Tissue Doppler imaging versus conventional echocardiography in assessment of cardiac diastolic function in full term neonates with perinatal asphyxia

Abstract

Background and objective

Limited number of studies evaluated cardiac diastolic function in neonates with perinatal asphyxia using tissue Doppler imaging. The aim of this study was to evaluate the echocardiographic parameters in full-term neonates with perinatal asphyxia compared to healthy full-term neonates. Diagnostic value of echocardiographic parameters of diastolic dysfunction in predicting mortality in asphyxiated neonates was assessed.

Setting

Neonatal intensive care unit at the Obstetric and Gynecology Hospital, Cairo University, Egypt (a tertiary care center).

Patients and methods

This study included 20 neonates with perinatal asphyxia (cases) and 20 healthy full-term nonasphyxiated neonates (as controls). The studied groups were assessed by conventional pulsed wave Doppler and tissue Doppler imaging.

Results

Among pulsed wave Doppler parameters, cases had statistically significant lower values (denoting more diastolic dysfunction) than controls as regards mitral E velocity (p = .04) and mitral E/A ratio (p = .04). Similarly, among tissue Doppler parameters, cases had statistically significant lower values (denoting more diastolic dysfunction) than controls as regards septal E′/A′ ratio (p = .019), left ventricular E′ velocity (p = .001), and E′/A′ ratio (p < .001). Septal E′/A′ ratio and right ventricular E′/A′ ratio were significantly lower (p = .012 and p = .025, respectively) among nonsurvivors (denoting more diastolic dysfunction) compared to survivors. Moreover, cases had statistically significant higher values (denoting more diastolic dysfunction) than controls as regards septal (p < .001), left ventricular (p < .001), and right ventricular (p < .001) tissue Doppler-based myocardial performance indices. Asphyxiated neonates showed statistically significant higher evidence of left ventricular diastolic dysfunction than controls in both pulsed wave Doppler and tissue Doppler with p < .001 and p = .001, respectively; while there was no difference as regards right ventricular diastolic dysfunction. Tissue Doppler was able to detect higher number of neonates with left ventricular diastolic dysfunction than conventional pulsed wave Doppler.

Conclusions

Tissue Doppler imaging was found to be able to detect diastolic dysfunction early in neonates with perinatal asphyxia specifically as regards the left ventricle. Assessment of myocardial function is important in asphyxiated neonates. Tissue Doppler imaging should be considered an integral part of assessment of cardiac function in asphyxiated neonates.

Keywords:

• Diastolic dysfunction
• hypoxic ischemic encephalopathy
• myocardial performance index
• Tei’s index
• tissue Doppler imaging

Disclosure statement

No potential conflict of interest was reported by the authors.