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Updated: Apr 5, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Intermediate Diastolic Velocity as a Parameter of Cardiac Dysfunction in Growth-Restricted Fetuses
Xiangna Tang1, Edgar Hernandez-Andrade, Hyunyoung Ahn
1Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md. and Detroit, Mich., USA.
Insights
Evaluating fetal growth restriction, this study found that abnormal intracardiac diastolic velocities, specifically elevated E/IDV ratios, indicate a higher risk of adverse perinatal outcomes like death or acidemia.
Area of Science:
- Fetal Medicine
- Cardiology
- Neonatology
Background:
- Intracardiac diastolic velocities are crucial indicators of fetal well-being.
- Fetal growth restriction (FGR) is associated with increased risk of adverse perinatal outcomes.
- Assessing diastolic function in FGR fetuses is essential for risk stratification.
Purpose of the Study:
- To evaluate intermediate intracardiac diastolic velocities in fetuses with growth restriction.
- To determine the association between abnormal diastolic velocities and perinatal outcomes in FGR fetuses.
Main Methods:
- Doppler ultrasonography was used to measure peak E and A velocities, and the lowest intermediate diastolic velocity (IDV) at the atrioventricular valves.
- Measurements were performed in 400 normally grown and 100 growth-restricted fetuses.
- The prevalence of abnormal IDV, E/IDV, and A/IDV ratios was assessed in fetuses with perinatal death or acidemia (pH ≤7.1).
Main Results:
- Growth-restricted fetuses with reduced umbilical artery diastolic velocities showed significantly lower IDV and higher E/IDV ratios in both ventricles.
- In fetuses with perinatal death or acidemia, 85% had an elevated E/IDV or A/IDV ratio (>95th percentile).
- Elevated E/IDV ratios in the absence of reversed atrial velocities in the ductus venosus increased the likelihood of perinatal demise or acidemia by nearly 7-fold.
Conclusions:
- E/IDV and A/IDV ratios in cardiac ventricles may serve as valuable markers for predicting perinatal demise or acidemia in FGR fetuses.
- These Doppler-derived indices offer insights into diastolic dysfunction and associated risks in growth-restricted fetuses.
Objective:
To evaluate the intermediate intracardiac diastolic velocities in fetuses with growth restriction.
Methods:
Doppler waveforms of the two atrioventricular valves were obtained. Peak velocities of the E (early) and A (atrial) components, and the lowest intermediate velocity (IDV) between them, were measured in 400 normally grown and in 100 growth-restricted fetuses. The prevalence of abnormal IDV, E/IDV, and A/IDV ratios in fetuses presenting with perinatal death or acidemia at birth (pH ≤7.1) was estimated.
Results:
IDV was significantly lower and E/IDV ratios significantly higher in the two ventricles of growth-restricted fetuses with reduced diastolic velocities in the umbilical artery (p < 0.05). In 13 fetuses presenting with perinatal death or acidemia at birth, 11 (85%) had either an E/IDV or A/IDV ratio >95th percentile, whereas 5 (38%) showed absent or reversed atrial velocities in the ductus venosus (DV-ARAV; p < 0.04). Fetuses without DV-ARAV but with elevated E/IDV ratios in either ventricle were nearly 7-fold more likely to have perinatal demise or acidemia at birth (OR 6.9, 95% CI 1.4-34) than those with E/IDV ratios <95th percentile.
Conclusion:
The E/IDV and A/IDV ratios in the two cardiac ventricles might provide information about the risk of perinatal demise or acidemia in growth-restricted fetuses.
