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Fetal Cardiac Muscle Contractility Decreases With Gestational Age

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Fetal Cardiac Muscle Contractility Decreases With Gestational Age

Abstract and Introduction

Abstract


Background Present data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI).
Methods TVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201–273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four-chamber view, and the acquired data was correlated using regression analysis.
Results Left ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E'/A' ratio also increased with gestational age, while a longitudinal shortening was demonstrated.
Conclusions Fetal cardiac muscle contractility decreases with gestational age. As numerous fetal- and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.

Introduction


Recent findings demonstrate changes in cardiac muscle contractility in the sheep fetus explained by changes in cardiac troponins with gestational age. Contractility is here correlated with the process of cardiomyocyte binucleation, a transition from mono- to binucleated cardiomyocytes that, as in the human fetus, occur before birth.

Currently there is limited data regarding the functional properties of the human fetal myocardium, and how the human fetal heart works and develops throughout gestation. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Color-coded tissue velocity imaging (TVI) facilitates quantitative assessment of myocardial wall motion with a high temporal resolution, which is important considering the high velocity and short duration of the movements of the myocardial walls. In line with other researchers we believe that this technique can add to the evaluation of myocardial function and dysfunction and in gaining new insights into the physiology of the fetal cardiovascular system.

The general objective of this study was to evaluate fetal myocardial characteristics and deformation properties using TVI. Particularly evaluating the contractile function and atrioventricular (AV) plane displacement, with the intention to learn if cardiac muscle contractility in the human fetus, as in the sheep fetus, change with gestational age.

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