23,24,25,26,27,28], pre-eclampsia [29], IUGR [11,30,31,32,33,34], and other fetal conditions [35,36,37,38]. Several studies have proposed methods to improve the repeatability of fetal MPI by defining fixed machine settings [39] and using the clicks of the aortic and mitral valves as landmarks to delineate the constituent time intervals [9,40,41].…”

Section: Introductionmentioning

confidence: 99%

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

et al. 2015

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Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.

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Evaluation of systolic and diastolic ventricular performance of the right ventricle in fetuses with ductal constriction using the Doppler Tei index

Cited by 69 publications

References 26 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Early Intertwin Differences in Myocardial Performance During the Twin-to-Twin Transfusion Syndrome

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

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