Original article
Quantitative assessment of right ventricular function using doppler tissue imaging in fetuses with and without heart failure

https://doi.org/10.1016/j.echo.2003.09.012Get rights and content

Abstract

Background

Previous reports have established the use of Doppler tissue imaging (DTI) for noninvasive assessment of ventricular function, but the technique has not been validated for diagnosis of fetal cardiac failure.

Objective

The purpose of this study was to assess right ventricular (RV) function in fetuses with heart failure using DTI.

Methods

In all, 43 fetuses (36 control, 7 heart failure) were assessed using pulsed Doppler echocardiography combined with DTI. RV peak myocardial velocities during early diastole (Ea), atrial contraction, and systole were measured; and tricuspid peak velocities during early diastole (E) and atrial contraction. The ratio of E/Ea was used as an index of filling pressure were measured. From DTI, a Doppler-derived index of combined systolic/diastolic myocardial performance (DTI-Tei index) was measured.

Results

Compared with control fetuses, the mean Ea was significantly lower and the mean E was significantly higher in fetuses with heart failure, although these parameters did overlap between the 2 groups. The mean RV myocardial wall-motion velocity during atrial contraction, ratio of Ea/RV myocardial wall-motion velocity during atrial contraction, and RV myocardial wall-motion velocity during systole did not differ between the 2 groups. Compared with control fetuses, the mean E/Ea was significantly higher (9.71 ± 0.91 vs 6.20 ± 0.97; P < .0001) and the mean DTI-Tei index was significantly greater (0.79 ± 0.11 vs 0.55 ± 0.05; P < .0001) in fetuses with heart failure. In addition, the DTI-Tei index z score was >2 in all fetuses with heart failure.

Conclusions

This study demonstrated a clinically important application of DTI-derived tricuspid annular velocities in fetuses with heart failure. Although DTI velocities were not sufficiently sensitive to identify fetuses with heart failure versus control fetuses, DTI-Tei index and E/Ea were useful and sensitive indicators of global RV dysfunction.

Section snippets

Study subjects

The study group consisted of 43 fetuses (36 control and 7 fetuses with heart failure). The control fetuses (16-39 weeks gestation) were referred for echocardiography secondary to family history of congenital heart disease, fetal arrhythmia (not present at time of study), or an abnormality of another organ system noted on obstetric sonography. No evidence of structural cardiovascular disease was detected by 2-dimensional/Doppler echocardiography. The fetuses with heart failure (27-35 weeks

Control fetuses

In control fetuses, the mean values for Ea, Aa, Ea/Aa, and Sa were 5.59 ± 1.24, 7.24 ± 1.40, 0.78 ± 0.16, and 5.08 ± 1.293 cm/s, respectively. Figure 2 illustrates the relationships between age and RV myocardial wall-motion velocities. The Ea, Ea/Aa, and Sa increased significantly with increasing gestational age, whereas Aa was generally unaffected. The mean values for E, A, and E/A were 34 ± 7, 44 ± 7, and 0.78 ± 0.12 cm/s, respectively. Figure 3 illustrates the relationships between age and

Discussion

This study demonstrated a clinically important application of DTI-derived tricuspid annular velocities in fetuses with heart failure.

References (27)

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