EP01.17: Monochorionic‐diamniotic twins with selective fetal growth restriction exhibit quantitative cardiac changes in early second trimester

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To evaluate the left ventricular contractility in complicated monochorionic-diamniotic (MCDA) twin gestations using speckle-tracking imaging. This is a prospective cohort study of MCDA twin gestations examined between 20-25 weeks of gestation. We used speckle tracking (TomTec, Germany) to obtain left ventricular global longitudinal strain (LVGLS) and ejection fraction (EF). Parameters were compared to fetal z-scores. We analysed 34 fetuses of MCDA twin gestations. There were 18 MCDA fetuses complicated by selective fetal growth restriction (sFGR). At 20-25 weeks the LVGLS had a median z-score of 1.06 [0, 2.18] in uncomplicated MCDA fetuses with an ejection fraction z-score between -2.5 and 2.5. However, in sFGR twin fetuses, the LVGLS was increased with a median z-score of 2.51 [1.63, 3.38] with a decreased ejection fraction z-score median of -3.82 [-5.29, -1.84]. The non-growth-restricted fetus counterparts had normal but decreased LVGLS z-scores of 0.78 [-0.06, 1.47] with preserved ejection fraction z-score of -1.22 [-2.37, -0.75]. In the two fetuses with fetal death, the ejection fraction was severely depressed with a z-score of -9.27. In the second trimester, MCDA twins begin to exhibit changes reflecting sFGR complications. In sFGR fetuses, the LVGLS is higher reflecting increased longitudinal shortening of the left ventricle, similar to previous literature. However, despite increased LVGLS, these fetuses have decreased ejection fraction compared to control and non-FGR fetus counterparts. These early changes may be useful in predicting and detecting complication in MCDA twins. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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