Color Tissue Doppler to Analyze Fetal Cardiac Time Intervals: Normal Values and Influence of Sample Gate Size

Abstract

Purpose To assess the time intervals of the cardiac cycle in healthy fetuses in the second and third trimester using color tissue Doppler imaging (cTDI) and to evaluate the influence of different sizes of sample gates on time interval values.

Materials and Methods Time intervals were measured from the cTDI-derived Doppler waveform using a small and large region of interest (ROI) in healthy fetuses.

Results 40 fetuses were included. The median gestational age at examination was 26 + 1 (range: 20 + 5 – 34 + 5) weeks. The median frame rate was 116/s (100 – 161/s) and the median heart rate 143 (range: 125 – 158) beats per minute (bpm). Using small and large ROIs, the second trimester right ventricular (RV) mean isovolumetric contraction times (ICTs) were 39.8 and 41.4 ms (p = 0.17), the mean ejection times (ETs) were 170.2 and 164.6 ms (p < 0.001), the mean isovolumetric relaxation times (IRTs) were 52.8 and 55.3 ms (p = 0.08), respectively. The left ventricular (LV) mean ICTs were 36.2 and 39.4 ms (p = 0.05), the mean ETs were 167.4 and 164.5 ms (p = 0.013), the mean IRTs were 53.9 and 57.1 ms (p = 0.05), respectively. The third trimester RV mean ICTs were 50.7 and 50.4 ms (p = 0.75), the mean ETs were 172.3 and 181.4 ms (p = 0.49), the mean IRTs were 50.2 and 54.6 ms (p = 0.03); the LV mean ICTs were 45.1 and 46.2 ms (p = 0.35), the mean ETs were 175.2 vs. 172.9 ms (p = 0.29), the mean IRTs were 47.1 and 50.0 ms (p = 0.01), respectively.

Conclusion Isovolumetric time intervals can be analyzed precisely and relatively independent of ROI size. In the near future, automatic time interval measurement using ultrasound systems will be feasible and the analysis of fetal myocardial function can become part of the clinical routine.

Zusammenfassung

Ziel Analyse der Zeitintervalle des fetalen Herzzyklus gesunder Feten im 2. und 3. Trimenon mittels farbkodiertem Gewebedoppler (color DTI) und Evaluation des Einflusses der ROI-Größe auf die jeweiligen Zeitintervalle.

Material und Methoden Die Zeitintervalle wurden anhand der cTDI ermittelten Gewebedopplerkurven gemessen, wobei jeweils eine kleine (3 mm durchmessend) und eine große Region of Interest (freie Wand des Ventrikel) betrachtet wurde.

Ergebnisse 40 Feten wurden untersucht. Im Median betrug das Schwangerschaftsalter 26 + 1 (20 + 5 – 34 + 5) Wochen, die Bildwiederholrate 116/s (100 – 161/s) und die Herzfrequenz 143 (125 – 158) Schläge pro Minute. Im 2. Trimenon – jeweils mit kleiner und großer ROI gemessen – betrugen rechtsventrikulär die mittlere ICT 39,8 und 41,4 ms (p = 0,17), die mittlere ET 170,2 und 164,6 s (p < 0,001), die mittlere IRT 52,8 vs. 55,3 ms (p = 0,08). Linksventrikulär betrugen die mittlere ICT 36,2 vs. 39,4 ms (p = 0,05), die mittlere ET 167,4 und 164,5 ms (p = 0,013), die IRT 53,9 vs. 57,1 ms (p = 0,05). Im 3. Trimenon betrugen rechtsventrikulär die mittlere ICT 50,7 vs. 50,4 ms (p = 0,75), die mittlere ET 172,3 und 181,4 ms (p = 0,49), die mittlere IRT 50,2 und 54,6 ms (p = 0,03); linksventrikulär betrugen die mittlere ICT 45,1 und 46,2 ms (p = 0,35), die mittlere ET 175,2 und 172,9 ms (p = 0,29), die mittlere IRT 47,1 und 50,0 ms (p = 0,01).

Schlussfolgerung Isovolumetrische Zeitintervalle können präzise und relativ unabhängig der ROI-Größe analysiert werden. Zukünftig werden Ultraschallsysteme selbständig die Zeitintervalle des fetalen Herzzyklus messen können, so dass die Herzmuskelfunktionsanalyse somit zum Bestandteil der klinischen Routine werden könnte.

Key words

cardiac - heart - ultrasound Doppler

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