Temporal evolution of cardiac function indices, including aortic isthmus and modified-tei index, in relation with Doppler changes in severe intrauterine growth restriction
Aim
To evaluate longitudinal changes in the cardiac function parameters in relation to the hemodynamic deterioration in severe intrauterine growth restricted (IUGR) fetuses.
Method
The cardiac function was serially studied in a cohort of 51 early-onset IUGR by means of aortic isthmus index (IFI), modified myocardial performance index (Mod-MPI), E/A ratios in both ventricles, and peak systolic velocities (PSV) in the aorta and pulmonary arteries.
IUGR fetuses were classified as;
Stage 1 (S1) (n = 51); increased umbilical artery pulsatility index (UA-PI) (>2 SD)
Stage 2 (S2) (n = 48); reduced middle cerebral artery (MCA-PI) (<2 SD)
Stage 3 (S3) (n = 32) ductus venosus (DV-PI) > 2 and ≤5 SD and
Stage 4 (S4) (n = 12); DV-PI > 5 SD.
In each stage, all cardiac parameters were analysed. Individual data were normalised by converting the measurements in z-scores. In addition, 56 normally grown fetuses were studied as controls.
Results
IFI increased significantly at each stage of hemodynamic deterioration (mean Z-scores): controls −0.4; S1, −1.5; S2, −3, S3, −4.8; S4, −9.2; p = 0.002–0.0001). The Mod-MPI increased significantly in S1, but remained stable until S3, and then increased abruptly in S4, (controls −0.1; S1 0.8; S4, 2.1; p = 0.001). E/A ratios and PSVs in the pulmonary artery and in the aorta never exceeded }2 Z-scores at any hemodynamic stage.
Conclusion
IFI showed a progressive deterioration, which suggests that it might provide additional information to currently used parameters in order to predict perinatal outcome and indicate delivery. Mod-MPI seems to deteriorate in parallel with ductus venosus, and therefore, significant changes are seen only in very late stages.
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16/12/2011 15:50