Tissue Doppler imaging detects abnormalities in systolic and diastolic function in the fetus with congenital heart disease without heart failure

Abstract

DIASTOLIC FUNCTION IN THE FETUS WITH CONGENITAL HEART DISEASE WITHOUT HEART FAILURE BETTINA CUNEO, ALEKSANDRA ROCZEK, DAVID ROBERSON, ZHEN CHEN, JAMES HUHTA, The Heart Institute for Children, Oak Lawn, Illinois, University of South Florida, St. Petersburg, Florida, Rush Medical College, Department of Biostatistics, Chicago, Illinois, University of South Florida, Pediatrics, St. Petersburg, Florida OBJECTIVE: Using pulsed–wave tissue Doppler imaging (TDI), we compared right and left ventricular (RV, LV) systolic and diastolic function between fetuses with congenital heart disease (CHD) but no signs of congestive heart failure (CHF), and those with a structurally normal heart and normal function. STUDY DESIGN: We measured myocardial velocities in the RV and LV during systole and diastole in 187 fetuses (103 with CHD, 84 normal) at 18-38 weeks of gestation referred to two large perinatal cardiology services from 2005-2006 in this cross sectional retrospective study. Indices of diastolic function assessed were: peak mitral and tricuspid annular velocities (E0, A0) isovolumic relaxation time (IVRT); Indices of systolic function evaluated included: peak S wave velocity (S0), isovolumic contraction time (IVCT), and peak isovolumic velocity (IVV); and the myocardial performance index (MPI). Differences between normal and CHD fetuses were assessed by the independent two sample t-test and Mann Whitney U test. RESULTS: In the fetus with CHD but no clinical CHF, some RV indices were significantly higher compared to the normal group: MPI = 0.44 vs. 0.39 (p=0.01); IVV = 6.1 vs 4.3 cm/s (p= 0. 02); and IVRT = 50 vs 40 ms (p= 0.0003). There were no differences in LV indices. CONCLUSION: TDI detects subtle abnormalities in systolic and diastolic RV function in the fetus with CHD but no clinical signs of CHF. As with other markers of CHF in the fetus, the RV appears to manifest TDI changes before the LV. Further evaluation by TDI of the fetus with signs of heart failure may detect additional or more serious markers of diastolic or systolic dysfunction.