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. Differential ventricular dysfunction may be present in the fetus with CHF. A non-geometric measure of ventricular function that is not afterload dependent would be useful to measure the severity of myocardial dysfunction. Methods: Tei-index (isovolumetric time/ejection time) was measured prenatally in 23 normals (24-34 weeks gestational age-GA) and in 7 with BF (24-34 weeks 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) and 0.41 +/- 0.05 in the left ventricle (LV) and there were no significant RV-LV or gestational age (GA) differences. Among HF fetuses, RV and LV Tei-indices were both significantly increased (0.54 and 0.92) and not significantly different. CV score ranged from 2 to 8 (mean 5.43 out of 10) and correlated inversely with Tei-index (r = -0.52, r = -0.68). Conclusion: Hydrops fetalis is associated with biventricular dysfunction and congestive heart failure. Tei-index. correlates with CV score obtained within two weeks of delivery or intrauterine death. Tei-index may be useful in the serial assessment of myocardial dysfunction in the fetus with hydrops.