title: Assessment of fetal cardiomyopathy in early-stage twin-twin transfusion syndrome: comparison between commonly reported cardiovascular assessment scores.
abstract: OBJECTIVE
  To assess the relationship between commonly reported fetal cardiomyopathy scoring systems in early-stage twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  We reviewed retrospectively 100 cases of Quintero Stages I and II TTTS referred to our center for evaluation from 2008 to 2010. The cases were divided into groups of 25, representing each of four grades of TTTS cardiomyopathy as assessed by Cincinnati stage: no cardiomyopathy, Stage IIIa, Stage IIIb and Stage IIIc. Spearman correlation (rs ) was calculated between the Children's Hospital of Philadelphia (CHOP) score, cardiovascular profile score (CVPS), Cincinnati stage and myocardial performance index (MPI).
  
  
  RESULTS
  There was a weak correlation between the Cincinnati stage and the CHOP score (rs  = 0.36) and CVPS (rs  = -0.39), while correlation was strong between the CHOP score and CVPS (rs  = -0.72). MPI elevation was concordant with Cincinnati stage more frequently (82% of cases) than were ventricular hypertrophy (43%) or atrioventricular valve regurgitation (28%). 51% of fetuses with minimally elevated CHOP score (0-1) and 48% of fetuses with minimally depressed CVPS (9-10) had significant elevation (Z-score ≥ +3) in right ventricular or left ventricular MPI.
  
  
  CONCLUSIONS
  MPI has a strong influence on grading the severity of fetal cardiomyopathy using the Cincinnati stage among fetuses with mild TTTS. Furthermore, significant elevation of the MPI is common among fetuses with mild disease as assessed by the CHOP score and CVPS. These differences should be understood when assessing and grading cardiomyopathy in TTTS, particularly in early (Quintero Stages I and II) disease.
authors.affiliation: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Villa
authors.forename: M
authors.initials: M
authors.lastname: Habli
authors.forename: J K
authors.initials: JK
authors.lastname: Votava-Smith
authors.forename: J F
authors.initials: JF
authors.lastname: Cnota
authors.forename: F-Y
authors.initials: FY
authors.lastname: Lim
authors.forename: A A
authors.initials: AA
authors.lastname: Divanovic
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: E C
authors.initials: EC
authors.lastname: Michelfelder
mesh_terms: D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005318:Fetal Heart / Q000502:physiology*; D005330:Fetofetal Transfusion / Q000150:complications* / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: TTTS; fetal cardiomyopathy; fetal echocardiography; twin-twin transfusion