Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome - 30/05/13
Reprints: Helena M. Gardiner, PhD, MD, FRCP, FRCPCH, DCH, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College, Queen Charlotte’s and Chelsea Hospital, Du Cane Road, London W12 0HS, UK.Abstract |
Objective |
The objective of the study was to investigate whether vector velocity imaging (VVI), a non-Doppler speckle tracking ultrasound technology, is feasible in twin pregnancies and can aid management of twin-twin transfusion syndrome (TTTS).
Study Design |
Twenty-seven women pregnant with monochorionic diamniotic twins affected by TTTS and 28 monochorionic pregnancies that did not develop TTTS were included in a prospective case-control study at a fetal medicine center. Fetal echocardiograms were recorded with dummy electrocardiography to retain original frame rates when exported for offline speckle tracking analysis using Syngo-VVI software (Siemens Corp, Munich, Germany). Right and left ventricular (LV) free wall Lagrangian strain was measured from the original coordinates. Within-twin pair ventricular strain differences including relationship to Quintero staging and response to laser therapy for TTTS were analyzed by Wilcoxon signed-rank test.
Results |
The VVI strain measurements could be analyzed in 182 of 200 TTTS and 96 of 112 non-TTTS control ventricles. Within-pair strain was concordant in non-TTTS controls. Recipient LV strain was reduced at all Quintero stages compared with donors (P < .01). Recipient right ventricular strain was reduced only in stages 3 and 4 (P < .01). Strain improved at a median of 2 weeks following successful laser therapy. Intertwin differences in strain were independent of weight discordance.
Conclusion |
Recipient LV strain is reduced in stages 1 and 2 TTTS. Within-pair strain discordance may distinguish early TTTS from growth discordance and guide timing of and management following treatment.
Il testo completo di questo articolo è disponibile in PDF.Key words : fetus, myocardial strain, speckle tracking, twin-twin transfusion syndrome
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| This work was supported by the Tiny Tickers charity, the Richard and Jack Wiseman Trust, the National Institute of Health Research Biomedical Research Centre funding scheme, and Genesis Research Fund at the Institute of Reproduction and Developmental Biology, Imperial College and Queen Charlotte’s and Chelsea Hospital, London, UK. |
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| The authors report no conflict of interest. |
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| Cite this article as: Taylor-Clarke MC, Matsui H, Roughton M, et al. Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2013;208:462.e1-6. |
Vol 208 - N° 6
P. 462.e1-462.e6 - giugno 2013 Ritorno al numero
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