Fetal congestive heart failure: correlation of Tei-Index and Cardiovascular-Score

Introduction: Congestive heart failure (CHF) may be present in fetuses with hydrops fetalis (HF) and the severity is difficult to quantitate. Differen tial ventricular dysfunction may be present in the fetus with CHF. A non-ge ometric measure of ventricular function that is not afterload dependent wou ld be useful to measure the severity of myocardial dysfunction. Methods: Tei-index (isovolumetric time/ejection time) was measured prenatal ly in 23 normals (24-34 weeks gestational age-GA) and in 7 with BF (24-34 w eeks GA). Prenatal CHF severity was graded by a 10 point cardiovascular (CV ) score (2 points each for absence of hydrops, normal venous Doppler, heart function, arterial Doppler, and heart size, and 10/10 = normal). A paired student t-test was used to compare RV and LV and nonpaired t-test compared HF and normals. Tei-index and CV score were correlated. Results: Tei-index normals were 0.38 +/- 0.04 in the right ventricle (RV) a nd 0.41 +/- 0.05 in the left ventricle (LV) and there were no significant R V-LV or gestational age (GA) differences. Among HF fetuses, RV and LV Tei-i ndices were both significantly increased (0.54 and 0.92) and not significan tly different. CV score ranged from 2 to 8 (mean 5.43 out of 10) and correl ated inversely with Tei-index (r = -0.52, r = -0.68). Conclusion: Hydrops fetalis is associated with biventricular dysfunction an d congestive heart failure. Tei-index. correlates with CV score obtained wi thin two weeks of delivery or intrauterine death. Tei-index may be useful i n the serial assessment of myocardial dysfunction in the fetus with hydrops .