P356Assessment of right ventricle pre-ejection myocardial velocity and index of a global contractility in fetuses with high-output congestive heart failure using tissue doppler imaging

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Objective: Many diseases of the mother or the fetus may lead to fetal congestive heart failure (CHF) resulting in intrauterine or neonatal death. Tissue Doppler Imaging (TDI) is a relatively new method used for direct analysis of the myocardial function. The aim of this study was to analyze the myocardial function of the right ventricle (RV) in fetuses with CHF using TDI.Methods: Myocardial function of the RV was assessed in 54 normal fetuses and 83 fetuses with high-output CHF between 27 and 39 weeks' of gestation. Detailed echocardiography combined with pulse and tissue Doppler was performed in all cases. To determine the degree of CHF, Cardiovascular Score (CVS) was evaluated on each subject. TDI data was obtained at the level of 4-chamber view by placing the sample volume at the lateral part of the tricuspid annulus. Pre-ejection myocardial velocity was assessed and index of a global contractility (Tei-index) was calculated. All measurements were averaged at 3 to 5 consecutive cardiac cycles.Results: The CVS in fetuses with CHF ranged from 8 to 0 (mean 6±1.5). This parameter strongly correlated with TDI-Tei-index (r = -0.62; p<0.01). TDI-Tei-index was significantly higher in the group with CHF compared to normal (1.06±0.11vs.0.53±0.08, p<0.001). In subgroup with CHF and CVS>5 pre-ejection myocardial velocity was significantly elevated (average Z-score = 4,7). In fetuses with CVP≤5 significant decrease (average Z-score = -3,4) in pre-ejection myocardial velocity was noted. This finding was associated with poor outcome. Conclusion: Our results validate the potential clinical applicability of TDI-retrieved pre-ejection myocardial velocity and Tei-index in assessment of right ventricular function in fetuses with CHF. Further prospective studies in a clinical setting are needed to the advantageous of this approach to practice.

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