Assessment of foetal cardiac function by myocardial tissue doppler in foetal growth restriction

Barnali Basu, Ranjan Shetty, Krishnendu Gupta


Background: One of the consequences of IUGR is the development of cardiac diastolic dysfunction in fetuses. Tissue doppler in echocardiography is a new technique to detect myocardial tissue function and can act as a useful tool in the identification of this complication. Hence we decided to undertake this study to assess the utility of myocardial tissue doppler in detecting foetal cardiac dysfunction in IUGR. It was a prospective case control study in a tertiary care teaching hospital.

Methods: Foetal cardiac function in the third trimester of pregnancy was evaluated with the help of myocardial tissue doppler and compared between IUGR and normal growth babies and correlated with vessel doppler findings and neonatal outcomes.

Results: There were sixty two IUGR and fifty eight normal growth babies in the study. In babies with IUGR, particularly the ones with severe IUGR, abnormal vessel doppler and adverse neonatal outcomes, right ventricular MPI was found to be significantly lower. However, the variable had a poor sensitivity (40%) in detecting fetuses at risk for poor neonatal outcomes.

Conclusions: Myocardial tissue doppler shows right sided cardiac dysfunction in IUGR babies in comparison to normal growth babies It is however not a sensitive indicator of adverse perinatal outcome in IUGR babies.


Cardiac dysfunction, IUGR, Myocardial tissue doppler

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Mäkikallio K, Vuolteenaho O, Jouppila P, Räsänen J. Association of severe placental insufficiency and systemic venous pressure rise in the fetus with increased neonatal cardiac troponin T levels. Am J Obstet Gynecol. 2000;183:726-31.

Acharya G, Räsänen J, Mäkikallio K, Erkinaro T, Kavasmaa T, Haapsamo M, Mertens L, Huhta JC. Metabolic acidosis decreases foetal myocardial isovolumic velocities in a chronic sheep model of increased placental vascular resistance. Am J Physiol Heart Circ Physiol. 2008; 294:498-504.

Crispi F, Hernandez-Andrade E, Pelsers MM, Plasencia W, Benavides-Serralde JA, Eixarch E, et al. Dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol. 2008;199:254.

Mäkikallio K, Vuolteenaho O, Jouppila P, Räsänen J. Ultrasonographic and biochemical markers of human foetal cardiac dysfunction in placental insufficiency. Circulation. 2002;105:58-63.

Bahtiyar MO, Copel JA. Cardiac changes in the intrauterine growth-restricted fetus. Semin Perinatol. 2008;32:190-3.

Naujorks AA, Zielinsky P, Beltrame PA, Castagna RC, Petracco R, Busato A, Nicoloso AL, Piccoli A, Manica JL. Myocardial tissue doppler assessment of diastolic function in the growth-restricted fetus. Ultrasound Obstet Gynecol. 2009;34:68-73.

Comas M, Crispi F, Cruz-Martinez R. Usefulness of myocardial tissue Doppler versus conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction. Am J Obstet Gynecol. 2010;203:451-7.

Comas M, Crispi F, Cruz-Martinez R. Tissue doppler echocardiographic markers of cardiac dysfunction in small-for-gestational age fetuses. Am J Obstet Gynecol. 2011; 205:571-6.

Doppler Ultrasound in obstetrics and gynecology. In: Ott MWJ eds. Doppler ultrasound in the diagnosis and management of IUGR. 2nd ed. New York. Springer; 2005:281-93.

Chan LY, Fok WY, Wong JT, Yu CM, Leung TN, Lau TK. Reference charts of gestation-specific tissue doppler imaging indices of systolic and diastolic functions in the normal foetal heart. Am Heart J. 2005;150:750-5.