Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study

Abstract

BackgroundPresent data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI).MethodsTVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201–273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four-chamber view, and the acquired data was correlated using regression analysis.ResultsLeft ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E’/A’ ratio also increased with gestational age, while a longitudinal shortening was demonstrated.ConclusionsFetal cardiac muscle contractility decreases with gestational age. As numerous fetal- and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.

Z-Score Reference Ranges for Angular M-Mode Displacement at 22-40 Weeks' Gestation

“…5 ), indicating that growth in heart size does not result in an increase with equal proportion in the absolute MAPSE and TAPSE values. This is similar to previous findings by Elmstedt et al [27] that MAPSE normalized by left ventricular length decreases with advancing gestation.…”

“…TAPSE and MAPSE can also be evaluated using other off-line techniques such as three-dimensional multiplanar time-motion ultrasound [28] , colored TDI [27] , twodimensional speckle tracking [29] and spatiotemporal image correlation (STIC) [6] . Messing et al [6] compared CM and STIC M-mode in measuring TAPSE and demonstrated that STIC M-mode produces similar measures with a greater success rate compared to CM.…”

Maternal obesity affects fetal myocardial function as early as in the first trimester

“…After 20 weeks of gestation, we found no further increase in global strain and strain rate. Other studies have reported conflicting descriptions of gestational changes in strain or strain rate, with either a decrease, an increase or no changes with increased gestation. The difference in results might be due to the use of different equipment manufacturers and methods of acquisition (deformation by speckle tracking or TDI).…”

Contractile properties of developing human fetal cardiac muscle

“…As the human fetal heart ages, the longitudinal shortening (ratio of atrioventricular plane displacement to left ventricular length) decreases (Elmstedt et al . ) and the left ventricle end diastolic volume increases (Luewan et al . ; Brooks et al .…”

“…As the human fetal heart ages, the longitudinal shortening (ratio of atrioventricular plane displacement to left ventricular length) decreases (Elmstedt et al 2012) and the left ventricle end diastolic volume increases (Luewan et al 2014;Brooks et al 2014). Heart rate decreases as the fetus grows, while diastolic filling and atrial contraction durations, and the peak velocities of the septum, atrial contraction and ventricle ejection all increase (Elmstedt et al 2013).…”