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Evaluation of Myocardial Function According to Early Diastolic Intraventricular Pressure Difference in Fetuses
Yuka Yamamoto1, Ken Takahashi2, Yo Takemoto1
1Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
Insights
Intraventricular pressure difference (IVPD) exists in fetal hearts and increases with gestational age. This finding correlates with stroke volume and cardiac output, offering insights into fetal cardiac development.
Area of Science:
- Cardiology
- Fetal Medicine
- Physiology
Background:
- Intraventricular pressure difference (IVPD) is a key indicator of adult myocardial diastolic function.
- Previous research has not investigated IVPD in the fetal stage.
- Understanding fetal IVPD is crucial for assessing diastolic function and ventricular dominance.
Purpose of the Study:
- To determine the existence and prenatal changes of IVPD.
- To evaluate the correlation of IVPD with established fetal cardiac parameters.
- To assess ventricular dominance in fetal cardiac development.
Main Methods:
- Retrospective analysis of data from 117 healthy fetuses (17-36 weeks gestation).
- Calculation of total and segmental IVPD using Euler's equation and color M-mode data.
- Evaluation of stroke volume, cardiac output, E/A ratio, and myocardial performance index.
Main Results:
- Significant increase in total IVPD in both ventricles during late gestation.
- Apical IVPD percentage increased significantly in late gestation for both ventricles.
- IVPD correlated strongly with stroke volume and cardiac output in both ventricles.
Conclusions:
- IVPD is present in fetal ventricles and increases with gestational age.
- Increased IVPD contributes to ventricular lengthening in late gestation.
- IVPD changes correlate with stroke volume and cardiac output, providing insights into fetal cardiac development and potential left ventricular dominance.
Background:
Intraventricular pressure difference (IVPD), the diastolic suction during early diastole, is known as a useful marker of myocardial diastolic function in adults with different heart diseases, but there are no studies of fetal IVPD. The aim of this study was to determine whether IVPD exists and changes prenatally and whether IVPD correlates with preexisting parameters to evaluate fetal cardiac diastolic function and ventricular dominance.
Methods:
Cross-sectional study data (stroke volume, fetal cardiac output, E/A ratio, and myocardial performance index) from 117 healthy fetuses at 17 to 36 weeks of gestation were retrospectively evaluated. The total IVPD was calculated using Euler's equation with color M-mode data. Segmental IVPD was evaluated as apical, mid, and basal IVPDs.
Results:
The total IVPD in the right ventricle and left ventricle significantly increased in late gestation compared with that in different fetuses studied at midgestation (right and left ventricles, ρ = 0.813 and ρ = 0.895, respectively; P < .001). In both ventricles, the apical IVPD percentage, but not basal or mid IVPD, significantly increased at late gestation compared with that in different fetuses studied at midgestation. Both stroke volumes were correlated with IVPD (right and left ventricles, ρ = 0.796 and ρ = 0.784, respectively; P < .001). Although myocardial performance index in the left ventricle did not show a significant correlation with IVPD, the E/A ratio had a very weak correlation with IVPD (right ventricle, ρ = 0.576, P < .001; left ventricle, ρ = 0.338, P < .01).
Conclusions:
IVPD has been proved to exist in both ventricles during the fetal stage. The total IVPD increased in late gestation, and the ventricular length increased because of increased apical IVPD in both ventricles. Furthermore, the increase of IVPD in both ventricles was correlated with stroke volume and, accordingly, cardiac output. Left ventricular dominance in IVPD from the fetal stage may offer interesting insight into fetal cardiac development.
