Fetal ventricular strain in uncomplicated and selective growth‐restricted monochorionic diamniotic twin pregnancies and cardiovascular response in pre‐twin–twin transfusion syndrome

Autor: A. Agarwal, Ramesha Papanna, Kenneth J. Moise, Anthony Johnson, Cynthia S. Bell, Roopali Donepudi, Christoph Wohlmuth, I. E. Averiss, Blair Stevens, Helena M. Gardiner
Rok vydání: 2020
Předmět:
selective intrauterine growth restriction
sIUGR
Twins
Intrauterine growth restriction
0302 clinical medicine
Obstetrics and gynaecology
Pregnancy
Single-Blind Method
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Twin Pregnancy
ventricular strain
Fetal Growth Retardation
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
Obstetrics
cardiovascular
Obstetrics and Gynecology
Gestational age
Fetofetal Transfusion
General Medicine
Original Papers
Fetal Weight
Multilevel Analysis
Regression Analysis
Female
Ductus venosus
Adult
medicine.medical_specialty
Heart Ventricles
Gestational Age
Ultrasonography
Prenatal
03 medical and health sciences
Fetal Heart
Fetus
twin–twin transfusion syndrome
medicine
Humans
Placental Circulation
Radiology
Nuclear Medicine and imaging
monochorionic
Original Paper
business.industry
Reproducibility of Results
medicine.disease
TTTS
Reproductive Medicine
Pregnancy
Twin
business
Zdroj: Ultrasound in Obstetrics & Gynecology
ISSN: 1469-0705
0960-7692
Popis: Objectives Our primary aim was to confirm whether intertwin discordance in ventricular strain and ductus venosus (DV) time intervals predicts twin–twin transfusion syndrome (TTTS). Secondary aims were to create gestational‐age ranges for ventricular strain in uncomplicated monochorionic diamniotic (MCDA) twin pregnancies without selective intrauterine growth restriction (sIUGR) and to characterize the relationship of ventricular strain with gestational age in MCDA twin pregnancies with sIUGR that did not develop TTTS. Methods In the period 2015–2018, we enrolled 150 MCDA twin pregnancies consecutively into this prospective, blinded study of global longitudinal left and right ventricular strain. With the observer blinded to twin pairing and pregnancy outcome, videoclips of the four‐chamber view, which had been recorded during ultrasound surveillance in the usual window for development of TTTS (16–26 completed gestational weeks), underwent offline measurement of strain. Uncomplicated MCDA twin pregnancies, without sIUGR, were used to test the association between strain, gestational age and estimated fetal weight using mixed‐effects multilevel regression. Inter‐rater reliability was tested in 208 strain measurements in 31 fetuses from pregnancies which did not develop TTTS and within‐fetus variation was assessed in 16 such fetuses, in which multiple four‐chamber views were taken on the same day. The effect of sIUGR on strain in otherwise uncomplicated MCDA twin pregnancy was analyzed. MCDA twin pregnancies were defined as ‘pre‐TTTS’ when, having been referred for TTTS evaluation, they did not satisfy Quintero staging criteria, but subsequently developed TTTS requiring laser treatment. MCDA pregnancies which did not develop TTTS comprised the ‘non‐TTTS’ group. Cardiovascular parameters measured in these cases included tissue Doppler parameters and DV early filling time as a percentage of the cardiac cycle (DVeT%). Intertwin strain and DVeT% discordance was compared between non‐TTTS and pre‐TTTS cases, matched for gestational age. Results Paired strain data were available for intertwin comparison in 127/150 MCDA twin pregnancies, comprising 14 pre‐TTTS and 113 non‐TTTS pregnancies, after exclusions. Scans were collected at a median frame rate of 97 (range, 28–220) Hz. Laser therapy was performed at a median gestational age of 20.6 (range, 17.2–26.6) weeks. There were no group differences in right (RV) or left (LV) ventricular strain discordance between 68/113 non‐TTTS and 13/14 pre‐TTTS MCDA twin pregnancies 3.6% was found in eight of 13 pre‐TTTS pregnancies. In non‐TTTS pregnancies, the estimated variability in ventricular strain within each twin during the day was high (RV, 19.7; LV, 12.9). However, within each pair (intertwin variation), variability was low (RV, 5.5; LV, 2.9). Interclass correlation reflecting the proportion of total variability represented by the variability between twin pairs was low (RV, 0.22; LV, 0.18). Both RV (P
Databáze: OpenAIRE
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