Citation Information :
Stamatian F, Caracostea G. Assessment of Cardiac Dysfunction in the Intrauterine Growth-restricted Fetuses from Pre-eclamptic Mothers. Donald School J Ultrasound Obstet Gynecol 2014; 8 (2):123-127.
Although it is known that cardiac parameters have abnormal values in severely affected fetuses with intrauterine growth restriction (IUGR), recent research suggested that subclinical cardiac dysfunction may be present from the early stages of fetal deterioration. The identification and monitoring of cardiac dysfunction may be relevant for the management of these cases.
Materials and methods
In this prospective observational study, we evaluated 17 IUGR fetuses from nulliparous pregnant women diagnosed with pre-eclampsia. Cardiac structural assessment was performed using segmental sequential analysis. Cardiac function was assessed by conventional echocardiography and Tissue Doppler Imaging (TDI).
Results
Gestational age at admittance ranged between 24 and 30 weeks. A severe form of pre-eclampsia was diagnosed in 2 of 17 cases. Conventional cardiac examination showed low left and right ventricular diastolic filling with low E and A velocities, and increased myocardial performance indexes for both ventricles. Using TDI we observed decreased myocardial velocities and impaired contractility (demonstrated by low left and right diastolic velocities, as well as increased E’/A’ ratios).
Conclusion
Our study confirms the presence of early cardiac dysfunction in IUGR fetuses. Further studies are warranted to confirm the utility of TDI in obstetric ultrasound routine examination for monitoring fetal cardiac function in high-risk pregnancies.
How to cite this article
Caracostea G, Stamatian F. Assessment of Cardiac Dysfunction in the Intrauterine Growthrestricted Fetuses from Pre-eclamptic Mothers. Donald School J Ultrasound Obstet Gynecol 2014;8(2):123-127.
Cardiac changes in the intrauterine growth-restricted fetus. Semin Perinatol 2008;32:190-193.
Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses. Ultrasound Obstet Gynecol 2009;34:430-436.
Myocardial tissue Doppler assessment of diastolic function in the growthrestricted fetus. Ultrasound Obstet Gynecol 2009;34:68-73.
Usefulness of myocardial tissue Doppler vs conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction. Am J Obstet Gynecol 2010;203:45.e1-7.
Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 2002;99(1):159.
A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment. Ultrasound Obstet Gynecol 2005;26:227-232.
Validation of the fetal myocardial performance index in the second and third trimesters of gestation. Ultrasound Obstet Gynecol 2009;33: 58-63.
Functional assessment of the fetal heart: a review. Ultrasound Obstet Gynecol 2012;39:131-144.
From anatomy to function: the developing image of ultrasound evaluation. Ultrasound Obstet Gynecol 2008;31:615-617.
Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol 2008;199:254.e1-8.
Cardiac function monitoring of fetuses with growth restriction. Eur J Obstet Gynecol Reprod Biol 2003;110:159-163.
Systolic myocardial velocity alterations in the growth-restricted fetus with cerebroplacental redistribution. Ultrasound Obstet Gynecol 2009;34:62-67.
Fetal hemodynamic adaptive changes related to intrauterine growth: the Generation R Study. Circulation 2008;117:649-659.
Assessing fetal cardiac ventricular function. Semin Fetal Neonatal Med 2005;10:515-541.
Assessment of fetal myocardial performance using myocardial deformation analysis. Am J Cardiol 2007;99:993-996.
Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction. Ultrasound Obstet Gynecol 2007;29:296-303.
The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life. BMJ 1993;306:422-426.
Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound Obstet Gynecol 2006;28:126-136.
Characterization of ventricular myocardial performance in the fetus by tissue Doppler imaging. Circ J 2009;73:943-947.