Correlation Between Cardiac Tissue Doppler and Peripheral Vascular Doppler in the Anemic Fetus – An Additional Method to Determine the Transfusion Threshold?

Abstract

Purpose: To examine the relationship between cardiac tissue Doppler and peripheral vascular Doppler measurements in fetal anemia.

Materials and Methods: We analyzed high frame rate cardiac Tissue Doppler Imaging (TDI) data files of 26 anemic fetuses. The peak systolic tissue velocity (PSV), peak systolic displacement (PD), and peak systolic strain (PS) were determined in the mid-segment of the ventricular walls (ROI 1 right ventricle (RV), ROI 2 left ventricle (LV)) and in the basal segment of the ventricular walls (ROI 3 tricuspid annulus, ROI 4 mitral annulus). TDI parameters were correlated with established fetal vascular Doppler parameters (peak systolic blood flow velocity (V_max) in the middle cerebral artery (MCA), pulsatility index (PI) in the MCA, in the umbilical artery (UA), and in the venous duct (DV)).

Results: The PSV in the LV correlated significantly negatively with the PI in the MCA. Both the PSV and PD in the LV correlated significantly negatively with the PI in the UA. The PS in the RV correlated significantly negatively with the PI in the UA. The left ventricular PSV and PD correlated significantly positively with the PI in the DV. The V_max in the MCA did not correlate with any systolic myocardial TDI parameter.

Conclusion: In fetal anemia, peak systolic myocardial TDI parameters correlate with vascular Doppler parameters, confirming that TDI is a promising method to evaluate myocardial function in the anemic fetus. This suggests combining both techniques to quantify fetal myocardial function in anemia even more accurately, possibly allowing for the determination of the indication for intrauterine transfusion.

Zusammenfassung

Ziel: Untersuchung des Zusammenhangs zwischen kardialem Gewebedoppler und peripherem Gefäßdoppler in fetaler Anämie.

Material und Methoden: Mittels Gewebedoppler untersuchten wir Herzen von 26 anämischen Feten. Wir bestimmten maximale systolische Gewebegeschwindigkeit (peak systolic velocity, PSV), maximales systolisches Displacement (peak systolic displacement, PD) und maximale systolische Gewebeverformung (peak systolic strain, PS) im mittleren Segment der lateralen Wände des rechten (ROI 1) sowie des linken (ROI 2) Ventrikels. Weiterhin wurden diese Parameter in der lateralen Wand auf Höhe des Trikuspidalklappenanulus (ROI 3) und des Mitralklappenanulus (ROI 4) bestimmt. Wir korrelierten die erhobenen Gewebedoppler- mit bereits etablierten Gefäßdopplerparametern (Pulsatility Index (PI) in Arteria cerebri media (MCA), Arteria umbilicalis (UA) und Ductus venosus (DV) sowie maximale systolische Blutflussgeschwindigkeit (V_max) in der MCA).

Ergebnisse: PSV im linken Ventrikel korrelierte signifikant negativ mit dem PI in der MCA. Sowohl PSV als auch PD im linken Ventrikel korrelierten signifikant negativ mit dem PI in der UA. PS im rechten Ventrikel korrelierte signifikant negativ mit dem PI in der UA. PSV und PD im linken Ventrikel korrelierten signifikant positiv mit dem PI im DV. Die V_max in der MCA korrelierte mit keinem der untersuchten systolischen Parameter.

Schlussfolgerung: Maximale systolische myokardiale Gewebedopplerparameter korrelieren mit etablierten Gefäßdopplerparametern im anämischen Fetus. Die Kombination von kardialem Gewebedoppler und peripherem Gefäßdoppler ist zur genaueren Quantifizierung der fetalen myokardialen Funktion in Anämie geeignet und könnte zur Indikationsstellung der intrauterinen Transfusion beitragen.

Key words

echocardiography - ultrasound Doppler - anemia - fetus

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