Myocardial function of hydropic fetuses at the time of diagnosis

Jan Degenhardt; Aline Wolter; Christian Enzensberger; Andreea Kawecki; Oliver Graupner; Justus Reitz; Thomas Kohl; Roland Axt-Fliedner

doi:10.5114/pcard.2019.91331

eISSN: 2449-6731
ISSN: 2449-6723

Prenatal Cardiology

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abstract:

Research paper

Myocardial function of hydropic fetuses at the time of diagnosis

Jan Degenhardt

^{1, 2}

,

Aline Wolter

³

,

Christian Enzensberger

⁴

,

Andreea Kawecki

³

,

Oliver Graupner

⁵

,

Justus G. Reitz

³

,

Thomas Kohl

⁶

,

Roland Axt-Fliedner

³

Praenatal plus, Praxis für Pränatale Medizin und Genetik, Cologne, Germany
Medical Faculty, Justus-Liebig University, Giessen, Germany
Department of Obstetrics and Gynaecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
Department of Gynaecology and Obstetrics, University Medical Center Aachen, Aachen, Germany
Department of Obstetrics and Gynaecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
German Centre for Fetal Surgery & Minimally Invasive Therapy (DZFT), University Medical Center Mannheim, Mannheim, Germany

Prenat Cardio 2019; 9(1): 12-16

DOI: https://doi.org/10.5114/pcard.2019.91331

Online publish date: 2019/12/29

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Introduction
Fetuses with heart failure are at risk of developing hydrops fetalis due to ventricular dysfunction. Therefore, we aim to assess myocardial function in hydropic fetuses at the time of diagnosis. Material and methods: Fetal echocardiography was performed using a Toshiba Aplio XG ultrasound system. The mitral annular plane systolic excursion (MAPSE) and the tricuspid annular plane systolic excursion (TAPSE) as well as isovolumetric contraction time (ICT´), ejection time (ET´), and isovolumetric relaxation time (IRT´) for the left and right ventricle were measured using pulsed wave tissue Doppler imaging (pw TDI). The myocardial performance index (MPI´) was calculated. E´- and A´-wave peak velocities were assessed for both ventricles and the E´/A´ ratio was calculated. Results were compared to gestational age-matched healthy controls without Doppler alterations or anatomic malformations by using the unpaired Student’s t-test.

Results
30 hydropic fetuses were included. Mean gestational age (GA) was 25 (18–33) weeks. Left ventricular MPI´ was 0.66 (0.32–1.46, SD = 0.28) and significantly higher in hydropic fetuses (p < 0.05) than in healthy controls (MPI´ controls 0.58 [0.42–0.79, SD = 0.11]). Fetuses with altered Doppler parameters (UA, DV) showed no significant changes in their myocardial function compared to hydropic fetuses with physiological Doppler flow patterns. Conclusion: In fetuses with hydrops and normal Doppler parameters, analysis of myocardial function by pw TDI may help to detect pre-clinical alterations days before manifest changes in fetal circulation. This may lead to adjusted fetal surveillance and optimised pre- and perinatal management.

keywords:

Myocardial function of hydropic fetuses at the time of diagnosis

Jan Degenhardt 1, 2 , Aline Wolter 3 , Christian Enzensberger 4 , Andreea Kawecki 3 , Oliver Graupner 5 , Justus G. Reitz 3 , Thomas Kohl 6 , Roland Axt-Fliedner 3

fetal echocardiography, hydrops fetalis, ventricular dysfunction, pulsed Doppler echocardiography

Jan Degenhardt

^{1, 2}

,

Aline Wolter

³

,

Christian Enzensberger

⁴

,

Andreea Kawecki

³

,

Oliver Graupner

⁵

,

Justus G. Reitz

³

,

Thomas Kohl

⁶

,

Roland Axt-Fliedner

³