Fetal cardiac parameters for prediction of twin‐to‐twin transfusion syndrome
ABSTRACT Objectives To assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI′) at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin‐to‐twin transfusion syndrome (TTTS). Methods This was a single‐center observ...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2014-10, Vol.44 (4), p.434-440 |
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| creator | Zanardini, C. Prefumo, F. Fichera, A. Botteri, E. Frusca, T. |
| description | ABSTRACT
Objectives
To assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI′) at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin‐to‐twin transfusion syndrome (TTTS).
Methods
This was a single‐center observational study of 100 uncomplicated monochorionic diamniotic twin pregnancies attending the twin pregnancy clinic at the University Hospital Spedali Civili of Brescia from 2009 to 2012. MPI and MPI′ were obtained from the left (LV) and right (RV) ventricles of each twin at around 18 weeks of gestation (range, 17 + 1 to 19 + 4 weeks) and fortnightly thereafter. Cases which later developed TTTS formed the study group, and the remaining controls were subdivided into those continuing as uncomplicated pregnancies and those which later developed selective intrauterine growth restriction (sIUGR). Data were analyzed by receiver–operating characteristics curve analysis and univariate and multivariable logistic regression.
Results
Of the 100 pregnancies, 88 were controls (84 uncomplicated and four developed sIUGR) and 12 developed TTTS. RV‐MPI and LV‐MPI, and LV‐MPI′ were significantly higher in future TTTS recipients than in controls, while RV‐MPI′ was significantly lower in donors. RV‐MPI and LV‐MPI and LV‐MPI′ were found to be predictive indicators in pregnancies that had not yet developed TTTS. Their negative predictive values were > 90%, and their specificities > 80%. The best performing index was LV‐MPI′, with a sensitivity of 91.7% and specificity of 88.6%.
Conclusions
Before diagnosis of TTTS, the cardiac function (as assessed by MPI and MPI′) of the future donor twin is not grossly abnormal, but that of the recipient is abnormal. We identified cardiac indices predictive of the subsequent development of TTTS, and suggest a possible role of these indices in planning the follow‐up of monochorionic diamniotic twin pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2014; 44: 386–387 |
| doi_str_mv | 10.1002/uog.13442 |
| format | Article |
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Objectives
To assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI′) at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin‐to‐twin transfusion syndrome (TTTS).
Methods
This was a single‐center observational study of 100 uncomplicated monochorionic diamniotic twin pregnancies attending the twin pregnancy clinic at the University Hospital Spedali Civili of Brescia from 2009 to 2012. MPI and MPI′ were obtained from the left (LV) and right (RV) ventricles of each twin at around 18 weeks of gestation (range, 17 + 1 to 19 + 4 weeks) and fortnightly thereafter. Cases which later developed TTTS formed the study group, and the remaining controls were subdivided into those continuing as uncomplicated pregnancies and those which later developed selective intrauterine growth restriction (sIUGR). Data were analyzed by receiver–operating characteristics curve analysis and univariate and multivariable logistic regression.
Results
Of the 100 pregnancies, 88 were controls (84 uncomplicated and four developed sIUGR) and 12 developed TTTS. RV‐MPI and LV‐MPI, and LV‐MPI′ were significantly higher in future TTTS recipients than in controls, while RV‐MPI′ was significantly lower in donors. RV‐MPI and LV‐MPI and LV‐MPI′ were found to be predictive indicators in pregnancies that had not yet developed TTTS. Their negative predictive values were > 90%, and their specificities > 80%. The best performing index was LV‐MPI′, with a sensitivity of 91.7% and specificity of 88.6%.
Conclusions
Before diagnosis of TTTS, the cardiac function (as assessed by MPI and MPI′) of the future donor twin is not grossly abnormal, but that of the recipient is abnormal. We identified cardiac indices predictive of the subsequent development of TTTS, and suggest a possible role of these indices in planning the follow‐up of monochorionic diamniotic twin pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2014; 44: 386–387</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.13442</identifier><identifier>PMID: 24919586</identifier><identifier>CODEN: UOGYFJ</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Echocardiography, Doppler, Pulsed - methods ; Female ; Fetal Growth Retardation - diagnostic imaging ; fetal heart ; Fetal Heart - diagnostic imaging ; Fetal Heart - physiopathology ; Fetofetal Transfusion - diagnostic imaging ; Fetofetal Transfusion - physiopathology ; Gestational Age ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Logistic Models ; Longitudinal Studies ; monochorionic ; MPI ; myocardial performance index ; Pregnancy ; Pregnancy Complications - diagnostic imaging ; Pregnancy, Twin ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; TDI ; tissue Doppler imaging ; TTTS ; Twins ; Ultrasonography, Prenatal - methods</subject><ispartof>Ultrasound in obstetrics & gynecology, 2014-10, Vol.44 (4), p.434-440</ispartof><rights>Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd</rights><rights>Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4872-4d74389add4d98f2c4897837bdf702dd09e2ab40b95020667aa666bcc7699bc93</citedby><cites>FETCH-LOGICAL-c4872-4d74389add4d98f2c4897837bdf702dd09e2ab40b95020667aa666bcc7699bc93</cites><orcidid>0000-0001-7793-714X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.13442$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.13442$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24919586$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zanardini, C.</creatorcontrib><creatorcontrib>Prefumo, F.</creatorcontrib><creatorcontrib>Fichera, A.</creatorcontrib><creatorcontrib>Botteri, E.</creatorcontrib><creatorcontrib>Frusca, T.</creatorcontrib><title>Fetal cardiac parameters for prediction of twin‐to‐twin transfusion syndrome</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objectives
To assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI′) at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin‐to‐twin transfusion syndrome (TTTS).
Methods
This was a single‐center observational study of 100 uncomplicated monochorionic diamniotic twin pregnancies attending the twin pregnancy clinic at the University Hospital Spedali Civili of Brescia from 2009 to 2012. MPI and MPI′ were obtained from the left (LV) and right (RV) ventricles of each twin at around 18 weeks of gestation (range, 17 + 1 to 19 + 4 weeks) and fortnightly thereafter. Cases which later developed TTTS formed the study group, and the remaining controls were subdivided into those continuing as uncomplicated pregnancies and those which later developed selective intrauterine growth restriction (sIUGR). Data were analyzed by receiver–operating characteristics curve analysis and univariate and multivariable logistic regression.
Results
Of the 100 pregnancies, 88 were controls (84 uncomplicated and four developed sIUGR) and 12 developed TTTS. RV‐MPI and LV‐MPI, and LV‐MPI′ were significantly higher in future TTTS recipients than in controls, while RV‐MPI′ was significantly lower in donors. RV‐MPI and LV‐MPI and LV‐MPI′ were found to be predictive indicators in pregnancies that had not yet developed TTTS. Their negative predictive values were > 90%, and their specificities > 80%. The best performing index was LV‐MPI′, with a sensitivity of 91.7% and specificity of 88.6%.
Conclusions
Before diagnosis of TTTS, the cardiac function (as assessed by MPI and MPI′) of the future donor twin is not grossly abnormal, but that of the recipient is abnormal. We identified cardiac indices predictive of the subsequent development of TTTS, and suggest a possible role of these indices in planning the follow‐up of monochorionic diamniotic twin pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2014; 44: 386–387</description><subject>Adult</subject><subject>Echocardiography, Doppler, Pulsed - methods</subject><subject>Female</subject><subject>Fetal Growth Retardation - diagnostic imaging</subject><subject>fetal heart</subject><subject>Fetal Heart - diagnostic imaging</subject><subject>Fetal Heart - physiopathology</subject><subject>Fetofetal Transfusion - diagnostic imaging</subject><subject>Fetofetal Transfusion - physiopathology</subject><subject>Gestational Age</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Longitudinal Studies</subject><subject>monochorionic</subject><subject>MPI</subject><subject>myocardial performance index</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - diagnostic imaging</subject><subject>Pregnancy, Twin</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>TDI</subject><subject>tissue Doppler imaging</subject><subject>TTTS</subject><subject>Twins</subject><subject>Ultrasonography, Prenatal - methods</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkb9OwzAQxi0EoqUw8AIoEgsMac-Oa8cjqmhBqlQGOkeO7aBUSVzsRFU3HoFn5ElwaWFAQiw-6-6n7_58CF1iGGIAMursyxAnlJIj1MeUiRg4jI9RHwSDmDNBeujM-xUAMJqwU9QjVGAxTlkfPU1NK6tISadLqaK1dLI2rXE-KqyL1s7oUrWlbSJbRO2mbD7e3lu7e8I_ap1sfNH5Xd1vG-1sbc7RSSErby4OcYCW0_vnyUM8X8weJ3fzWNGUk5hqTpNUSK2pFmlBQlbwNOG5LjgQrUEYInMKuRgDAca4lIyxXKmwjsiVSAboZq-7dva1M77N6tIrU1WyMbbzGWYYMxLo9H80XALEmAsS0Otf6Mp2rgmLBCpMQSjGu963e0o5670zRbZ2ZS3dNsOQ7RzJgiPZlyOBvToodnlt9A_5bUEARntgU1Zm-7dStlzM9pKfxFaWNQ</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Zanardini, C.</creator><creator>Prefumo, F.</creator><creator>Fichera, A.</creator><creator>Botteri, E.</creator><creator>Frusca, T.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7793-714X</orcidid></search><sort><creationdate>201410</creationdate><title>Fetal cardiac parameters for prediction of twin‐to‐twin transfusion syndrome</title><author>Zanardini, C. ; Prefumo, F. ; Fichera, A. ; Botteri, E. ; Frusca, T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4872-4d74389add4d98f2c4897837bdf702dd09e2ab40b95020667aa666bcc7699bc93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Echocardiography, Doppler, Pulsed - methods</topic><topic>Female</topic><topic>Fetal Growth Retardation - diagnostic imaging</topic><topic>fetal heart</topic><topic>Fetal Heart - diagnostic imaging</topic><topic>Fetal Heart - physiopathology</topic><topic>Fetofetal Transfusion - diagnostic imaging</topic><topic>Fetofetal Transfusion - physiopathology</topic><topic>Gestational Age</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Longitudinal Studies</topic><topic>monochorionic</topic><topic>MPI</topic><topic>myocardial performance index</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - diagnostic imaging</topic><topic>Pregnancy, Twin</topic><topic>Prospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>TDI</topic><topic>tissue Doppler imaging</topic><topic>TTTS</topic><topic>Twins</topic><topic>Ultrasonography, Prenatal - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zanardini, C.</creatorcontrib><creatorcontrib>Prefumo, F.</creatorcontrib><creatorcontrib>Fichera, A.</creatorcontrib><creatorcontrib>Botteri, E.</creatorcontrib><creatorcontrib>Frusca, T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zanardini, C.</au><au>Prefumo, F.</au><au>Fichera, A.</au><au>Botteri, E.</au><au>Frusca, T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fetal cardiac parameters for prediction of twin‐to‐twin transfusion syndrome</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2014-10</date><risdate>2014</risdate><volume>44</volume><issue>4</issue><spage>434</spage><epage>440</epage><pages>434-440</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><coden>UOGYFJ</coden><abstract>ABSTRACT
Objectives
To assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI′) at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin‐to‐twin transfusion syndrome (TTTS).
Methods
This was a single‐center observational study of 100 uncomplicated monochorionic diamniotic twin pregnancies attending the twin pregnancy clinic at the University Hospital Spedali Civili of Brescia from 2009 to 2012. MPI and MPI′ were obtained from the left (LV) and right (RV) ventricles of each twin at around 18 weeks of gestation (range, 17 + 1 to 19 + 4 weeks) and fortnightly thereafter. Cases which later developed TTTS formed the study group, and the remaining controls were subdivided into those continuing as uncomplicated pregnancies and those which later developed selective intrauterine growth restriction (sIUGR). Data were analyzed by receiver–operating characteristics curve analysis and univariate and multivariable logistic regression.
Results
Of the 100 pregnancies, 88 were controls (84 uncomplicated and four developed sIUGR) and 12 developed TTTS. RV‐MPI and LV‐MPI, and LV‐MPI′ were significantly higher in future TTTS recipients than in controls, while RV‐MPI′ was significantly lower in donors. RV‐MPI and LV‐MPI and LV‐MPI′ were found to be predictive indicators in pregnancies that had not yet developed TTTS. Their negative predictive values were > 90%, and their specificities > 80%. The best performing index was LV‐MPI′, with a sensitivity of 91.7% and specificity of 88.6%.
Conclusions
Before diagnosis of TTTS, the cardiac function (as assessed by MPI and MPI′) of the future donor twin is not grossly abnormal, but that of the recipient is abnormal. We identified cardiac indices predictive of the subsequent development of TTTS, and suggest a possible role of these indices in planning the follow‐up of monochorionic diamniotic twin pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2014; 44: 386–387</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>24919586</pmid><doi>10.1002/uog.13442</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7793-714X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Wiley Online Library (Open Access Collection) |
| subjects | Adult Echocardiography, Doppler, Pulsed - methods Female Fetal Growth Retardation - diagnostic imaging fetal heart Fetal Heart - diagnostic imaging Fetal Heart - physiopathology Fetofetal Transfusion - diagnostic imaging Fetofetal Transfusion - physiopathology Gestational Age Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Logistic Models Longitudinal Studies monochorionic MPI myocardial performance index Pregnancy Pregnancy Complications - diagnostic imaging Pregnancy, Twin Prospective Studies ROC Curve Sensitivity and Specificity TDI tissue Doppler imaging TTTS Twins Ultrasonography, Prenatal - methods |
| title | Fetal cardiac parameters for prediction of twin‐to‐twin transfusion syndrome |
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