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01-12-2020 | Anemia | Research

Fetal cardiac function at intrauterine transfusion assessed by automated analysis of color tissue Doppler recordings

Authors: Lotta Herling, Jonas Johnson, Kjerstin Ferm-Widlund, Fredrik Bergholm, Peter Lindgren, Sven-Erik Sonesson, Ganesh Acharya, Magnus Westgren

Published in: Cardiovascular Ultrasound | Issue 1/2020

Abstract

Background

Fetal anemia is associated with a hyperdynamic circulation and cardiac remodeling. Rapid intrauterine transfusion (IUT) of blood with high hematocrit and viscosity into the umbilical vein used to treat this condition can temporarily further affect fetal heart function. The aim of this study was to evaluate the short-term changes in fetal myocardial function caused by IUT using automated analysis of cine-loops of the fetal heart obtained by color tissue Doppler imaging (cTDI).

Methods

Fetal echocardiography was performed before and after IUT. cTDI recordings were obtained in a four-chamber view and regions of interest were placed at the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls. Myocardial velocities were analyzed by an automated analysis software to obtain peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm), rapid ventricular filling (Em) and Em/Am ratio was calculated.

Myocardial velocities were converted to z-scores using published reference ranges. Delta z-scores (after minus before IUT) were calculated. Correlations were assessed between variables and hemoglobin before IUT.

Results

Thirty-two fetuses underwent 70 IUTs. Fourteen were first time transfusions. In the LV and septal walls, all myocardial velocities were significantly increased compared to normal values, whereas in the RV only Sm was increased before IUT (z-scores 0.26–0.52). In first time IUTs, there was a negative correlation between LV Em (rho = − 0.61, p = 0.036) and LV Em/Am (rho = − 0.82, p = 0.001) z-scores and hemoglobin before IUT. The peak myocardial velocities that were increased before IUT decreased, whereas LV Em/Am increased significantly after IUT.

Conclusions

This study showed that peak myocardial velocities assessed by cTDI are increased in fetuses before IUT reflecting the physiology of hyperdynamic circulation. In these fetuses, the fetal heart is able to adapt and efficiently handle the volume load caused by IUT by altering its myocardial function.

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Title: Fetal cardiac function at intrauterine transfusion assessed by automated analysis of color tissue Doppler recordings
Authors: Lotta Herling
Jonas Johnson
Kjerstin Ferm-Widlund
Fredrik Bergholm
Peter Lindgren
Sven-Erik Sonesson
Ganesh Acharya
Magnus Westgren
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Anemia
Fetal Anemia
Published in: Cardiovascular Ultrasound / Issue 1/2020
Electronic ISSN: 1476-7120
DOI: https://doi.org/10.1186/s12947-020-00214-1

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