Abstract 2760: Tissue Doppler Velocities in Fetuses with and without Congenital Heart Disease - A Multicenter Study
BACKGROUND Tissue Doppler imaging (TDI) is a sensitive index of myocardial function. Its role in the fetus has not been extensively evaluated.
OBJECTIVE To compare tissue Doppler velocities in fetuses with congenital heart disease (CHD) with normal fetuses corrected for gestational age.
STUDY DESIGN Cross-sectional study conducted at 2 large perinatal centers (2003 – 2007). 89 fetuses with CHD were compared to 207 normal fetuses in 5 gestational age groups (Table⇓). Abnormal fetuses were divided into (1) non-obstructive lesions (n=42), (2) left ventricular outflow tract (LVOT) obstruction (n=9), (3) right ventricular outflow tract (RVOT)o-bstruction (n=6), (4) single left ventricle (n=7), and (5) single right ventricle (n=25). TDI data included peak systolic (s’), peak early (e’) and late diastolic velocities (a’). Linear regression was used to compare fetuses with CHD to normal fetuses correcting for gestational age.
RESULTS Normal fetuses had a linear increase in TDI velocities with advancing gestation (Table⇓). Right ventricular (RV) and left ventricular (LV) TDI velocities were lower in fetuses with RVOT obstruction with reduction in RV a’ achieving statistical significance. In contrast, TDI velocities in fetuses with LVOT obstruction were no different from normal. Fetuses with non-obstructive lesions had higher TDI velocities compared to normal. Fetuses with a single RV had lower TDI velocities with reduction in RV e’ and septal s’ achieving statistical significance while fetuses with a single LV showed no difference in the LV and septal TDI velocities.
CONCLUSIONS TDI velocities increase significantly with advancing fetal gestational age. Differences are noted in TDI velocities among fetuses with CHD when compared to normal. Observed trends appear to demonstrate the dominant role of the right ventricle in the fetal circulation. Further studies with a larger cohort of abnormal fetuses will be needed to better define these interesting observations.