Fetal cardiac function at intrauterine transfusion assessed by automated analysis of color tissue Doppler recordings

Herling, Lotta; Johnson, Jonas; Ferm-Widlund, K.; Bergholm, Fredrik; Labas, P; Sonesson, Sven‐Erik; Acharya, Ganesh; Westgren, Magnus

doi:10.1186/s12947-020-00214-1

Cited by 4 publications

(8 citation statements)

References 29 publications

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“…The significantly increased MAPSE values found before IUT are in accordance with the fetal hyperdynamic circulation that is present in anemia, which has previously been described in fetuses showing increased blood flow velocities 3,22,23 and myocardial velocities in the left ventricular wall 8 . An increase in MAPSE agrees with the fetal left ventricle being the main ventricle supplying blood to the brain, the myocardium, and the upper extremities.…”

Section: Discussionsupporting

confidence: 87%

“…Our group has previously reported that certain myocardial velocities, specifically those in the left ventricular wall and interventricular septum, were significantly elevated before IUT and decreased after transfusion. 8 The magnitude of change in z scores in this study was within ±2 SD, a range that is commonly accepted as the normal distribution for different measurements in fetal and pediatric echocardiography 30,31 and used as a cut-off for abnormal measurements. 32 This indicates that these fetuses exhibit adaptation to anemia.…”

Section: Discussionmentioning

confidence: 57%

“…described an increase in the myocardial peak systolic strain in fetuses with severe anemia, which normalized after IUT. Our group has previously reported that certain myocardial velocities, specifically those in the left ventricular wall and interventricular septum, were significantly elevated before IUT and decreased after transfusion 8 …”

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…Using these methods, myocardial deformation (strain), myocardial velocities, cardiac cycle time intervals, and atrioventricular plane displacement (AVPD) can be measured. 6 , 7 There are data suggesting increased myocardial velocities before IUT 8 and increased peak systolic myocardial strain in anemic fetuses that partially normalizes after IUT. 9 Hypothetically, a better understanding of fetal cardiac function could help refine and individualize the management and timing of IUTs.…”

Section: Introductionmentioning

confidence: 99%

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Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion before and after intrauterine blood transfusion in pregnancies affected by red blood cell alloimmunization

Zamprakou,

Söderhult,

Ferm‐Widlund

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionMaternal red blood cell alloimmunization during pregnancy can lead to hemolysis and various degrees of fetal anemia, which can be treated with intrauterine blood transfusion (IUT) to prevent adverse outcomes. Knowledge about fetal myocardial function and adaptation is limited. The aim of the present study was to measure fetal atrioventricular plane displacement before and after IUT and compare these measurements with previously established reference ranges.Material and methodsAn observational study was conducted on pregnant women affected by red blood cell alloimmunization. Fetal echocardiography was performed before and after IUT. The atrioventricular plane displacement of the left and right ventricular walls and interventricular septum, described as mitral, septal, and tricuspid annular plane systolic excursion (MAPSE, SAPSE, and TAPSE, respectively), was assessed using color tissue Doppler imaging with automated analysis software. A Mann–Whitney U test was used to compare the z scores to the normal mean before and after IUT.ResultsTwenty‐seven fetuses were included. The mean z score for pre‐IUT MAPSE was significantly increased compared with the reference ranges, +0.46 (95% confidence interval [CI] +0.17 to +0.75; p = 0.039), while the mean z scores for post‐IUT SAPSE and TAPSE were significantly decreased, −0.65 (95% CI −1.11 to −0.19; p < 0.001) and −0.60 (95% CI −1.04 to −0.17; p = 0.003), respectively. The difference in atrioventricular plane displacement z scores before and after IUT was statistically significant in all three locations. The median difference between the pre‐IUT and post‐IUT z scores was −0.66 (95% CI −1.03 to −0.33, p < 0.001) for MAPSE, −1.05 (95% CI −1.43 to −0.61, p < 0.001) for SAPSE, and −0.60 (95% CI −1.19 to −0.01, p = 0.046) for TAPSE.ConclusionsThis study suggests that atrioventricular plane displacement, when determined using automated analysis software, may represent a quantitative parameter, describing fetal myocardial function and adaptation before and after IUT.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion before and after intrauterine blood transfusion in pregnancies affected by red blood cell alloimmunization

Zamprakou,

Söderhult,

Ferm‐Widlund

et al. 2023

Acta Obstet Gynecol Scand

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Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

Noll,

Gijtenbeek,

Verweij

et al. 2024

Prenatal Diagnosis

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ObjectivesThis systematic review explores cardiac adaptation in monochorionic (MC) twins with twin–twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) and assesses the risk of congenital heart defects (CHDs).MethodsAdhering to PRISMA guidelines, 63 studies were reviewed (49 on cardiac adaptation, 13 on CHD, one on both). A narrative synthesis of cardiac adaptation patterns was performed. Additionally, a meta‐analysis compared the livebirth prevalence of CHD in TTTS and sFGR against uncomplicated MC twins.ResultsIn TTTS recipients, cardiac function may be impaired for diastolic, systolic, as well as global functions, while in donors, cardiac function is generally preserved. In sFGR, large twins may show hypertrophic cardiomyopathy, and small twins may show impaired systolic function. Co‐occurrence of TTTS and sFGR magnifies cardiac impact but is often underreported. Meta‐analysis for CHD prevalence revealed a relative risk ratio of 3.5 (95% CI: 2.5–4.9) for TTTS and 2.2 (95%CI: 1.3–3.5) for sFGR compared with uncomplicated MC twins.ConclusionsThis study highlights the well‐documented cardiac adaptation in TTTS, contrasting with limited understanding in sFGR. Elevated CHD risks were observed in both conditions. Enhanced cardiovascular surveillance is warranted in complicated MC twin pregnancies. Future research should explore cardiac adaptation in sFGR and its long‐term consequences.

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Evaluation of levosimendan as treatment option in a large case-series of preterm infants with cardiac dysfunction and pulmonary hypertension

et al. 2023

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Levosimendan as a calcium-sensitizer is a promising innovative therapeutical option for the treatment of severe cardiac dysfunction (CD) and pulmonary hypertension (PH) in preterm infants, but no data are available analyzing levosimendan in cohorts of preterm infants. The design/setting of the evaluation is in a large case-series of preterm infants with CD and PH. Data of all preterm infants (gestational age (GA) < 37 weeks) with levosimendan treatment and CD and/or PH in the echocardiographic assessment between 01/2018 and 06/2021 were screened for analysis. The primary clinical endpoint was defined as echocardiographic response to levosimendan. Preterm infants (105) were finally enrolled for further analysis. The preterm infants (48%) were classified as extremely low GA newborns (ELGANs, < 28 weeks of GA) and 73% as very low birth weight infants (< 1500 g, VLBW). The primary endpoint was reached in 71%, without difference regarding GA or BW. The incidence of moderate or severe PH decreased from baseline to follow-up (24 h) in about 30%, with a significant decrease in the responder group (p < 0.001). The incidence of left ventricular dysfunction and bi-ventricular dysfunction decreased significantly from baseline to follow-up (24 h) in the responder-group (p = 0.007, and p < 0.001, respectively). The arterial lactate level decreased significantly from baseline (4.7 mmol/l) to 12 h (3.6 mmol/l, p < 0.05), and 24 h (3.1 mmol/l, p < 0.01). Conclusion: Levosimendan treatment is associated with an improvement of both CD and PH in preterm infants, with a stabilization of the mean arterial pressure during the treatment and a significant decrease of arterial lactate levels. Future prospective trials are highly warranted. What is Known: • Levosimendan as a calcium-sensitizer and inodilator is known to improve the low cardiac output syndrome (LCOS), and improves ventricular dysfunction, and PH, both in pediatric as well as in adult populations. Data related to critically ill neonates without major cardiac surgery and preterm infants are not available. What is New: • This study evaluated the effect of levosimendan on hemodynamics, clinical scores, echocardiographic severity parameters, and arterial lactate levels in a case-series of 105 preterm infants for the first time. Levosimendan treatment in preterm infants is associated with a rapid improvement of CD and PH, an increase of the mean arterial pressure, and a significant decrease in arterial lactate levels, as surrogate marker for a LCOS. • How this study might affect research, practice, or policy. As no data are available regarding the use of levosimendan in this population, our results hopefully animate the research community to conduct future prospective trails analyzing levosimendan in randomized controlled trials (RCT) and observational control studies. Additionally, our results potentially motivate clinicians to introduce levosimendan as second second-line therapy in cases of severe CD and PH in preterm infants without improvement using standard treatment strategies.

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Fetal cardiac function at intrauterine transfusion assessed by automated analysis of color tissue Doppler recordings

Cited by 4 publications

References 29 publications

Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion before and after intrauterine blood transfusion in pregnancies affected by red blood cell alloimmunization

Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion before and after intrauterine blood transfusion in pregnancies affected by red blood cell alloimmunization

Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

Evaluation of levosimendan as treatment option in a large case-series of preterm infants with cardiac dysfunction and pulmonary hypertension

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