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

Cardiovascular Ultrasound

Kjerstin Ferm-Widlund¹  Jonas Johnson¹  Peter Lindgren²  Ganesh Acharya²  Lotta Herling²  Magnus Westgren²  Fredrik Bergholm³  Sven-Erik Sonesson⁴ 

[1] Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital;Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet;Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology;Pediatric Cardiology Unit, Department of Women’s and Children’s Health, Karolinska University Hospital;

关键词: Fetal cardiac function;    Tissue Doppler imaging;    Automated analysis;    Intrauterine transfusion;    Fetal anemia;   

DOI  :  10.1186/s12947-020-00214-1

来源: DOAJ

【 摘 要 】

Abstract Background Fetal anemia is associated with a hyperdynamic circulation and cardiac remodeling. Rapid intrauterine transfusion (IUT) of blood with high hematocrit and viscosity into the umbilical vein used to treat this condition can temporarily further affect fetal heart function. The aim of this study was to evaluate the short-term changes in fetal myocardial function caused by IUT using automated analysis of cine-loops of the fetal heart obtained by color tissue Doppler imaging (cTDI). Methods Fetal echocardiography was performed before and after IUT. cTDI recordings were obtained in a four-chamber view and regions of interest were placed at the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls. Myocardial velocities were analyzed by an automated analysis software to obtain peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm), rapid ventricular filling (Em) and Em/Am ratio was calculated. Myocardial velocities were converted to z-scores using published reference ranges. Delta z-scores (after minus before IUT) were calculated. Correlations were assessed between variables and hemoglobin before IUT. Results Thirty-two fetuses underwent 70 IUTs. Fourteen were first time transfusions. In the LV and septal walls, all myocardial velocities were significantly increased compared to normal values, whereas in the RV only Sm was increased before IUT (z-scores 0.26–0.52). In first time IUTs, there was a negative correlation between LV Em (rho = − 0.61, p = 0.036) and LV Em/Am (rho = − 0.82, p = 0.001) z-scores and hemoglobin before IUT. The peak myocardial velocities that were increased before IUT decreased, whereas LV Em/Am increased significantly after IUT. Conclusions This study showed that peak myocardial velocities assessed by cTDI are increased in fetuses before IUT reflecting the physiology of hyperdynamic circulation. In these fetuses, the fetal heart is able to adapt and efficiently handle the volume load caused by IUT by altering its myocardial function.

【 授权许可】

Unknown