Letter to the Editor Tei index: The earliest detectable cardiac structural and functional abnormality detectable in Hb Bart's foetal edema Guihua Chao a , Chenguang Zheng a , Dahua Meng a , Jialing Su a , Xijin Xie a , Wei Li b , Michael Henein c, ⁎ a Maternal and Child Health Hospital, Children's Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi, China b Royal Brompton Hospital, London, UK c Heart Centre and Department of Medicine, Umea University, Sweden Received 9 December 2008; accepted 14 December 2008 Available online 23 February 2009 Abstract Objective: Premature death and still births are common in Hb Bart's foetal edema which carries significant risk to mothers. We aimed to identify early changes in cardiac structure and function in a cohort of HB Bart's foetuses, using Doppler echocardiography. Methods: We studied 97 HB Bart's foetuses in different gestation groups; I (20–24 weeks),…, V (37–42 weeks) and compared them with age matched controls. We measured right and left atrial diameters as well as right and left ventricular diameters. From the Doppler filling and ejection velocities of the right and left ventricles we measured Tei index in 30 foetuses and compared them with age matched normal controls. Results: The four cardiac chamber dimensions were not significantly different from the respective controls (p = NS for all). The right atrial diameter was enlarged in groups II, III, IV and V (p b 0.05 vs normal controls). The right ventricle was significantly dilated in group III, IV and V (p b 0.05–0.01) compared with normals. The left atrium and left ventricle were enlarged in groups III and IV, respectively (p b 0.05 vs normals). Transmitral and transtricuspid E/A ratio was significantly less than normal in groups III (p b 0.01), IV (p b 0.05) and IV (p b 0.05). LV and RV fractional shortening and stroke distance of group IV and V were significantly less than the respective normals (p b 0.05 for all). LVand RV Tei index increased progressively from 20-week gestation (p b 0.05) with respect to controls. Conclusions: In HB Bart's foetuses left and right ventricular asynchrony develop earlier than overt cavity dilatation and impairment of systolic function. The use of such markers of ventricular asynchronous function may play an important role in optimum management of these pregnancies. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Doppler echocardiography; Hb Bart's foetal edema; Cardiac function; Tei index 1. Introduction α thalassaemia is a common genetic disease that is well established in Southern China, particularly Guangxi [1]. Foet- uses with homozygous thalassaemia, known as Hb Bart's disease, usually die during the last trimester, thus causing significant maternal risk [2,3]. Early identification of ill foet- uses is therefore of particular importance since it may indicate a serious need for termination as an attempt to save mothers, especially those with other co-morbidities. Although invasive investigations have been the corner stone for diagnosis of this condition, Doppler echocardiography [4,5] currently repre- sents the mainstay investigation for such foetuses since it is non-invasive in nature and measurements are easy to obtain and highly reproducible. The aim of this study therefore, was to assess the presence and progression of cardiac dysfunction in Hb Bart's disease foetuses. International Journal of Cardiology 134 (2009) e150 – e154 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Heart Centre, Norrlands University Hospital, SE90185 Umea, Sweden. E-mail address: Michael.henein@medicin.umu.se (M. Henein). 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.12.182