Introduction

Fetuses with heart failure are at risk of developing hydrops fetalis due to ventricular dysfunction. Therefore, we aim to assess myocardial function in hydropic fetuses at the time of diagnosis. Material and methods: Fetal echocardiography was performed using a Toshiba Aplio XG ultrasound system. The mitral annular plane systolic excursion (MAPSE) and the tricuspid annular plane systolic excursion (TAPSE) as well as isovolumetric contraction time (ICT´), ejection time (ET´), and isovolumetric relaxation time (IRT´) for the left and right ventricle were measured using pulsed wave tissue Doppler imaging (pw TDI). The myocardial performance index (MPI´) was calculated. E´- and A´-wave peak velocities were assessed for both ventricles and the E´/A´ ratio was calculated. Results were compared to gestational age-matched healthy controls without Doppler alterations or anatomic malformations by using the unpaired Student’s t-test.

Results

30 hydropic fetuses were included. Mean gestational age (GA) was 25 (18–33) weeks. Left ventricular MPI´ was 0.66 (0.32–1.46, SD = 0.28) and significantly higher in hydropic fetuses (p < 0.05) than in healthy controls (MPI´ controls 0.58 [0.42–0.79, SD = 0.11]). Fetuses with altered Doppler parameters (UA, DV) showed no significant changes in their myocardial function compared to hydropic fetuses with physiological Doppler flow patterns. Conclusion: In fetuses with hydrops and normal Doppler parameters, analysis of myocardial function by pw TDI may help to detect pre-clinical alterations days before manifest changes in fetal circulation. This may lead to adjusted fetal surveillance and optimised pre- and perinatal management.