Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

Tongprasert, Fuanglada; Srisupundit, Kasemsri; Luewan, Suchaya; Traisrisilp, Kuntharee; Jatavan, Phudit; Tongsong, Theera

doi:10.1002/pd.5140

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…This finding indicated that foetuses with anaemia have subtle changes in myocardial function from late first trimester, and the earliest sign is prolonged ICT. Similarly, Tongprasert et al 47 . demonstrated that among foetuses with Hb Bart's disease at mid‐pregnancy (18–22 weeks), ICT was significantly longer compared with unaffected foetuses.…”

Section: Haemodynamic Changes In Foetal Haemoglobin Bart's Diseasementioning

confidence: 89%

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Foetal haemodynamic response to anaemia

et al. 2020

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This study aims to update new knowledge regarding foetal cardiovascular response to anaemia, using foetal haemoglobin Bart's disease as a study model. Original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The main foetal cardiovascular changes in response to anaemia are consequences of hypervolaemia and increased cardiac output to meet tissue oxygen requirement. New challenging insights are as follows: (i) the earliest morphological change is an increase in cardiac size and remodelling of the sphericity (an increase in diameter more pronounced than that in long axis) followed by several markers, such as placentomegaly and hepatosplenomegaly. (ii) The earliest functional change is increased peak systolic velocity of the red blood cells because of low viscosity, especially in the middle cerebral artery. (iii) The foetal heart has very high reserve potentials to cope with anaemia: increasing workload without increased central venous pressure and increased myocardial performance without compromising shortening fraction. This hard-working period with good performance lasts long, including most part of the second and third trimester. (iv) At the time cardiomegaly myocardial cellular damage has already occurred, in spite of good cardiac function. (v) Anaemic hydrops foetalis is mainly due to hypervolaemia, hypoalbuminaemia, and high vascular permeability, not heart failure. (vi) Foetal heart failure occurs only when the adaptive mechanism becomes exhausted or long after the development of anaemic hydrops foetalis. Heart failure is a very late result of a longstanding overworked heart. (vii) Ultrasound is highly effective in the detection of foetal response to anaemia. An increase in cardiac size and middle cerebral artery is very helpful in predicting the affected foetuses in pre-hydropic phase. (viii) Theoretically, intrauterine treatment of anaemic hydrops results in satisfactory outcomes as long as cardiac function is normal, but intrauterine intervention should be strongly considered in pre-hydropic phase because myocardial cell damage could have already occurred in this phase or early hydropic phase. Anaemic hydrops foetalis is not primarily caused by heart failure as commonly advocated, but it is rather a consequence of hypervolaemia, hypoalbuminaemia, and high vascular permeability while heart failure is a very late consequence of a longstanding overworked heart. New insights gained from this review may be useful to base clinical practice on which sonographic markers imply significant pathological changes, how ultrasound can be helpful in early detection of anaemic response, when intrauterine transfusion for anaemia due to non-lethal causes should be administered, etc.

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Section: Haemodynamic Changes In Foetal Haemoglobin Bart's Diseasementioning

confidence: 89%

“…Anaemic foetuses can perfectly maintain normal diastolic flow. Additionally, some studies on myocardial performance indicated that isovolumetric relaxation time is unchanged in foetal anaemia, 46,47 suggesting no significant impact on afterload in spite of increased blood volume.…”

Section: Functional Changesmentioning

confidence: 99%

Foetal haemodynamic response to anaemia

et al. 2020

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“…Note that this finding is usually not seen in hydrops fetalis resulting from other anemic causes. In most cases, hydrops fetalis due to anemia secondary to any cause other than Hb Bart disease is associated with polyhydramnios, 52–55 resulting from hypervolemia with high renal blood flow, with no severe asphyxia leading to fetal oliguria.…”

Section: High‐output Hydropic Phasementioning

confidence: 99%

“…• Tongprasert et al 55 compared fetal cardiac function, represented by the Tei index, between 28 fetuses with Hb Bart disease and 42 unaffected fetuses at midpregnancy (18–22 weeks). They found that in the affected fetuses, the ICT and ICT + isovolumetric relaxation time were significantly longer than those of unaffected fetuses (47.9 ± 12.5 versus 35.0 ± 6.7 milliseconds; P < .001; and 96.2 ± 13.6 versus 80.9 ± 10.6 milliseconds; P < .001 respectively).…”

Section: Low‐output Hydropic Phasementioning

confidence: 99%

Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease

Thammavong

Luewan

Wanapirak

et al. 2020

J of Ultrasound Medicine

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Insights gained from this review are as follows: (1) Ultrasound is highly effective in early detection of fetal hemoglobin (Hb) Bart disease. (2) The most sensitive parameters in predicting Hb Bart anemia appear to be the cardiac diameter–to–thoracic diameter ratio, middle cerebral artery peak systolic velocity, and placental thickness. (3) Several other ultrasound markers are helpful in increasing specificity, such as hepatosplenomegaly. (4) Hydrops fetalis is not a consequence of heart failure but rather of hypervolemia and high vascular permeability of fetuses, whereas heart failure is a very late consequence of a long‐standing overworked heart. (5) Management guidelines for fetuses at risk of Hb Bart disease are proposed.

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“…A modified index was recently proposed as (ICT + IRT)/VFT, which has been shown significantly decreasing with gestational age, while no significant correlation of MPI with gestational ages was found (Khandoker et al , 2016). From a clinical standpoint, PEP, ICT, IRT, VET are the most useful cardiac intervals for assessing fetal development and wellbeing, as sensitive markers of the functional state of the fetal myocardium, cardiac performance and ANS function, and can reflect the early development of hypoxemia and acidosis (Tongprasert et al , n.d.; Hassan et al , 2013; Velayo et al , 2011; Mensah-Brown et al , 2010; Cruz-Martínez et al , 2012; Yumoto et al , 2005; Marzbanrad et al , 2016).…”

Section: D-dus Applications For Fetal Monitoringmentioning

confidence: 99%

Cardiotocography and beyond: a review of one-dimensional Doppler ultrasound application in fetal monitoring

2018

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One-dimensional Doppler ultrasound (1D-DUS) provides a low-cost and simple method for acquiring a rich signal for use in cardiovascular screening. However, despite the use of 1D-DUS in cardiotocography (CTG) for decades, there are still challenges that limit the effectiveness of its users in reducing fetal and neonatal morbidities and mortalities. This is partly due to the noisy, transient, complex and nonstationary nature of the 1D-DUS signals. Current challenges also include lack of efficient signal quality metrics, insufficient signal processing techniques for extraction of fetal heart rate and other vital parameters with adequate temporal resolution, and lack of appropriate clinical decision support for CTG and Doppler interpretation. Moreover, the almost complete lack of open research in both hardware and software in this field, as well as commercial pressures to market the much more expensive and difficult to use Doppler imaging devices, has hampered innovation. This paper reviews the basics of fetal cardiac function, 1D-DUS signal generation and processing, its application in fetal monitoring and assessment of fetal development and wellbeing. It also provides recommendations for future development of signal processing and modeling approaches, to improve the application of 1D-DUS in fetal monitoring, as well as the need for annotated open databases.

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Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

Cited by 5 publications

References 25 publications

Foetal haemodynamic response to anaemia

Foetal haemodynamic response to anaemia

Ultrasound Features of Fetal Anemia Lessons From Hemoglobin Bart Disease

Cardiotocography and beyond: a review of one-dimensional Doppler ultrasound application in fetal monitoring

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