Investigating myocardial performance in normal and sick fetuses by abdominal Doppler signal derived indices.

Abstract

IntroductionFetal myocardial performance indices are applied to assess aspects of systolic and diastolic function in developing fetal heart. The aim of this study was to determine normal values of Tei Index (TI) and modified TI (KI) for systolic and diastolic performance in early (<30 weeks), Mid (30–35 weeks) and late (36–41 weeks) relating to both normal fetuses as well as fetuses carrying a variety of fetal abnormalities, which do not call for precise anatomic imaging.Material and methodsFetal Electrocardiogram Signals (FES) and Doppler Ultrasound Signal (DUS) were simultaneously documented from 55 normal and 25 abnormal fetuses with a variety of abnormalities including Congenital Heart Diseases (CHDs) and a variety of non-CHDs. The isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ventricular ejection time (VET) and ventricular filling time (VFT) were estimated from continuous DUS signals by a hybrid of Hidden Markov and Support Vector Machine based automated model. The TI and the KI were calculated by using the formula (ICT ​+ ​IRT)/VET and (ICT ​+ ​IRT)/VFT respectively.ResultsThe TI was not found to show any significant change from early to late fetuses, nor between normal and abnormal cases. On the other hand, KI was shown to significantly decline in values from early to late normal cases and from normal to abnormal groups. Significant correlation (r = −0.36; p < 0.01) of gestational ages with only KI (not TI) was found in this study.ConclusionModified TI (KI) may be a useful index to monitor the normal development of fetal myocardial function and identify fetuses with a variety of CHD and non-CHD cases.