Color Doppler myocardial imaging demonstrates reduced diastolic tissue velocity in growth retarded fetuses with flow redistribution.
OBJECTIVE
In fetuses suffering from intrauterine growth retardation with cerebroplacental redistribution (IUGR CPR), the diastolic heart function may be particularly susceptible to hypoxemia as described in postnatal pathological conditions. Using the newly introduced ultrasound technique, color Doppler myocardial imaging (CDMI), we investigated the correlation between diastolic tissue velocities and diastolic blood flow velocities and compared diastolic myocardial tissue velocities in fetuses with IUGR CPR and normal fetuses.


METHODS
Peak early and active atrial tissue velocities (E' and A') were acquired from both ventricular free walls in 18 fetuses with IUGR CPR and 42 normal fetuses. In 35 normal fetuses, blood flow across the atrio-ventricular valves was also recorded. Umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) flows were obtained in all fetuses. Nonparametric tests were used for statistical analysis.


RESULTS
There was a tendency towards increased E' and A' with fetal age in normal pregnancies. No correlation between tissue velocity and blood flow velocity was established. IUGR CPR fetuses had significantly lower E' and A', but when indexing to heart length, only A' remained significantly lower. E'/A' ratio was increased in the left ventricle but unchanged in the right.


CONCLUSIONS
CDMI is easily applicable during standard fetal echocardiography and provides new information on the diastolic properties of the fetal myocardium. In fetuses with IUGR CPR, diastolic tissue velocities are abnormal and especially A' may be a marker of diastolic dysfunction.
Departments of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark. unmack@live.dk
Lene U
LU
Larsen
Olav B
OB
Petersen
Erik
E
Sloth
Niels
N
Uldbjerg
D015415:Biomarkers; D001783:Blood Flow Velocity; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018618:Echocardiography, Doppler, Color; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006321:Heart / Q000196:embryology / Q000503:physiopathology*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000196:embryology; D006801:Humans; D008297:Male; D011247:Pregnancy; D012039:Regional Blood Flow; D014427:Twins; D016216:Ultrasonography, Prenatal; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000196:embryology
D015415:Biomarkers