Quantitative assessment of right ventricular function using doppler tissue imaging in fetuses with and without heart failure.
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.
Aoki
Mieko
M
Department of Pediatrics, Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita, Japan.
Harada
Kenji
K
Ogawa
Masaki
M
Tanaka
Toshinobu
T
D001783:Blood Flow Velocity / Q000502:physiology; D015150:Echocardiography, Doppler; D005333:Fetus / Q000002:abnormalities* / Q000503:physiopathology*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D013223:Statistics as Topic; D014261:Tricuspid Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D016216:Ultrasonography, Prenatal; D018497:Ventricular Dysfunction, Right / Q000151:congenital / Q000000981:diagnostic imaging / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*