Fetal ventricular strain in uncomplicated and selective growth‐restricted monochorionic diamniotic twin pregnancies and cardiovascular response in pre‐twin–twin transfusion syndrome

Abstract

variability was low (5.5 RV, 2.9 LV). Interclass correlation reflecting the proportion of total variability represented by the variability between twin pairs was low (0.22 RV, 0.18 LV). Both RV (p<0.001) and LV (p=0.025) strain showed a negative association with gestational age. LV strain was on average 1.83 higher in sIUGR compared to normally grown fetuses (p = 0.023) in MCDA controls with no statistically significant difference in RV strain (p=0.271). Conclusions Although we have previously reported ventricular strain as a possible predictor of developing TTTS, we found no significant inter-group differences in "pre-TTTS", compared with age-matched MCDA controls in this blinded prospective study. We recommend DVeT% discordance may be a more practical screening tool in MCDA pregnancies. This study also provides new information on the gestational change, biological and technical variation of global longitudinal ventricular strain in uncomplicated MCDAs and those with isolated sIUGR.

Novel Speckle Tracking Analysis Showed Excellent Reproducibility for Size and Shape of the Fetal Heart and Good Reproducibility for Strain and Fractional Shortening

“…The challenge of evaluating the fetal heart increases by the fact that it reacts differently to different abnormal conditions. Different groups explored changes in fetal heart deformation in different fetal complications including congenital anomalies, cardiac overload such as twin to twin transfusion syndrome, or to chronic hypoxia such as fetal growth restriction [37][38][39][40]. However, still reliable and reproducible methods to estimate cardiac function are needed.…”

Cardiac time intervals and myocardial performance index for prediction of twin–twin transfusion syndrome

“…No differences in right ventricular (RV) or LV strain discordance between "pre-TTTS" and MCDA controls were found. 5 As we believe that cardiac function is already compromised in "pre-TTTS," modalities with better test characteristics than ventricular strain, such as the MPI and measurement of cardiac time intervals 6 by color tissue Doppler imaging (cTDI), may be able to discriminate between normal and abnormal cardiac function. 4,7,8 The aim of this prospective study was therefore to explore whether intertwin discordance in MPI or cardiac time intervals by cTDI in MCDA pregnancies with amniotic fluid difference not yet fulfilling TTTS criteria could distinguish future TTTS pregnancies from those only affected by discordant growth or discordant amniotic fluid volume without TTTS.…”

Twin–twin transfusion syndrome: don't rely on fluids and bladders to catch it early

“…Measurements of cardiac contractility and systolic function, including long-axis function, appear to change later in the disease process and systolic function tends to diminish only in more advanced disease stages 1,7 . In a prospective study evaluating global longitudinal ventricular strain in monochorionic pregnancies undergoing routine biweekly surveillance, with the observer blinded to twin pairing and outcome, intertwin discordance in ventricular strain values was seen in those that developed TTTS.…”

“…In a prospective study evaluating global longitudinal ventricular strain in monochorionic pregnancies undergoing routine biweekly surveillance, with the observer blinded to twin pairing and outcome, intertwin discordance in ventricular strain values was seen in those that developed TTTS. Unlike Doppler recordings of the DV waveform, which are easier to obtain and more reproducible, a shortcoming of strain is lack of reproducibility due to technical difficulties with its measurement; hence, although strain is an interesting parameter to increase knowledge of the pathophysiology of TTTS, it is difficult to support its adoption into routine clinical practice 1 .…”

“…Prospective studies suggest that twin-twin transfusion syndrome (TTTS) complicates approximately 10% of all monochorionic pregnancies 1 . If left untreated, TTTS is associated with mortality rates above 80% 2 .…”