Predictive value of cardiovascular parameters in twin‐to‐twin transfusion syndrome

Abstract

Objective

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

“…In seven studies, echocardiographic findings were analyzed in relation to IUFD . We could only perform a meta‐analysis on atrioventricular regurgitation.…”

“…Five studies assessed the preoperative myocardial performance index (MPI) as a separate parameter, of which two report an increased risk of recipient demise . In a study of 105 recipients, the risk of recipient demise was four times higher if the MPI z score was above a cutoff z score of 1.645, which corresponds to the 95th percentile (p < .01). After adjustment for gestational age and placental localization, there was no increased risk (OR 3.09, 95% CI, 0.94‐9.30, p = .06).…”

“…In three studies, the Children's Hospital of Philadelphia (CHOP) score (a sum of 12 cardiovascular parameters, including the MPI) was analyzed in relation to IUFD . A CHOP score above 5 is generally considered as abnormal.…”

“…A CHOP score above 5 is generally considered as abnormal. Interestingly, only a CHOP score ≥ 3 was associated with recipient demise (40% with a score ≥ 3 vs 13% with a score < 3, p < .01) and a score > 5 was not . In the study of 466 TTTS cases, “global cardiac dysfunction” was included in the analysis, a factor defined as an abnormal MPI, ventricular dyskinesia, abnormal ejection fraction, and abnormal CHOP score (or other measure of cardiac dysfunction; exact cutoff values for separate parameters were not stated).…”

Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome

“…The increases in ICT and IRT but not ET can be interpreted as myocardial impairment of both contraction and relaxation with shortening of the diastolic filling time. Although several studies have evaluated cardiac dysfunction in recipients using Mod‐MPI, only a few reports have assessed its components, mainly focusing on the diastolic function . Divanović et al reported increased IRT in recipients, and this change was more significant in advanced‐stage TTTS .…”