Myocardial Tissue Doppler in Intrauterine Growth Restriction

Objective: A recently postulated method to detect function of the myocardium is the use of Tissue Doppler Echocardiography. As in IUGR, subclinical cardiac dysfunction may set in before the development of ultrasonically visible changes in the foetal circulation; the technique may be able to detect growth restriction changes earlier than conventional vessel Doppler. We undertook this study to assess whether myocardial tissue Doppler is an effective tool in detecting foetal cardiac changes in Intrauterine growth restriction. Materials and Methods: Fetuses in the third trimester of gestation (28-40 weeks) were taken for this prospective case control study. Myocardial Tissue Doppler was used to assess their foetal cardiac function. E’, A, E’/A’ and Myocardial performance index (MPI’) of both ventricles and the interventricular septum were compared between the two groups of IUGR and normal growth fetuses among the study subjects. Comparison was also done after further classifying the IUGR group based on their birth weight, vessel Doppler inferences and outcomes in the neonatal period. Results: Among the 63 patients taken for the study, thirty-three were found to have IUGR and thirty were of normal growth fetuses. In fetuses with IUGR, there was a significant difference in the interventricular septal variables in comparison to their normal counterparts. In fetuses with birth weight between 1-1.5 kg, the right ventricle and left ventricle parameters were also found to be affected. The parameters showed no remarkable deviation in the IUGR fetuses with respect to vessel Doppler and fetal outcomes. Conclusion: We conclude that Myocardial tissue Doppler can diagnose cardiac dysfunction in IUGR. This change was more significant in babies with very low birth weight, abnormal vessel Doppler and adverse perinatal outcomes. Myocardial tissue Doppler has, however, a low specificity in predicting adverse perinatal outcomes in IUGR babies and comparable sensitivity to Conventional Vessel Doppler.http://impactfactor.org/PDF/IJTPR/12/IJTPR,Vol12,Issue12,Article9.pd