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Patey O, Bartsota M, Maric T, Patel D, Savvidou M, Carvalho JS. Impact of maternal bariatric surgery on offspring perinatal cardiac function: A prospective study. BJOG 2024; 131:1080-1088. [PMID: 38155109 DOI: 10.1111/1471-0528.17747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To assess perinatal cardiac function in offspring of women with previous bariatric surgery and examine its association with maternal glucose control. DESIGN Prospective study. SETTING Maternity unit, UK. POPULATION Fifty-four fetuses/neonates; 29 of post-bariatric surgery women and 25 of women without surgery. METHODS Prospective, longitudinal observational study of pregnant women with and without previous bariatric surgery, matched for early pregnancy body mass index. Cardiac function of all offspring was assessed by two-dimensional conventional, spectral tissue Doppler and speckle-tracking echocardiography at 35-37 weeks of gestation and at 5-7 weeks of age. Maternal glycated haemoglobin (HbA1c) was measured at 27-30 weeks of gestation. Maternal demographics and fetal/infant cardiac function indices were compared between the groups. Correlation coefficient (r) is reported. MAIN OUTCOME MEASURES Fetal/infant cardiac function indices. RESULTS Compared with no-bariatric neonates, offspring of post-bariatric women were smaller at birth (birthweight centiles: 64.96 ± 36.41 versus 40.17 ± 27.99; p = 0.007). There were no significant differences in fetal/infant cardiac function indices and perinatal cardiac changes, between groups. There was a positive correlation between maternal HbA1c and fetal left ventricular (LV) longitudinal strain (r = 0.33) and LV longitudinal strain rate (r = 0.29), suggesting an inverse relation between HbA1c and fetal LV systolic function, but this was mainly seen in offspring of women with no previous bariatric surgery (r = 0.56 and r = 0.50, respectively). CONCLUSIONS Maternal bariatric surgery does not appear to inadvertently affect the offspring cardiac performance. We found an inverse correlation between maternal HbA1c levels and fetal LV systolic function but this was mainly seen in the no-bariatric pregnancies.
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Affiliation(s)
- Olga Patey
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Margarita Bartsota
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Tanya Maric
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Makrina Savvidou
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
- Fetal Medicine Unit, Chelsea & Westminster Hospital, London, UK
| | - Julene S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Zhang J, Xiao S, Zhu Y, Zhang Z, Cao H, Xie M, Zhang L. Advances in the Application of Artificial Intelligence in Fetal Echocardiography. J Am Soc Echocardiogr 2024; 37:550-561. [PMID: 38199332 DOI: 10.1016/j.echo.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
Congenital heart disease is a severe health risk for newborns. Early detection of abnormalities in fetal cardiac structure and function during pregnancy can help patients seek timely diagnostic and therapeutic advice, and early intervention planning can significantly improve fetal survival rates. Echocardiography is one of the most accessible and widely used diagnostic tools in the diagnosis of fetal congenital heart disease. However, traditional fetal echocardiography has limitations due to fetal, maternal, and ultrasound equipment factors and is highly dependent on the skill level of the operator. Artificial intelligence (AI) technology, with its rapid development utilizing advanced computer algorithms, has great potential to empower sonographers in time-saving and accurate diagnosis and to bridge the skill gap in different regions. In recent years, AI-assisted fetal echocardiography has been successfully applied to a wide range of ultrasound diagnoses. This review systematically reviews the applications of AI in the field of fetal echocardiography over the years in terms of image processing, biometrics, and disease diagnosis and provides an outlook for future research.
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Affiliation(s)
- Junmin Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Sushan Xiao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ye Zhu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zisang Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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Yildirim M, Oluklu D, Menekse Beser D, Uyan Hendem D, Tanacan A, Sahin D. The Importance of Tissue Doppler Imaging and M-Mode Ultrasonography in Fetuses With Preterm Premature Rupture of Membranes: A Case-Control Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:85-94. [PMID: 37772464 DOI: 10.1002/jum.16340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/29/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To compare the cardiac functions of fetuses with preterm premature rupture of membranes (PPROM) between their control groups and investigate its relationship with perinatal outcomes. METHODS This prospective study was conducted with 102 pregnant women. Pregnant women with PPROM were divided into two subgroups Group A, between 26 and 30 weeks, and Group B, between 30 and 34 weeks. A control group was formed by randomly including one healthy pregnant woman for each study patient. Sociodemographic, obstetric data, tissue Doppler imaging, and M-mode imaging results were compared. The relationship between echocardiographic parameters and perinatal outcomes was also investigated. RESULTS Tricuspid annular plane systolic excursion (TAPSE), S', and ET' of systolic cardiac parameters were shortened in both groups compared with their controls. Diastolic function indicator E'/A', and global function indicator myocardial performance index' increased in both groups. Isovolumetric contraction time' did not change between groups. A correlation was found between myocardial performance index', and the length of neonatal intensive care unit stay in Group A and TAPSE and duration of respiratory support and length of neonatal intensive care unit stay in Group B. CONCLUSIONS The fetal cardiac function seems to be affected by PPROM, and these changes are associated with neonatal outcomes. Therefore, administering fetal cardiac function evaluation in pregnancies complicated by PPROM may help physicians establish more appropriate clinical management protocols in this special population.
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Affiliation(s)
- Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Oluklu D, Uyan Hendem D, Menekse Beser D, Yildirim M, Laleli Koc B, Kara O, Tanacan A, Sahin D. The influence of maternal inflammatory bowel diseases on fetal cardiac functions: A case-control study. Early Hum Dev 2023; 187:105877. [PMID: 37866290 DOI: 10.1016/j.earlhumdev.2023.105877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/28/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The altered maternal inflammatory milieu and changes in maternal vascular structure (arterial stiffness) and function may affect the fetal heart in pregnant women diagnosed with inflammatory bowel disease (IBD). AIMS To investigate fetal cardiac functions in IBD pregnancies and to reveal the relationship between IBD duration and fetal cardiac functions. STUDY DESIGN Prospective case-control study. SUBJECTS The case group included 19 pregnant women with ulcerative colitis and seven with Crohn's disease who were in remission at the time of the study. The control group consisted of 52 healthy pregnant women matched for gestational age in the third trimester of pregnancy (at 32 to 33 weeks). OUTCOME MEASURES Fetal cardiac functions. The assessment was blinded as to whether the patients were cases or controls. RESULTS The right ventricular E', E'/A', S', and tricuspid annular plane systolic excursion (TAPSE) were significantly lower, and E/E', myocardial performance index (MPI'), and isovolumetric relaxation time (IVRT') were significantly higher in fetuses of IBD pregnancies. Diastolic functions (E/E', E', E'/A', and IVRT'), systolic functions (S' and TAPSE), and global function (MPI') were changed in the case group. A significantly strong correlation was between maternal disease duration and fetal right ventricle diastolic function parameters (E/E', E, E', E'/A') in the case group (r2 = 0.780; p ≤0.001, r2 = 0.570; p ≤0.001, r2 = 0.604; p ≤0.001, r2 = 0.638; p ≤0.001, respectively). CONCLUSION Diastolic and systolic fetal cardiac functions changed in IBD pregnancies. As the disease duration increases, especially fetal cardiac diastolic functions may be affected.
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Affiliation(s)
- Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bergen Laleli Koc
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Liefke J, Sepúlveda-Martinez A, Shakya S, Ehrenborg KS, Arheden H, Morsing E, Ley D, Heiberg E, Hedström E. Early-Onset Fetal Growth Restriction Increases Left Ventricular Sphericity in Adolescents Born Very Preterm. Pediatr Cardiol 2023:10.1007/s00246-023-03265-z. [PMID: 37596421 DOI: 10.1007/s00246-023-03265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023]
Abstract
Left ventricular shape alterations predict cardiovascular outcomes and have been observed in children born preterm and after fetal growth restriction (FGR). The aim was to investigate whether left ventricular shape is altered in adolescents born very preterm and if FGR has an additive effect. Adolescents born very preterm due to verified early-onset FGR and two control groups with birthweight appropriate for gestational age (AGA), born at similar gestational age and at term, respectively, underwent cardiac MRI. Principal component analysis was applied to find the modes of variation best explaining shape variability for end-diastole, end-systole, and for the combination of both, the latter indicative of function. Seventy adolescents were included (13-16 years; 49% males). Sphericity was increased for preterm FGR versus term AGA for end-diastole (36[0-60] vs - 42[- 82-8]; p = 0.01) and the combined analysis (27[- 23-94] vs - 51[- 119-11]; p = 0.01), as well as for preterm AGA versus term AGA for end-diastole (30[- 56-115] vs - 42[- 82-8]; p = 0.04), for end-systole (57[- 29-89] vs - 30[- 79-34]; p = 0.03), and the combined analysis (44[- 50-145] vs - 51[- 119-11]; p = 0.02). No group differences were observed for left ventricular mass or ejection fraction (all p ≥ 0.33). Sphericity was increased after very preterm birth and exacerbated by early-onset FGR, indicating an additive effect to that of very preterm birth on left ventricular remodeling. Increased sphericity may be a prognostic biomarker of future cardiovascular disease in this cohort that as of yet shows no signs of cardiac dysfunction using standard clinical measurements.
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Affiliation(s)
- Jonas Liefke
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Alvaro Sepúlveda-Martinez
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de La Universidad de Chile, Santiago de Chile, Chile
| | - Snehlata Shakya
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Morsing
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - David Ley
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden.
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Radiology, Skåne University Hospital, Lund, Sweden.
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Menekse Beser D, Oluklu D, Uyan Hendem D, Yildirim M, Turgut E, Sahin D. Effect of glycemic control on fetal hearts of pregestational diabetic women by tissue doppler and M-mode imaging. Echocardiography 2023; 40:822-830. [PMID: 37458597 DOI: 10.1111/echo.15649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To determine whether changes in fetal heart function according to glycemic control in pregnant women with Type 1 and Type 2 diabetes using spectral tissue Doppler imaging (TDI) and M-mode imaging. METHODS This study included 68 pregestational diabetic women (DM) at 30-32 gestational weeks. All participants were divided into two groups: type 1(n = 17) and type 2(n = 51), and then these groups were divided into the subgroups as well-controlled and poorly controlled, according to fasting glucose (FG) and 1-h postprandial glucose (PPG) values. Cardiac parameters were compared for well- and poorly-controlled groups with TDI and M-mode imaging. The correlation of cardiac parameters with FG, PPG, and HbA1c values was evaluated. Their roles in predicting neonatal outcomes were also assessed. RESULTS Thickness measurements, early diastolic annular peak velocity (E'), late diastolic annular peak velocity (A'), tissue isovolumetric relaxation time (IRT'), and tissue myocardial performance index (MPI') were increased in both poorly controlled groups. Tissue ejection time (ET') was significantly reduced in the poorly controlled groups, while tissue isovolumetric contraction time (ICT') was not significantly changed in any group. Tricuspid, mitral, and septal annular plane excursions (TAPSE, MAPSE, and SAPSE, respectively) were significantly decreased in all poorly controlled subgroups. E', E'/A', MPI', IRT', ET', and M-mode imaging parameters significantly correlated with FG notably. CONCLUSION Maternal hyperglycemia leads to subtle changes in systolic and diastolic functions both in the interventricular septum and ventricles, so it is essential to ensure glycemic control in both Type 1 and Type 2 DM.
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Affiliation(s)
- Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Oluklu D, Menekse Beser D, Uyan Hendem D, Yıldırım M, Lalelı Koc B, Tanacan A, Sahin D. Assessment of fetal cardiac morphology and functional changes in early-onset and late-onset fetal growth restriction. Int J Gynaecol Obstet 2023; 161:241-249. [PMID: 36453150 DOI: 10.1002/ijgo.14602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To compare the fetal cardiac morphology and functions of early-onset fetal growth restriction (EO-FGR) and late-onset fetal growth restriction (LO-FGR) groups with gestational weeks-matched controls. METHODS A total of 164 pregnant women were included, 28 of whom were in the EO-FGR group, 54 in the LO-FGR group, and 82 in the control group. Fetal echocardiographic evaluation was performed with two-dimensional, M-mode, tissue Doppler imaging (TDI), and pulsed wave Doppler. RESULTS Fetal cardiac morphologic measurements and diastolic and systolic functions changed in EO-FGR and LO-FGR fetuses compared with controls. The EO- and LO-FGR fetuses had reduced right and left cardiac output, increased myocardial performance index, and significantly higher mitral and tricuspid E/E' ratios compared with controls. The EO-FGR fetuses had lower mitral and tricuspid E and E' values. In LO-FGR fetuses, mitral and tricuspid E' values were lower than in their controls (P = 0.001 and P < 0.001). On the other hand, the mitral and tricuspid E values were not significantly changed (P = 0.107 and P = 0.196). CONCLUSION We hypothesized that EO-FGR and LO-FGR fetuses had insufficient myocardial maturation. Especially in the LO-FGR fetuses, TDI is the earliest and most sensitive technique to show subtle changes in fetal cardiac functions.
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Affiliation(s)
- Deniz Oluklu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yıldırım
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bergen Lalelı Koc
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Domínguez-Gallardo C, Ginjaume-García N, Ullmo J, Fernández-Oliva A, Parra J, Vázquez A, Cruz-Lemini M, Llurba E. Longitudinal Behavior of Left-Ventricular Strain in Fetal Growth Restriction. Diagnostics (Basel) 2023; 13:diagnostics13071252. [PMID: 37046470 PMCID: PMC10093576 DOI: 10.3390/diagnostics13071252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses.
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Youssef L, Castellani R, Valenzuela-Alcaraz B, Sepulveda-Martinez Á, Crovetto F, Crispi F. Cardiac remodeling from the fetus to adulthood. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:249-264. [PMID: 36785500 DOI: 10.1002/jcu.23336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/10/2022] [Accepted: 07/24/2022] [Indexed: 06/18/2023]
Abstract
Prenatal cardiac remodeling refers to in utero changes in the fetal heart that occur as a response to an adverse intrauterine environment. In this article, we will review the main mechanisms leading to cardiac remodeling and dysfunction, summarizing and describing the major pathological conditions that have been reported to be related to this in utero plastic adaptive process. We will also recap the current evidence regarding the persistence of fetal cardiac remodeling and dysfunction, both in infancy and later in adult life. Moreover, we will discuss primary, secondary, and tertiary preventive measures and future clinical and research aspects.
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Affiliation(s)
- Lina Youssef
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Roberta Castellani
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Brenda Valenzuela-Alcaraz
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Álvaro Sepulveda-Martinez
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Clínica Alemana de Santiago, Santiago de Chile, Chile
| | - Francesca Crovetto
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Fàtima Crispi
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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Gómez O, Nogué L, Soveral I, Guirado L, Izquierdo N, Pérez-Cruz M, Masoller N, Escobar MC, Sanchez-de-Toledo J, Martínez-Crespo JM, Bennasar M, Crispi F. Cord blood cardiovascular biomarkers in tetralogy of fallot and D-transposition of great arteries. Front Pediatr 2023; 11:1151814. [PMID: 37187588 PMCID: PMC10175815 DOI: 10.3389/fped.2023.1151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Previous reports suggest that cord blood biomarkers could serve as a prognostic tool for conotruncal congenital heart defects (CHD). We aimed to describe the cord blood profile of different cardiovascular biomarkers in a prospective series of fetuses with tetralogy of Fallot (ToF) and D-transposition of great arteries (D-TGA) and to explore their correlation with fetal echocardiography and perinatal outcome. Methods A prospective cohort study (2014-2019), including fetuses with isolated ToF and D-TGA and healthy controls, was conducted at two tertiary referral centers for CHD in Barcelona. Obstetric ultrasound and fetal echocardiography were performed in the third trimester and cord blood was obtained at delivery. Cord blood concentrations of N-terminal precursor of B-type natriuretic peptide, Troponin I, transforming growth factorβ (TGFβ), placental growth factor, and soluble fms-like tyrosine kinase-1 were determined. Results Thirty-four fetuses with conotruncal-CHD (22 ToF and 12 D-TGA) and 36 controls were included. ToF-fetuses showed markedly increased cord blood TGFβ (24.9 ng/ml (15.6-45.3) vs. normal heart 15.7 ng/ml (7.2-24.3) vs. D-TGA 12.6 ng/ml (8.7-37.9); P = 0.012). These results remained statistically significant even after adjusting for maternal body mass index, birth weight and mode of delivery. TGFß levels showed a negative correlation with the pulmonary valve diameter z-score at fetal echocardiography (r = -0.576, P = 0.039). No other differences were found in the rest of cord blood biomarkers among the study populations. Likewise, no other significant correlations were identified between cardiovascular biomarkers, fetal echocardiography and perinatal outcome. Conclusions This study newly describes increased cord blood TGFβ concentrations in ToF compared to D-TGA and normal fetuses. We also demonstrate that TGFβ levels correlate with the severity of right ventricle outflow obstruction. These novel findings open a window of research opportunities on new prognostic and potential preventive strategies.
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Affiliation(s)
- Olga Gómez
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Fetal Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Correspondence: Olga Gómez
| | - Laura Nogué
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Iris Soveral
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- Department of Obstetrics, Hospital General de Hospitalet, Barcelona, Spain
| | - Laura Guirado
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Nora Izquierdo
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Miriam Pérez-Cruz
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- Sant Joan de Déu Research Institute (IRSJD), Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network, Carlos III Health Institute, Madrid, Spain
| | - Narcís Masoller
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - María Clara Escobar
- Sant Joan de Déu Research Institute (IRSJD), Barcelona, Spain
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Sant Joan de Déu Research Institute (IRSJD), Barcelona, Spain
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Josep Maria Martínez-Crespo
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Fetal Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Mar Bennasar
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center, Sant Joan de Déu Hospital, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Fetal Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
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Pan M, Li W, Guo X, Mao Y, Peng X, Sun X, Huang C, Wang B, Zhao B. Preliminary study on the evaluation of mitral annulus displacement in normal fetuses by automated cardiac motion quantitation. J Matern Fetal Neonatal Med 2022; 35:5872-5880. [PMID: 33706654 DOI: 10.1080/14767058.2021.1900102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the characteristics of mitral annular plane systolic excursion (MAPSE) in different longitudinal directions in normal fetuses using a new method, automatic cardiac motion quantification (aCMQ). METHODS A cross-sectional study was conducted in 164 fetuses with structurally normal hearts. The time-displacement curves of the septal mitral annulus (SMA) in three directions, including point A, B and C (MAPSE-SMA-A, MAPSE-SMA-B, MAPSE-SMA-C), were recorded by aCMQ. The time to peak (TTP) in three directions, including point A, B and C (TTP-SMA-A, TTP-SMA-B, TTP-SMA-C) were recorded. In the same way, various parameters of the lateral mitral annulus (LMA) were obtained including MAPSE-LMA-A, MAPSE-LMA-B, MAPSE-LMA-C, TTP-LMA-A, TTP-LMA-B and TTP-LMA-C. Free angle M-mode echocardiography (FAM) was used to obtain MAPSE of LMA (FAM-MAPSE). Finally, all the data were analyzed statistically. RESULTS MAPSE was positively correlated with gestational age, and the difference between the second- and third-trimester groups was statistically significant. MAPSE-LMA in point B and C were greater than those of SMA. MAPSE-LMA-C and MAPSE-SMA-A were the largest in three directions.The difference between point B and C were statistically significant (p < .05), with no significant difference at point A (p > .05). There was no significant difference found in all TTP (all p > .05). The MAPSE-LMA-C was less than the FAM-MAPSE, and the differences were found significantly (p < .05), but there was better correlation (p < .05). CONCLUSIONS The longitudinal movement of the fetal mitral annulus is comprehensive, with multiple directions and different displacements. Perpendicular to the mitral annulus is the maximum displacement. It is positively related to the gestational age. From the second trimester, the longitudinal contraction of the left ventricle wall has good synchronization. It possesses clinical value in selecting different methods and parameters during evaluating left ventricular function.
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Affiliation(s)
- Mei Pan
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Wengang Li
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xianfeng Guo
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaolu Sun
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Chao Huang
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Bei Wang
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
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Menekse Beser D, Oluklu D, Uyan Hendem D, Yildirim M, Tugrul Ersak D, Goncu Ayhan S, Sahin D. Fetal echocardiographic evaluation before and after nifedipine treatment in preterm labor. Echocardiography 2022; 39:1245-1251. [PMID: 36029144 DOI: 10.1111/echo.15444] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/06/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the effect of nifedipine used for tocolysis on cardiac morphology and functions. METHODS The study included 47 pregnant women diagnosed with preterm labor at 32-33 weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI) before and after the 48th hour of nifedipine treatment. RESULTS No significant change was observed in Doppler parameters (pulsatility indices of the umbilical artery, middle cerebral artery, ductus venosus) and cardiac morphology (cardiothoracic ratio, end-diastolic longitudinal diameters, sphericity indices, wall thickness) after nifedipine treatment. The parameters obtained with TDI (e', a', s', e'/a', E/e' of mitral and tricuspid valves), M- mode (TAPSE, MAPSE), pulsed Doppler (myocardial performance index, left cardiac output, right cardiac output, tricuspid E, A waves, tricuspid E/A ratio, mitral E, A waves, mitral E/A ratio) did not change after nifedipine treatment. CONCLUSION To date, this is the first study to examine the effects of nifedipine on the fetal heart using the TDI. Since nifedipine is a drug that is frequently used and well-tolerated in the prevention of preterm labor, it is crucial that it does not cause changes in fetal cardiac parameters during tocolysis. Therefore, we used TDI in addition to conventional methods to evaluate the effect of nifedipine, which is frequently used in obstetrics, on cardiac functions in the early period. Nifedipine treatment seems not to affect systolic or diastolic functions. This indicates that nifedipine is reliable on cardiac functions and morphology in pregnancies treated for preterm labor.
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Affiliation(s)
- Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Duygu Tugrul Ersak
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Turgut E, Özdemir H, Turan G, Bayram M, Karcaaltincaba D. Comparison of cardiac morphology and function in small for gestational age fetuses and fetuses with late-onset fetal growth retardation. J Perinat Med 2022; 50:391-397. [PMID: 34905668 DOI: 10.1515/jpm-2021-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare cardiac structural and functional findings of fetuses with fetal growth restriction (FGR) and small for gestational age (SGA). METHODS In this prospective cohort study, patients were classified into three groups using Delphi procedure according to fetal weight, umbilical, uterine artery Doppler and cerebroplacental ratio. Fetal cardiac ultrasonographic morphology and Doppler examination was performed to all pregnant women at 36 weeks of gestation. RESULTS Seventy three patients were included in the study. There were one (6.7%) patient in the control group, 2 (13.3%) in the SGA group and 12 (80%) in the FGR group who needed neonatal intensive care unit (NICU) and NICU requirement was significantly higher in FGR fetuses (p<0.001). Left spherical index was found to be lower only among FGR fetuses (p=0.046). Left ventricular wall thickness was decreased and the right/left ventricular wall ratio was increased in FGR fetuses (p=0.006, p<0.001). Tricuspid/mitral valve ratio and mitral annular plane systolic excursion value was lower in FGR fetuses (p=0.034, p=0.024 respectively). Also, myocardial performance index was remarkably higher in FGR group (p=0.002). CONCLUSIONS We detected cardiac morphological changes in cases of both SGA and FGR-more pronounced in the FGR cases. Findings related to morphological changes on the left side in FGR cases were considered secondary to volume increase in FGR cases as an indicator of a brain-protective effect. In the FGR group, both systolic and diastolic dysfunctions were detected in the left heart.
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Affiliation(s)
- Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Halis Özdemir
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Gökçe Turan
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Merih Bayram
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Deniz Karcaaltincaba
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
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Oluklu D, Kara O, Turgut E, Goncu Ayhan S, Yildirim M, Sahin D. Evaluation of fetal cardiac morphology and functions in pregnant women with familial Mediterranean fever. Echocardiography 2022; 39:606-611. [PMID: 35279878 DOI: 10.1111/echo.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We aimed to evaluate and compare fetal cardiac morphology and functions of pregnant women with familial Mediterranean fever (FMF) and healthy pregnant women. METHODS The study included 34 pregnant women with FMF and 68 healthy pregnant women matched with maternal age, gravidity, parity, gestational age, and pre-pregnancy body mass index (BMI) in 34th-37th gestational weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode imaging, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI). RESULTS Fetal cardiac morphological measures, including cardiothoracic ratio, cardiac axis angle, right and left ventricular area, sphericity index, and ventricular septal thickness was similar in both groups. Compared with the control group, myocardial performance index (MPI), which indicates global myocardial performance, was significantly higher, and ejection time (ET) was significantly shortened in the FMF group. In addition, which shows the diastolic functional parameters such as, tricuspid E wave, E/A, E/E' ratio, and mitral E wave, E/A, E/E' ratio, were significantly higher; tricuspid A and mitral A waves were significantly lower. We found that mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) were significantly lower in those with FMF duration over eight years than those with FMF duration less than 8 years. CONCLUSION There is no fetal cardiac morphological change in pregnant women with FMF. However, there may be changes in diastolic function. As the maternal FMF duration increases, systolic functions may also change.
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Affiliation(s)
- Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Drogalis-Kim D, Cheifetz I, Robbins N. Early nutritional influences of cardiovascular health. Expert Rev Cardiovasc Ther 2021; 19:1063-1073. [PMID: 34927523 DOI: 10.1080/14779072.2021.2021070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke. AREAS COVERED This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD. EXPERT OPINION Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.
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Affiliation(s)
- Diana Drogalis-Kim
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Ira Cheifetz
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Nathaniel Robbins
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Herling L, Johnson J, Ferm-Widlund K, Zamprakou A, Westgren M, Acharya G. Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:853-863. [PMID: 34096674 DOI: 10.1002/uog.23703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The primary aim of this study was to evaluate the feasibility of automated measurement of fetal atrioventricular (AV) plane displacement (AVPD) over several cardiac cycles using myocardial velocity traces obtained by color tissue Doppler imaging (cTDI). The secondary objectives were to establish reference ranges for AVPD during the second half of normal pregnancy, to assess fetal AVPD in prolonged pregnancy in relation to adverse perinatal outcome and to evaluate AVPD in fetuses with a suspicion of intrauterine growth restriction (IUGR). METHODS The population used to develop the reference ranges consisted of women with an uncomplicated singleton pregnancy at 18-42 weeks of gestation (n = 201). The prolonged-pregnancy group comprised women with an uncomplicated singleton pregnancy at ≥ 41 + 0 weeks of gestation (n = 107). The third study cohort comprised women with a singleton pregnancy and suspicion of IUGR, defined as an estimated fetal weight < 2.5th centile or an estimated fetal weight < 10th centile and umbilical artery pulsatility index > 97.5th centile (n = 35). Cineloops of the four-chamber view of the fetal heart were recorded using cTDI. Regions of interest were placed at the AV plane in the left and right ventricular walls and the interventricular septum, and myocardial velocity traces were integrated and analyzed using an automated algorithm developed in-house to obtain mitral (MAPSE), tricuspid (TAPSE) and septal (SAPSE) annular plane systolic excursion. Gestational-age specific reference ranges were constructed and normalized for cardiac size. The correlation between AVPD measurements obtained using cTDI and those obtained by anatomic M-mode were evaluated, and agreement between these two methods was assessed using Bland-Altman analysis. The mean Z-scores of fetal AVPD in the cohort of prolonged pregnancies were compared between cases with normal and those with adverse outcome using Mann-Whitney U-test. The mean Z-scores of fetal AVPD in IUGR fetuses were compared with those in the normal reference population using Mann-Whitney U-test. Inter- and intraobserver variability for acquisition of cTDI recordings and offline analysis was assessed by calculating coefficients of variation (CV) using the root mean square method. RESULTS Fetal MAPSE, SAPSE and TAPSE increased with gestational age but did not change significantly when normalized for cardiac size. The fitted mean was highest for TAPSE throughout the second half of gestation, followed by SAPSE and MAPSE. There was a significant correlation between MAPSE (r = 0.64; P < 0.001), SAPSE (r = 0.72; P < 0.001) and TAPSE (r = 0.84; P < 0.001) measurements obtained by M-mode and those obtained by cTDI. The geometric means of ratios between AVPD measured by cTDI and by M-mode were 1.38 (95% limits of agreement (LoA), 0.84-2.25) for MAPSE, 1.00 (95% LoA, 0.72-1.40) for SAPSE and 1.20 (95% LoA, 0.92-1.57) for TAPSE. In the prolonged-pregnancy group, the mean ± SD Z-scores for MAPSE (0.14 ± 0.97), SAPSE (0.09 ± 1.02) and TAPSE (0.15 ± 0.90) did not show any significant difference compared to the reference ranges. Twenty-one of the 107 (19.6%) prolonged pregnancies had adverse perinatal outcome. The AVPD Z-scores were not significantly different between pregnancies with normal and those with adverse outcome in the prolonged-pregnancy cohort. The mean ± SD Z-scores for SAPSE (-0.62 ± 1.07; P = 0.006) and TAPSE (-0.60 ± 0.89; P = 0.002) were significantly lower in the IUGR group compared to those in the normal reference population, but the differences were not significant when the values were corrected for cardiac size. The interobserver CVs for the automated measurement of MAPSE, SAPSE and TAPSE were 28.1%, 17.7% and 15.3%, respectively, and the respective intraobserver CVs were 33.5%, 15.0% and 17.9%. CONCLUSIONS This study showed that fetal AVPD can be measured automatically by integrating cTDI velocities over several cardiac cycles. Automated analysis of AVPD could potentially help gather larger datasets to facilitate use of machine-learning models to study fetal cardiac function. The gestational-age associated increase in AVPD is most likely a result of increasing cardiac size, as the AVPD normalized for cardiac size did not change significantly between 18 and 42 weeks. A decrease was seen in TAPSE and SAPSE in IUGR fetuses, but not after correction for cardiac size. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Herling
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - J Johnson
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - K Ferm-Widlund
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - A Zamprakou
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Pregnancy and Delivery Medical Unit, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - M Westgren
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - G Acharya
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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Saglam A, Derwig I, Gul M, Kasap B, Yilmaz N, Sezik M, Celik O, Tiryaki S, Özcil MD, Sipahioğlu H, İnci S, Demircan F. Foetal cardiac function in third trimester pregnancies with reduced fetal movements. J OBSTET GYNAECOL 2021; 42:28-34. [PMID: 33938348 DOI: 10.1080/01443615.2020.1869706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of our study was to investigate the possible relationship between poor perinatal outcome and foetal cardiac functions in pregnant women with reduced foetal movements (RFM). This cross-sectional study included 126 pregnant women with normal foetal movements (Group 1, Controls) and 42 pregnant women over 32 weeks gestation with RFM (Group 2). Group 2 was further divided into two subgroups according to their perinatal outcome: normal perinatal outcome (Group 2a) and poor perinatal outcome (Group 2b). Cardiotocography, the E/A ratio in both atrioventricular valves, myocardial performance index (MPI) and foetal tricuspid annular plane systolic excursion (f-TAPSE) were evaluated. Foetuses with poor perinatal outcome had a higher MPI (p = .003), higher tricuspid and mitral E/A (p < .001), and lower f-TAPSE values (p < .001). In regression analysis, f-TAPSE was the only parameter (p = .04) independently associated with poor perinatal outcome. İn conclusion, examining f-TAPSE may predict adverse perinatal outcome in pregnancies with RFM.IMPACT STATEMENTWhat is already known on this subject? Reduced foetal movement (RFM) is associated with adverse pregnancy outcome. Cardiotocography, amniotic fluid assessment, estimated birthweight, foetal Doppler and formal foetal movement count (kick chart) are generally used in the clinical assessment of pregnancies with reduced foetal movements. These tests, we currently use to assess foetal wellbeing in women with reduced foetal movements, have limited sensitivity in predicting foetal compromise.What do the results of this study add? Foetal cardiac Doppler may potentially be used as an important adjunct to the conventional management of women with a perception of reduced foetal movements.What are the implications of these findings for clinical practice and/or further research? Foetal echocardiographic evaluation, such as f-TAPSE, may influence clinical practice by enabling improved risk stratification for poor perinatal outcome, thus allowing more timely definitive intervention. This could help to decrease the rate of stillbirth related to reduced foetal movements. The few established echocardiographically derived parameters, which can asses global right ventricle function, are not always easy to obtain, however, f-TAPSE is easily obtainable using ultrasound and it appears to be a clinically useful echocardiographic measurement of right ventricular function.
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Affiliation(s)
- Aylin Saglam
- Department of Obstetrics and Gynecology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Iris Derwig
- Chelsea Westminster Hospital NHS Foundation Trust, London, England
| | - Murat Gul
- Department of Cardiology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Burcu Kasap
- Department of Obstetrics and Gynecology, Mugla Sıtkı Koçman University, Muğla, Turkey
| | - Nuh Yilmaz
- Department of Pediatric Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Mekin Sezik
- Department of Obstetrics and Gynecology, Department of Perinatology, Isparta Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Onder Celik
- Private Clinic Obstetrics and Gynecology, Usak, Turkey
| | - Sibel Tiryaki
- Department of Pediatric Cardiology, Mugla Sıtkı Koçman University, Muğla, Turkey
| | - Mustafa Doğan Özcil
- Department of Obstetrics and Gynecology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Haydar Sipahioğlu
- Department of Obstetrics and Gynecology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Sinan İnci
- Department of Cardiology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Fadime Demircan
- Department of Obstetrics and Gynecology, Uskudar Yunus Emre Hospital, Istanbul, Turkey
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18
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Semmler J, Abdel-Azim S, Anzoategui S, Zhang H, Nicolaides KH, Charakida M. Influence of birth weight on fetal cardiac indices at 35-37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:266-272. [PMID: 33094501 DOI: 10.1002/uog.23522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Echocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation. METHODS This was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy-induced hypertension or pre-eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA-PI by UA-PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters. RESULTS The study population included 146 (9.7%) small-for-gestational-age (SGA) fetuses with birth weight < 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non-SGA and non-FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth-weight Z-score. There were no significant associations between cardiac morphological and functional indices and UtA-PI Z-score or CPR Z-score. CONCLUSIONS This screening study at 35-37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphology and function but UtA-PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Semmler
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - S Abdel-Azim
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - S Anzoategui
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - H Zhang
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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19
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Fetal cardiac function by mitral and tricuspid annular plane systolic excursion using spatio-temporal image correlation M-mode and left cardiac output in fetuses of pregestational diabetic mothers. Obstet Gynecol Sci 2021; 64:257-265. [PMID: 33499582 PMCID: PMC8138066 DOI: 10.5468/ogs.20274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) and cardiac output (CO) in fetuses of pregnant women with pregestational diabetes mellitus (DM) using spatio-temporal image correlation M-mode (STIC-M) and virtual organ computer-aided analysis (VOCAL). Methods This study was prospective and cross-sectional. It included 45 fetuses each from mothers with pregestational DM and healthy mothers, with gestation ages ranging from 20 to 36.6 weeks. The fetal cardiac volumes were obtained and analyzed by STIC and VOCAL methods. MAPSE and TAPSE were measured by STIC-M in the apical or basal four-chamber view. The values of the right (RV) and left ventricular (LV) CO were calculated by STIC and VOCAL. Results The median values of TAPSE were 6.1 and 6.2 mm in the diabetic and control groups (P<0.001), respectively. The median values of MAPSE were 4.6 mm in the fetuses of mothers with diabetes and 4.8 mm in fetuses of healthy mothers. The fetal LV CO (60.4 L/min vs. 71.1 L/min; P=0.033, respectively) and RV CO (65.2 vs. 70.1 L/min; P=0.026, respectively) were lower in the pregestational DM group than in the control group. A significant effect of pregestational DM was observed in all functional parameters after adjusting, with fetal heart rate as covariant. There was moderate significant positive correlation between MAPSE and LV CO (r=0.53; P=0.0001) and between TAPSE and RV CO (r=0.46; P=0.0001). Conclusion Significant difference in functional parameters (TAPSE, MAPSE and LV CO) obtained by STIC and VOCAL were observed in the fetuses of the pregestational DM group compared to those of the control group.
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20
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Soveral I, Crispi F, Walter C, Guirado L, García-Cañadilla P, Cook A, Bonnin A, Dejea H, Rovira-Zurriaga C, Sánchez de Toledo J, Gratacós E, Martínez JM, Bijnens B, Gómez O. Early cardiac remodeling in aortic coarctation: insights from fetal and neonatal functional and structural assessment. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:837-849. [PMID: 31909552 DOI: 10.1002/uog.21970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Coarctation of the aorta (CoA) is associated with left ventricular (LV) dysfunction in neonates and adults. Cardiac structure and function in fetal CoA and cardiac adaptation to early neonatal life have not been described. We aimed to investigate the presence of cardiovascular structural remodeling and dysfunction in fetuses with CoA and their early postnatal cardiac adaptation. METHODS This was a prospective observational case-control study, conducted between 2011 and 2018 in a single tertiary referral center, of fetuses with CoA and gestational age-matched normal controls. All fetuses/neonates underwent comprehensive echocardiographic evaluation in the third trimester of pregnancy and after birth. Additionally, myocardial microstructure was assessed in one fetal and one neonatal CoA-affected heart specimen, using synchrotron radiation-based X-ray phase-contrast microcomputed tomography and histology, respectively. RESULTS We included 30 fetuses with CoA and 60 gestational age-matched controls. Of these, 20 CoA neonates and 44 controls were also evaluated postnatally. Fetuses with CoA showed significant left-to-right volume redistribution, with right ventricular (RV) size and output dominance and significant geometry alterations with an abnormally elongated LV, compared with controls (LV midventricular sphericity index (median (interquartile range; IQR), 2.4 (2.0-2.7) vs 1.8 (1.7-2.0); P < 0.001). Biventricular function was preserved and no ventricular hypertrophy was observed. Synchrotron tomography and histological assessment revealed normal myocyte organization in the fetal and neonatal specimens, respectively. Postnatally, the LV in CoA cases showed prompt remodeling, becoming more globular (LV midventricular sphericity index (mean ± SD), 1.5 ± 0.3 in CoA vs 1.8 ± 0.2 in controls; P < 0.001) with preserved systolic and normalized output, but altered diastolic, parameters compared with controls (LV inflow peak velocity in early diastole (mean ± SD), 97.8 ± 14.5 vs 56.5 ± 12.9 cm/s; LV inflow peak velocity in atrial contraction (median (IQR), 70.5 (60.1-84.9) vs 47.0 (43.0-55.0) cm/s; LV peak myocardial velocity in atrial contraction (mean ± SD), 5.1 ± 2.6 vs 6.3 ± 2.2 cm/s; P < 0.05). The neonatal RV showed increased longitudinal function in the presence of a patent arterial duct. CONCLUSIONS Our results suggest unique fetal cardiac remodeling in CoA, in which the LV stays smaller from the decreased growth stimulus of reduced volume load. Postnatally, the LV is acutely volume-loaded, resulting in an overall geometry change with higher filling velocities and preserved systolic function. These findings improve our understanding of the evolution of CoA from fetal to neonatal life. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Soveral
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
| | - F Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - C Walter
- Pediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - L Guirado
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
| | - P García-Cañadilla
- PhySense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- Institute of Cardiovascular Science, University College London, London, UK
| | - A Cook
- Institute of Cardiovascular Science, University College London, London, UK
| | - A Bonnin
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland
| | - H Dejea
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland
- Institute for Biomedical Engineering, ETH Zürich, Zürich, Switzerland
| | - C Rovira-Zurriaga
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - E Gratacós
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - J M Martínez
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- PhySense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - O Gómez
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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van Oostrum NHM, Derks K, van der Woude DAA, Clur SA, Oei SG, van Laar JOEH. Two-dimensional Speckle tracking echocardiography in Fetal Growth Restriction: a systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 254:87-94. [PMID: 32950891 DOI: 10.1016/j.ejogrb.2020.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/12/2022]
Abstract
Background Fetal growth restriction (FGR), defined as an estimated fetal weight (EFW)<10th percentile, is associated with an increased risk for adverse fetal and neonatal outcome. Early antenatal diagnosis is important and remains challenging. Deformation changes in the fetal myocardium are early signs of myocardial dysfunction. These changes can be measured using two-dimensional speckle tracking echocardiography (2D-STE) to predict impaired placental function in the growth restricted fetus. Aim To review the literature on fetal heart deformation values measured with 2D-STE, in fetuses with an EFW< 10th centile and appropriate for gestational age (AGA) fetuses, and to compare the results in both groups. Methods The EMBASE, Medline, and Cochrane databases were searched from inception until April 2020. Observational studies on evaluating the cardiac deformation values longitudinal strain, strain rate, and/or global dyssynchrony of both ventricles in FGR, using 2D-STE, were included. Methodological quality was assessed using the Newcastle-Ottowa risk of bias scale. Results Four studies met the inclusion criteria. The mean gestational age (GA) varied from 30 to 38 weeks in the FGR group and 20 to 40 weeks in AGA fetuses. The number of included FGR fetuses (with or without Doppler abnormalities), varied from 30 to 50. Longitudinal strain in FGR fetuses was described as comparable (n = 2), increased (n = 1) and>95th percentile (n = 1) compared to AGA fetuses. Strain rate was measured in two studies. One reported an increased strain rate, another showed comparable strain rate. Two studies addressed global left ventricle (LV) and right ventricle (RV) dyssynchrony. Dyssynchrony was increased in FGR compared to AGA fetuses. Conclusion The currently published data is limited and heterogeneous concerning GA and Doppler profiles. The data presentation and the interpretation thereof make qualitative comparisons impossible. Large prospective longitudinal cohort studies looking at the value of deformation measurements of the fetal heart in FGR and AGA fetuses are needed to assess the clinical significance of deformation values measured with 2D-STE.
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Affiliation(s)
- Noortje H M van Oostrum
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Kris Derks
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S A Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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22
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van Oostrum NHM, van der Woude DAA, Clur SAB, Oei SG, van Laar JOEH. Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses. Prenat Diagn 2020; 40:1525-1531. [PMID: 32735353 DOI: 10.1002/pd.5805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Small for gestational age (SGA) fetuses have an increased risk for adverse outcome. Placental insufficiency leads to changes in the circulation, with secondary adaptation of the fetal heart resulting in changed cardiac deformation. This deformation can be measured with 2D speckle tracking echocardiography (2D-STE). SGA is antenatally often undiagnosed. The measurement of deformation changes in the fetal heart might help in the prediction of SGA and identify fetuses in need of more intensive surveillance. METHODS In this longitudinal prospective cohort study, global longitudinal strain (GLS) and strain rate (GLSR), measured before 23 weeks gestational age were compared between SGA and appropriate for gestational age (AGA) fetuses, based on birthweight corrected for gestational age at birth. RESULTS The fetal heart rate was significantly increased in SGA; 158 beats per minute (146-163) vs 148 (134-156); P = 0.035 in AGA. Right ventricle GLS (RV-GLS) values were significantly increased in SGA; -15.87% (-11.69% to -20.55%) vs -20.24% (-16.29% to -24.28%); p = 0.024, respectively. CONCLUSION RV-GLS values, measured with 2D-STE, were significantly increased in SGA, indicating systolic RV dysfunction before 23 weeks gestational age in fetuses who will become SGA later in pregnancy. A large longitudinal prospective cohort study is needed to confirm these findings.
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Affiliation(s)
- Noortje H M van Oostrum
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Sally-Ann B Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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23
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Peixoto AB, Bravo-Valenzuela NJ, Martins WP, Tonni G, Mattar R, Moron AF, Pares DB, Araujo Júnior E. Reference ranges for the fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (mitral annular plane systolic excursion, tricuspid annular plane systolic excursion, and septum annular plane systolic excursion) between 20 and 36 + 6 weeks of gestation. J Perinat Med 2020; 48:601-608. [PMID: 32609650 DOI: 10.1515/jpm-2020-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
Objectives This study aimed to establish reference ranges for fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (MAPSE, TAPSE, and SAPSE) in normal pregnant women between 20 and 36 + 6 weeks of gestation. Methods This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. MAPSE, TAPSE, and SAPSE were measured by M-mode in real time in an apical or basal four-chamber view through placing the cursor at the atrioventricular junction, marked by the valve rings at the tricuspid, mitral, and basal septum, respectively. A regression analysis was done to determine the appropriate polynomial equation model for both measurements and standard deviation (SD) values in relation to gestational age (GA). The intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC) and limits of agreement (LoA). Results There was a significant positive correlation between MAPSE (r=0.705, p<0.0001), TAPSE (r=0.804, p<0.0001), and SAPSE (r=0.690, p<0.0001) and GA. The mean of each parameter ranged as follows: 2.87-5.56 mm, MAPSE; 3.98-8.07 mm, TAPSE; and 2.34-4.21 mm, SAPSE. Poor/moderate intra- and inter-observer reliability (CCC between 0.70 and 0.90) and poor/moderate agreement of all the tested parameters were evaluated (LoA between 10 and 50%). Conclusions Reference values were established for the fetal MAPSE, TAPSE, and SAPSE between 20 and 36 + 6 weeks of gestation in low-risk pregnant women. These parameters showed poor/moderate reproducibility.
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Affiliation(s)
- Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.,Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba-MG, Brazil.,Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | | | | | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Guastalla, Italy
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - David Baptista Pares
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Lee-Tannock A, Hay K, Gooi A, Kumar S. Longitudinal Reference Ranges for Tricuspid Annular Plane Systolic Excursion and Mitral Annular Plane Systolic Excursion in Normally Grown Fetuses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:929-937. [PMID: 31737932 DOI: 10.1002/jum.15177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to construct reference ranges for fetal tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) using conventional M-mode ultrasound (US) in the second half of pregnancy. METHODS Participants underwent US scans every 4 weeks from 18 weeks' gestation until delivery. The TAPSE and MAPSE were measured by conventional M-mode US at each examination. The relationships between TAPSE and MAPSE and gestational age and estimated fetal weight were modeled by Bayesian mixed effects linear regression. RESULTS Positive linear relationships were observed between both MAPSE and TAPSE and gestational age and estimated fetal weight. Reference centiles for TAPSE and MAPSE were developed. CONCLUSIONS This simple technique is a useful tool for assessing cardiac function and could be used for quantitative assessments of fetal cardiac function, particularly in high-risk pregnancies such as those complicated by maternal diabetes.
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Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Karen Hay
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alex Gooi
- Mater Health Services, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
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Bravo-Valenzuela NJ, Peixoto AB, Carrilho MC, Siqueira Pontes AL, Chagas CC, Simioni C, Araujo Júnior E. Fetal cardiac function by three-dimensional ultrasound using 4D-STIC and VOCAL - an update. J Ultrason 2019; 19:287-294. [PMID: 32021711 PMCID: PMC6988455 DOI: 10.15557/jou.2019.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023] Open
Abstract
Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.
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Affiliation(s)
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Milene Carvalho Carrilho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Caroline Cevante Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Christiane Simioni
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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DeVore GR, Gumina DL, Hobbins JC. Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile. Am J Obstet Gynecol 2019; 221:498.e1-498.e22. [PMID: 31153929 DOI: 10.1016/j.ajog.2019.05.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether abnormal global, transverse, and longitudinal ventricular contractility of the heart in fetuses with an estimated fetal weight <10th centile is present, irrespective of Doppler studies of the umbilical artery and cerebroplacental ratio. STUDY DESIGN This was a retrospective study of 50 fetuses with an estimated fetal weight <10th centile that were classified based on Doppler results from the pulsatility indices of the umbilical artery and middle cerebral artery, and the calculated cerebroplacental ratio (pulsatility indices of the umbilical artery/middle cerebral artery). Right and left ventricular measurements were categorized into 3 groups: (1) global ventricular contractility (fractional area change), (2) transverse ventricular contractility (24-segment transverse fractional shortening), and (3) basal-apical longitudinal contractility (longitudinal strain, longitudinal displacement fractional shortening, and basal lateral and septal wall annular plane systolic excursion). Z scores for the above measurements were computed for fetuses with an estimated fetal weight <10th centile using the mean and standard deviation derived from normal controls. Ventricular contractility measurements were considered abnormal if their Z score values were <5th centile (z score <-1.65) or >95th centile (Z score >1.65), depending on the specific ventricular measurement. RESULTS The average gestational age at the time of the examination was 32 weeks 4 days (standard deviation 3 weeks 4 days). None of the 50 study fetuses demonstrated absent or reverse flow of the umbilical artery Doppler waveform. Eighty-eight percent (44/50) of fetuses had one or more abnormal measurements of cardiac contractility of 1 or both ventricles. Analysis of right ventricular contractility demonstrated 78% (39/50) to have 1 or more abnormal measurements, which were grouped as follows: global contractility 38% (19/50), transverse contractility 66% (33/50); and longitudinal contractility 48% (24/50). Analysis of left ventricular contractility demonstrated 1 or more abnormal measurements in 58% (29/50) that were grouped as follows: global contractility 38% (19/50); transverse contractility 40% (20/50); and longitudinal contractility 40% (20/50). Of the 50 study fetuses, 25 had normal pulsatility index of the umbilical artery and cerebroplacental ratios, 80% of whom had 1 or more abnormalities of right ventricular contractility and 56% of whom had 1 or more abnormalities of left ventricular contractility. Abnormal ventricular contractility for these fetuses was present in all 3 groups of measurements; global, transverse, and longitudinal. Those with an isolated abnormal pulsatility index of the umbilical artery (n=11) had abnormalities of transverse contractility of the right ventricular and global contractility in the left ventricle. When an isolated cerebroplacental ratio abnormality was present, the right ventricle demonstrated abnormal global, transverse, and longitudinal contractility, with the left ventricle only demonstrating abnormalities in transverse contractility. When both the pulsatility index of the umbilical artery and cerebroplacental ratio were abnormal (3/50), transverse and longitudinal contractility measurements were abnormal for both ventricles, as well as abnormal global contractility of the left ventricle. CONCLUSIONS High rates of abnormal ventricular contractility were present in fetuses with an estimated fetal weight <10th centile, irrespective of the Doppler findings of the pulsatility index of the umbilical artery, and/or cerebroplacental ratio. Abnormalities of ventricular contractility were more prevalent in transverse measurements than global or longitudinal measurements. Abnormal transverse contractility was more common in the right than the left ventricle. Fetuses with estimated fetal weight less than the 10th centile may be considered to undergo assessment of ventricular contractility, even when Doppler measurements of the pulsatility index of the umbilical artery, and cerebroplacental ratio are normal.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, CA.
| | - Diane L Gumina
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
| | - John C Hobbins
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO
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Nakata M, Sakuma J, Takano M, Nagasaki S. Assessment of fetal cardiac function with echocardiography. J Obstet Gynaecol Res 2019; 46:31-38. [PMID: 31595615 DOI: 10.1111/jog.14143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/28/2022]
Abstract
The circulatory physiology of fetuses differs from that of neonates. The concept of biventricular combined cardiac output is necessary to understand and assess the fetal cardiac function. Fetal cardiac function has been estimated using echocardiographic methods such as M-mode, B-mode and pulsed wave Doppler. In addition, recent studies have reported the utility of tissue Doppler imaging in fetal echocardiography. However, parameters for fetal cardiac function remain to be established. Recently, we developed two novel techniques for assessing fetal cardiac function: an automatic fractional shortening method and E/e' determination using the dual-gate Doppler method. These two techniques are expected to be reliable and useful for assessing the fetal status in various pathological conditions.
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Affiliation(s)
- Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junya Sakuma
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Sumito Nagasaki
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
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Zanardini C, D'Antonio F, Hvingel B, Vårtun Å, Prefumo F, Flacco ME, Manzoli L, Acharya G. Agreement between anatomical M-mode and tissue Doppler imaging in the assessment of fetal atrioventricular annular plane displacement in uncomplicated pregnancies: A prospective longitudinal study. J Obstet Gynaecol Res 2019; 45:2150-2157. [PMID: 31441198 DOI: 10.1111/jog.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 07/04/2019] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the level of agreement between M-mode and pulsed-wave tissue Doppler imaging (PW-TDI) techniques in assessing fetal mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE) and septal annular plane systolic excursion (SAPSE) in a low-risk population. METHODS This prospective longitudinal study included healthy fetuses assessed from 18 to 40 weeks of gestation. Tricuspid annular plane systolic excursion, MAPSE and SAPSE were measured using anatomical M-mode and PW-TDI. The agreement between the two diagnostic tests was assessed using Bland-Altman analysis. RESULTS Fifty fetuses were included in the final analysis. Mean values of TASPE were higher than that of MAPSE. There was a progressive increase of TAPSE, MAPSE and SAPSE values with advancing gestation. For each parameter assessed, there was an overall good agreement between the measurements obtained with M-mode and PW-TDI techniques. However, the measurements made with M-mode were slightly higher than those obtained with PW-TDI (mean differences: 0.03, 0.05 and 0.03 cm for TAPSE, MAPSE and SAPSE, respectively). When stratifying the analyses by gestational age, the mean values of TAPSE, MAPSE and SAPSE measured with M-Mode were higher compared to those obtained with PW-TDI, although the mean differences between the two techniques tended to narrow with increasing gestation. Tricuspid annular plane systolic excursion, MAPSE and SAPSE measurements were all significantly, positively associated with gestational age (all P < 0.001). CONCLUSION Fetal atrioventricular annular plane displacement can be assessed with M-mode technique, or with PW-TDI as the velocity-time integral of the myocardial systolic waveform. Atrioventricular annular plane displacement values obtained with M-mode technique are slightly higher than those obtained with PW-TDI.
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Affiliation(s)
- Cristina Zanardini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Francesco D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Bodil Hvingel
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Åse Vårtun
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Li TG, Nie F, Li ZD, Wang YF, Li Q. Evaluation of right ventricular function in fetuses with isolated single umbilical artery using spatiotemporal image correlation M-mode. Cardiovasc Ultrasound 2019; 17:14. [PMID: 31325956 PMCID: PMC6642479 DOI: 10.1186/s12947-019-0164-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background Postnatal outcome of fetuses with isolated single umbilical artery (SUA) is determined mainly by right ventricular function. Our study examined whether there are differences in right ventricular function during the gestation period of fetuses with isolated SUA compared to healthy fetuses. Methods A prospective study was conducted on 77 fetuses with isolated SUA and 77 gestational age-matched controls from 22 to 39 weeks. For gestational age grouping, the isolated SUA fetuses and the control fetuses were divided into the second trimester group (22–27 weeks; 43 fetuses) and third trimester group (28–39 weeks; 34 fetuses). The fetal tricuspid annular plane systolic excursion (f-TAPSE) M-mode was applied to the tricuspid annulus, parallel to the ventricular septum, and the amplitude of the resulting wave was assessed using spatiotemporal image correlation (STIC) M-mode. We investigated the possible changes to the STIC M-mode indices during the course of pregnancy in both the isolated SUA and control groups. The relationship between f-TAPSE and gestational age was analyzed. Additionally, the correlations between f-TAPSE and birth weight was analyzed, and the birth weight differences between the isolated SUA and control groups in the third trimester were analyzed according to postpartum results. Results There was a significant difference in f-TAPSE between isolated SUA and control group in the third trimester (P < 0.05). There were significant correlations between gestational age (GA) and f-TAPSE among control fetuses (R2 = 0.9049; P < 0.01). A significant, positive correlation between GA and f-TAPSE was also found with isolated SUA fetuses (R2 = 0.8108; P < 0.01). The prevalence of small-for-gestational-age (SGA) fetuses and of discordant birth weight fetuses was significantly higher in the isolated SUA group than in the control group. In univariate analysis, the presence of an isolated SUA was associated with lower birth weight (2940 g compared with 3260 g) and with higher prevalence of SGA (13.0% compared with 3.9%; P < 0.01). The correlations between the birth weight and f-TAPSE in the two groups were analyzed in the third trimester, and the correlation in the isolated SUA group was better than that of the control group (R2 was 0.623 and 0.463 in the isolated SUA group and the control group, respectively). Conclusions Right ventricular function in isolated SUA is altered as early as in fetal third trimester. STIC M-mode can measure the right heart function of the fetus and may predict isolated SUA with SGA.
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Affiliation(s)
- Tian-Gang Li
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China.,Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu Province, People's Republic of China
| | - Fang Nie
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China.
| | - Zhen-Dong Li
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China
| | - Yan-Fang Wang
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China
| | - Qi Li
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China
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30
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DeVore GR, Cuneo BF, Satou G, Sklansky M. How to determine the percentage of study subjects < 5 th or > 95 th centile using the control group when only the mean and standard deviation are provided. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:139-141. [PMID: 30156342 DOI: 10.1002/uog.20110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/08/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- G R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana and Lancaster, CA, USA
| | - B F Cuneo
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - G Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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31
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Patey O, Carvalho JS, Thilaganathan B. Perinatal changes in cardiac geometry and function in growth-restricted fetuses at term. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:655-662. [PMID: 30084123 DOI: 10.1002/uog.19193] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/30/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the effect of fetal growth restriction (FGR) at term on fetal and neonatal cardiac geometry and function. METHODS This was a prospective study of 87 pregnant women delivering at term, comprising 54 normally grown and 33 FGR pregnancies. Fetal and neonatal conventional and spectral tissue Doppler and two-dimensional speckle tracking echocardiography were performed a few days before and within hours after birth. Fetal cardiac geometry, global myocardial deformation and performance and systolic and diastolic function were compared between normal and FGR pregnancies before and after birth. RESULTS Compared with normally grown fetuses, FGR fetuses exhibited more globular ventricular geometry and poorer myocardial deformation and cardiac function (left ventricular (LV) sphericity index (SI), 0.54 vs 0.49; right ventricular (RV) SI, 0.60 vs 0.54; LV torsion, 1.2 °/cm vs 3.0 °/cm; LV isovolumetric contraction time normalized by cardiac cycle length, 121 ms vs 104 ms; interventricular septum early diastolic myocardial peak velocity/atrial contraction myocardial diastolic peak velocity ratio, 0.60 vs 0.71; P < 0.01 for all). The poorest perinatal outcomes occurred in FGR fetuses with the most impaired cardiac functional indices. When compared with normally grown neonates, FGR neonates showed persistent alteration in cardiac parameters (LV-SI, 0.53 vs 0.50; RV-SI, 0.54 vs 0.44; LV torsion, 1.1 °/cm vs 1.4 °/cm; LV myocardial performance index (MPI'), 0.52 vs 0.42; P < 0.01 for all). Paired comparison of fetal vs neonatal cardiac indices in FGR demonstrated that birth was associated with a significant improvement in some, but not all, cardiac indices (RV-SI, 0.60 vs 0.54; RV-MPI', 0.49 vs 0.39; P < 0.001 for all). CONCLUSIONS Compared with normal pregnancies, FGR fetuses and neonates at term exhibit altered cardiac indices indicative of myocardial impairment that reflect adaptation to placental hypoxemia and alterations in hemodynamic load around the time of birth. Elucidating potential mechanisms that contribute to the alterations in perinatal cardiac adaptation in FGR could improve management and aid the development of better therapeutic strategies to reduce the risk of adverse pregnancy outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- O Patey
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
| | - J S Carvalho
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
| | - B Thilaganathan
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
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32
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DeVore GR, Klas B, Satou G, Sklansky M. Speckle Tracking of the Basal Lateral and Septal Wall Annular Plane Systolic Excursion of the Right and Left Ventricles of the Fetal Heart. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1309-1318. [PMID: 30208238 DOI: 10.1002/jum.14811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 01/01/2018] [Accepted: 03/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Annular plane systolic excursion (APSE) has been evaluated for the right (RV) and left (LV) ventricles using M-mode echocardiography. This study examined APSE using 2-dimensional speckle tracking (2DST) of the lateral and septal annuli of the RV and LV in normal fetuses. METHODS Two hundred normal fetuses were prospectively examined between 20 and 40 weeks' gestation, in which the end-diastolic and end-systolic lengths were measured from the apex to the insertion of the annuli into the lateral and septal walls of the RV and LV using 2DST. Subtracting the end-systolic from the end-diastolic length resulted in the APSE measurement. The APSE values from the ventricular and septal locations were regressed against biometric and gestational age independent variables, and the mean and standard deviation computed using fractional polynomial analysis. Within-subject repeated measures of variance were used to compare results within and between the right ventricular and left ventricular basal APSE values. RESULTS When regressed against the independent variables the R2 for the APSE of the right ventricular lateral wall ranged from 0.39 to 0.40, the left ventricular lateral wall 0.29 to 0.31, the right ventricular septal wall 0.22 to 0.40, and the left ventricular septal wall 0.05 to 0.07. There was a significant difference (P < .001) for APSE between the right ventricular and left ventricular lateral wall and their respective septal annuli, the left ventricular and right ventricular lateral wall annuli, and the left ventricular and right ventricular septal annuli. CONCLUSIONS The right ventricular and left ventricular lateral and septal wall APSE can be computed using 2DST and are associated with changing fetal biometric and age measurements.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
| | | | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Mądry W, Karolczak MA, Myszkowski M. Critical appraisal of MAPSE and TAPSE usefulness in the postoperative assessment of ventricular contractile function after congenital heart defect surgery in infants. J Ultrason 2019; 19:9-16. [PMID: 31088006 PMCID: PMC6750179 DOI: 10.15557/jou.2019.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction In this study, we assessed the adequacy of the two echocardiographic parameters representing the longitudinal systolic function of the ventricles, MAPSE & TAPSE, in perioperative monitoring. Aims 1. The assessment of MAPSE and TAPSE during the early (4 weeks) postoperative period after surgical correction of congenital heart defects in infants, performed with CPB. 2. The verification of the hypothesis, that the significant decline of TAPSE observed in this period is not related to the global RV systolic dysfunction. For this reason, systolic function of the RV was additionally assessed with another echocardiographic parameter: RVFAC. Material and methods Prospective study with 51 infants operated due to ASDII, VSD, AVSD and TOF. Four measurements of MAPSE,TAPSE and RVFAC were performed in the apical four-chamber projection. TAPSE and MAPSE were expressed as metric values and z-score; RV FAC values were expressed in percentages. Results TAPSE uniformly declined in the first postoperative day down to 34.5% of the initial value (p <0.00001), then gradually increased: up to 42.9% and 52% respectively, remaining significantly lower than preoperatively (p <0.001). RV FAC: increased by 21% (p <0.01), then remained stable in consecutive examinations. MAPSE declined by 21% during the first postoperative day, but with promptly normalized completely. Conclusions The movement of both AV valve annuli is subjected to different, not fully understood influences. The relatively slight decline of MAPSE makes this parameter suitable for the assessment of the postoperative LV systolic function. Deep, long-lasting decline of TAPSE, uniform in the whole group, does not permit to use this parameter and suggests the choice of another one, e.g. RVFAC.
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Affiliation(s)
- Wojciech Mądry
- Department of Cardiac Surgery and General Pediatric Surgery, Medical University of Warsaw , Warsaw , Poland
| | | | - Marcin Myszkowski
- Department of Cardiac Surgery and General Pediatric Surgery, Medical University of Warsaw , Warsaw , Poland
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Derpa VF, Koch R, Möllers M, Hammer K, Oelmeier de Murcia K, Köster HA, Falkenberg MK, Braun J, Klockenbusch W, Schmitz R. Comparison of Longitudinal and Apical Foetal Speckle Tracking Echocardiography Using Tissue Motion Annular Displacement and Segmental Longitudinal Strain. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:233-245. [PMID: 30482712 DOI: 10.1016/j.ultrasmedbio.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
The aim of our prospective pilot study with exploratory analysis was to compare longitudinal and apical foetal speckle tracking echocardiography (STE) using tissue motion annular displacement (TMAD) and segmental longitudinal strain (SLS). We compared two different STE quantification tools in a longitudinal and apical four-chamber view in 57 normal foetuses between 20 and 40 wk of gestation. Myocardial mechanical dyssynchrony and strain were assessed using offline quantification software (QLab Version 10.3, Philips Medical Systems, Andover, MA, USA). We compared the dyssynchrony measurements with TMAD and SLS in longitudinal and apical four-chamber views. Furthermore, we examined the segmental strain values of both ventricles with SLS and compared the differences between longitudinal and apical measurements. Dyssynchrony measurements with TMAD and SLS and strain measurements with SLS were feasible in all cases. In the apical view, the dyssynchrony measurements with TMAD were systematically greater than those achieved with SLS (p < 0.001). For the longitudinal view, no differences were observed between tools (p = 0.153). The application of SLS provided similar results for dyssynchrony in both views (intra-class correlation coefficient [ICC] = 0.281, p = 0.623), but the strain measurements in the left and right ventricles differed significantly between views (ICC = -0.082, p = 0.011, and ICC = -0.061, p = 0.024, respectively). For TMAD, we found large differences in the dyssynchrony values between longitudinal and apical assessment (ICC = -0.060, p = 0.03). Furthermore, TMAD exhibited reduced accuracy in the system's automatic tracking algorithm, limiting the data quality. The dyssynchrony assessment is affected less by the foetal position in SLS than in TMAD. The strain readings in SLS varied depending on the view in which they were assessed. The application of TMAD cannot be recommended for foetal STE.
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Affiliation(s)
- Vivian F Derpa
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany.
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Kerstin Hammer
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | | | - Helen A Köster
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Maria K Falkenberg
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
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35
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DeVore GR, Klas B, Satou G, Sklansky M. Longitudinal Annular Systolic Displacement Compared to Global Strain in Normal Fetal Hearts and Those With Cardiac Abnormalities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1159-1171. [PMID: 29086430 DOI: 10.1002/jum.14454] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to compare a new technique that measures the midventricular basal-apical longitudinal diastolic and systolic lengths, computes the longitudinal displacement fractional shortening, and compares it to global strain. METHODS Two hundred control fetuses were examined between 20 and 40 weeks' gestation, in whom the longitudinal displacement fractional shortening was computed from end-diastolic and end-systolic lengths measured from the apex to the mid portion of the distance between the level of the basal lateral and septal walls using 2-dimnsional speckle tracking. In addition, global strain was computed using speckle tracking. A correlation analysis was used to compare the longitudinal displacement fractional shortening to global strain. The longitudinal displacement fractional shortening of the right ventricle (RV) and left ventricle (LV) was measured in 10 fetuses with heart abnormalities. RESULTS The longitudinal displacement fractional shortening for the RV (mean ± SD, 22.94% ± 4.73%) and LV (21.05% ± 4.21%) was independent of gestational age and other biometric growth parameters, as was global strain (RV, -22.7% ± 4.07%); LV, -22.93% ± 3.52%). The RV longitudinal displacement fractional shortening was greater than that of the LV (P < .024). The correlations between the longitudinal displacement fractional shortening and global strain were 0.95 for the RV and 0.97 for the LV. Comparing the longitudinal displacement fractional shortening and global strain in fetuses with abnormal cardiac findings showed concordant findings in 9 of 10 fetuses. CONCLUSIONS The RV and LV longitudinal displacement fractional shortening can be computed from 2-dimensional images of the 4-chamber view and correlated with global strain. The longitudinal displacement fractional shortening was significantly greater for the RV than the LV and was abnormal in fetuses with RV and LV cardiac abnormalities.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
| | - Berthold Klas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, TomTec Imaging Systems GmbH, Munich, Germany
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Guirado L, Crispi F, Masoller N, Bennasar M, Marimon E, Carretero J, Gratacós E, Martínez JM, Friedberg MK, Gómez O. Biventricular impact of mild to moderate fetal pulmonary valve stenosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:349-356. [PMID: 28295792 DOI: 10.1002/uog.17456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To define the pattern of fetal echocardiographic changes associated with isolated pulmonary valve stenosis (PS) and to correlate the echocardiographic findings with neonatal outcome and the need for postnatal pulmonary valvuloplasty within the first 12 months postpartum. METHODS This was a prospective cohort study between January 2009 and October 2015 of 16 fetuses with isolated PS and 48 controls matched by gestational age at ultrasound examination (± 2 weeks) evaluated at the Fetal Cardiology Unit at BCNatal (Barcelona). Standard fetal ultrasound and comprehensive echocardiography, which included cardiovascular morphometric parameters, and systolic and diastolic functional and timing measurements, were performed in all cases. Baseline characteristics and perinatal outcome were retrieved from clinical records. Cases were followed up until 12 months of age, and admission to intensive care unit, days of hospitalization, need for prostaglandins and requirement for postnatal surgery were reviewed. Fetal PS cases were analyzed according to the need for postnatal pulmonary valvuloplasty. RESULTS The study groups were similar in terms of baseline, fetal ultrasound and perinatal characteristics. Median gestational age at diagnosis of PS was 33.4 (range, 20.0-36.5) weeks. Most cases corresponded to mild or moderate PS; only three fetuses had reversed flow in the ductus arteriosus before delivery. Six (37.5%) newborns, including all three with reversed flow in the ductus arteriosus prenatally, required postnatal pulmonary valvuloplasty. Fetuses with PS presented with larger and more globular hearts, with increased myocardial wall thickness in the third trimester. Despite preserved right ventricular (RV) ejection fraction and systolic longitudinal motion, PS cases showed increased right cardiac output and signs of diastolic dysfunction, with higher ductus venosus pulsatility index (0.72 ± 0.32 vs 0.53 ± 0.16, P = 0.004) and tricuspid E/E' ratio (7.52 ± 3.07 vs 5.76 ± 1.79, P = 0.022). In addition, fetuses with PS displayed a compensatory increase in left ventricular (LV) radial and longitudinal motion, as shown by a higher ejection fraction (79.3 ± 8.23% vs 67.6 ± 11.3%, P = 0.003) and mitral annular-plane systolic excursion (5.94 ± 1.38 vs 5.0 ± 1.22 mm, P = 0.035). Finally, fetuses requiring postnatal pulmonary valvuloplasty showed a different pattern of echocardiographic findings from those not requiring valvuloplasty, with a significantly smaller RV and pulmonary valve diameter, reduced tricuspid annular-plane systolic excursion (5.08 ± 1.59 vs 8.07 ± 1.93 mm, P = 0.028), increased LV cardiac output (340 ± 16 vs 176 ± 44 mL/min/kg, P = 0.003) and more pronounced signs of LV diastolic dysfunction (mitral E' velocity, 5.78 ± 0.90 vs 8.16 ± 1.58 cm/s, P = 0.008). CONCLUSIONS Fetuses with PS present with more hypertrophic, larger and more globular hearts in the third trimester of pregnancy, associated with a higher right cardiac output and impaired biventricular relaxation. In addition, signs of increased LV contraction were observed. Our data suggest that RV and LV functional parameters could be useful for predicting the need for postnatal pulmonary valvuloplasty. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Guirado
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - N Masoller
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Bennasar
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Marimon
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - J Carretero
- Pediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - E Gratacós
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - J M Martínez
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M K Friedberg
- The Labatt Family Heart Center, Division of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - O Gómez
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Maršál K. Physiological adaptation of the growth-restricted fetus. Best Pract Res Clin Obstet Gynaecol 2018; 49:37-52. [PMID: 29753694 DOI: 10.1016/j.bpobgyn.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/14/2018] [Indexed: 01/07/2023]
Abstract
The growth-restricted fetus in utero is exposed to a hostile environment and suffers undernutrition and hypoxia. To cope with the stress, the fetus changes its physiological functions. These adaptive changes aid intrauterine survival; however, they can lead to permanent functional and structural changes that can contribute to the development of serious chronic diseases later in life. Epigenetic mechanisms are an important part of the pathophysiological processes behind this "developmental origin of adult diseases." The dominant cardiovascular adaptive change is the redistribution of blood flow in hypoxic fetuses, with preferential supply of blood to the fetal brain, myocardium, and adrenal glands. The proportion of blood from the umbilical vein to the ductus venosus and foramen ovale increases, which increases the cardiac output of the left heart ventricle. The increased perfusion of fetal brain can be followed with Doppler ultrasound as increased diastolic velocities and decreased pulsatility index in the middle cerebral artery.
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Affiliation(s)
- Karel Maršál
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Skane University Hospital, S-221 85, Lund, Sweden.
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Sepúlveda-Martínez A, García-Otero L, Soveral I, Guirado L, Valenzuela-Alcaraz B, Torres X, Rodriguez-Lopez M, Gratacos E, Gómez O, Crispi F. Comparison of 2D versus M-mode echocardiography for assessing fetal myocardial wall thickness. J Matern Fetal Neonatal Med 2018; 32:2319-2327. [DOI: 10.1080/14767058.2018.1432041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Alvaro Sepúlveda-Martínez
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
- Fetal Medicine Unit, Department of Obstetrics and Gynecology Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Laura García-Otero
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Iris Soveral
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Laura Guirado
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Ximena Torres
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Mérida Rodriguez-Lopez
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
- Pontificia Universidad Javeriana, Seccional Cali, Cali, Colombia
| | - Eduard Gratacos
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Olga Gómez
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
| | - Fàtima Crispi
- Fetal i + D Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic of Gynecology, Obstetrics and Neonatology, IDIBAPS, Universitat de Barcelona, CIBER-ER, Barcelona, Spain
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Abstract
UNLABELLED Introduction The adaptive changes of the foetal heart in intrauterine growth restriction can persist postnatally. Data regarding its consequences for early circulatory adaptation to extrauterine life are scarce. The aim of this study was to assess cardiac morphometry and function in newborns with late-onset intrauterine growth restriction to test the hypothesis that intrauterine growth restriction causes cardiac shape and functional changes at birth. METHODS A comprehensive echocardiographic study was performed in 25 neonates with intrauterine growth restriction and 25 adequate-for-gestational-age neonates. RESULTS Compared with controls, neonates with intrauterine growth restriction had more globular ventricles, lower longitudinal tricuspid annular motion, and higher left stroke volume without differences in the heart rate. Neonates with intrauterine growth restriction also showed subclinical signs of diastolic dysfunction in the tissue Doppler imaging with lower values of early (e') diastolic annular peak velocities in the septal annulus. Finally, the Tei index in the tricuspid annulus was higher in the intrauterine growth restriction group. CONCLUSION Neonates with history of intrauterine growth restriction showed cardiac remodelling and signs of systolic and diastolic dysfunction. Overall, there was a significant tendency to worse cardiac function results in the right heart. The adaptation to extrauterine life occurred with more globular hearts, higher stroke volumes but a similar heart rate compared to adequate-for-gestational-age neonates.
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Crispi F, Miranda J, Gratacós E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol 2018; 218:S869-S879. [PMID: 29422215 DOI: 10.1016/j.ajog.2017.12.012] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
In the modern world, cardiovascular disease is a leading cause of death for both men and women. Epidemiologic studies consistently have suggested an association between low birthweight and/or fetal growth restriction and increased rate of cardiovascular mortality in adulthood. Furthermore, experimental and clinical studies have demonstrated that sustained nutrient and oxygen restriction that are associated with fetal growth restriction activate adaptive cardiovascular changes that might explain this association. Fetal growth restriction results in metabolic programming that may increase the risk of metabolic syndrome and, consequently, of cardiovascular morbidity in the adult. In addition, fetal growth restriction is strongly associated with fetal cardiac and arterial remodeling and a subclinical state of cardiovascular dysfunction. The cardiovascular effects ocurring in fetal life, includes cardiac morphology changes, subclinical myocardial dysfunction, arterial remodeling, and impaired endothelial function, persist into childhood and adolescence. Importantly, these changes have been described in all clinical presentations of fetal growth restriction, from severe early- to milder late-onset forms. In this review we summarize the current evidence on the cardiovascular effects of fetal growth restriction, from subcellular to organ structure and function as well as from fetal to early postnatal life. Future research needs to elucidate whether and how early life cardiovascular remodeling persists into adulthood and determines the increased cardiovascular mortality rate described in epidemiologic studies.
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Perez-Cruz M, Crispi F, Fernández MT, Parra JA, Valls A, Gomez Roig MD, Gratacós E. Cord Blood Biomarkers of Cardiac Dysfunction and Damage in Term Growth-Restricted Fetuses Classified by Severity Criteria. Fetal Diagn Ther 2017; 44:271-276. [PMID: 29190628 DOI: 10.1159/000484315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/13/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess cardiovascular function and damage in term small-for-gestational-age (SGA) and intrauterine growth-restricted (IUGR) fetuses by echocardiography and biomarkers in cord blood. METHODS This was a cohort study including 60 normal fetuses and 47 term small fetuses subclassified as small for gestational age (SGA) with estimated fetal weight (EFW) between the 3rd and 9th centiles and normal fetoplacental Doppler (n = 14) or intrauterine growth restriction (IUGR, n = 33) if EFW <3rd centile or EFW <10th centile together with cerebroplacental ratio <5th and/or mean uterine artery pulsatility index >95th centile. Fetal echocardiography included left myocardial performance index (MPI) and annular plane systolic excursion. Fetal B-type natriuretic peptide (BNP), troponin-I, heart-type fatty acid-binding proteins (H-FABP), and homocysteine concentrations were measured in cord blood collected at delivery. RESULTS Both SGA and IUGR cases presented echocardiographic signs of systolic and diastolic dysfunction with increased MPI (mean controls 0.43 [SD 0.12], SGA 0.47 [0.03], and IUGR 0.57 [0.08], p < 0.01) and decreased mitral annular plane systolic excursion (controls 6.0 mm [1.0], SGA 5.5 mm [0.6], and IUGR 4.9 mm [0.8], p = 0 01). IUGR fetuses presented increased levels of cord blood BNP (controls 17.2 pg/mL [11.5], SGA 22.4 pg/mL [10.7], and IUGR 31.2 pg/mL [26.8], p < 0.01). Troponin I was increased in both SGA and IUGR cases (controls 0.004 ng/mL [0.007], SGA 0.012 ng/mL [0.02], and IUGR 0.018 ng/mL [0.05], p < 0.01). H-FABP and homocysteine showed similar values among groups. CONCLUSIONS Cardiac dysfunction and cell damage is a common feature of term SGA and IUGR fetuses despite of the severity criteria for perinatal outcome. Further research is needed to evaluate the potential long-term consequences on their cardiovascular system.
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Affiliation(s)
- Míriam Perez-Cruz
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain.,Spanish Maternal & Child Health Network Retic SAMID, Barakaldo, Spain
| | - Fàtima Crispi
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - María Teresa Fernández
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Johanna Alexandra Parra
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Anna Valls
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Dolores Gomez Roig
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, .,Spanish Maternal & Child Health Network Retic SAMID, Barakaldo,
| | - Eduard Gratacós
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function. Heart Fail Rev 2017; 22:861-877. [DOI: 10.1007/s10741-017-9638-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Patey O. Re: Differential effect of assisted reproductive technology and small-for-gestational age on fetal cardiac remodeling. B. Valenzuela-Alcaraz, F. Crispi, M. Cruz-Lemini, B. Bijnens, L. García-Otero, M. Sitges, J. Balasch and E. Gratacós. Ultrasound Obstet Gynecol 2017; 50: 63-70. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:17-18. [PMID: 28681952 DOI: 10.1002/uog.17521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- O Patey
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St. George's University of London & St. George's University Hospitals NHS Foundation Trust, Molecular & Clinical Sciences Research Institute, London, UK
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Tanis JC, Mohammed N, Bennasar M, Martinez JM, Bijnens B, Crispi F, Gratacos E. Online versus offline spatiotemporal image correlation (STIC) M-mode for the evaluation of cardiac longitudinal annular displacement in fetal growth restriction. J Matern Fetal Neonatal Med 2017; 31:1845-1850. [PMID: 28508694 DOI: 10.1080/14767058.2017.1330408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Our first aim was to compare online M-mode with offline spatiotemporal image correlation (STIC) M-mode for assessing longitudinal annular displacement (LAD) in growth-restricted fetuses (FGR). Our second aim was to compare LAD measures of FGR cases with controls. MATERIALS AND METHODS Prospective study including 40 FGR cases (defined estimated fetal weight and birth weight <10th centile) and 72 normally grown fetuses matched to cases by gestational age at scan. LAD was measured with online M-mode and offline STIC M-mode at the left and right ventricular free walls and septum in all fetuses. RESULTS FGR cases had a significant decrease in LAD by STIC in all sites as compared to controls (e.g. right LAD in FGR mean 6.7 mm (SD 1.2) versus controls 7.2 mm (1.2), p = .033). There was a non-significant trend for lower values in FGR when using online M-mode (e.g. right LAD in FGR 6.9 mm (1.5) versus controls 7.4 mm (1.5), p = .084). CONCLUSIONS STIC M-mode seems a better method than online M-mode for detecting subtle changes in myocardial motion. STIC presents more precise results and allows an ideal placement of the M-mode arrow. These results confirm previous data suggesting decreased longitudinal motion in FGR.
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Affiliation(s)
- Jozien C Tanis
- a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.,b Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain.,c Department of Obstetrics and Gynecology, Fetal Medicine Unit , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Nuruddin Mohammed
- a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.,b Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain
| | - Mar Bennasar
- a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.,b Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain
| | - Josep Maria Martinez
- a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.,b Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain
| | - Bart Bijnens
- d ICREA , Universitat Pompeu Fabra , Barcelona , Spain
| | - Fatima Crispi
- a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.,b Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain
| | - Eduard Gratacos
- a BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu) , Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.,b Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain
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Patey O, Gatzoulis MA, Thilaganathan B, Carvalho JS. Perinatal Changes in Fetal Ventricular Geometry, Myocardial Performance, and Cardiac Function in Normal Term Pregnancies. J Am Soc Echocardiogr 2017; 30:485-492.e5. [DOI: 10.1016/j.echo.2017.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 01/22/2023]
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Función cardiaca fetal en preeclámpticas tratadas con parches de nitroglicerina. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, Figueras F, Sitges M, Bijnens B, Gratacós E. Fetal cardiovascular remodeling persists at 6 months in infants with intrauterine growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:349-356. [PMID: 26415719 DOI: 10.1002/uog.15767] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/30/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Intrauterine growth restriction is associated with increased cardiovascular risk later in life but the link between fetal disease and postnatal risk is not well-documented. We evaluated longitudinally the association between cardiovascular remodeling in small-for-gestational-age (SGA) fetuses and at 6 months of age. METHODS A cohort of 80 SGA fetuses (defined by estimated fetal and birth weights < 10(th) centile) delivered > 34 weeks' gestation was compared with 80 normally grown age-matched control fetuses, with follow-up at 6 months of corrected age (i.e. 6 months from estimated date of delivery according to first-trimester crown-rump length). Cardiovascular evaluation included a comprehensive echocardiographic assessment in both fetuses and infants and blood pressure and aortic intima-media thickness (aIMT) measurement in infants. Parameters were adjusted by linear regression analysis for gender, gestational age at delivery, pre-eclampsia, prenatal glucocorticoid exposure, Cesarean delivery, admission to neonatal intensive care unit and body surface area. RESULTS Both pre- and postnatally, when compared with controls, the SGA group showed a more globular cardiac shape (left sphericity index: controls 2.06 vs SGA 1.87 (P = 0.022) prenatally and 1.92 vs 1.67 (P = 0.007) postnatally), as well as signs of systolic longitudinal dysfunction (systolic annular peak velocity (S'): 7.2 vs 6.3 cm/s (P = 0.003) prenatally and 7.9 vs 6.4 cm/s (P < 0.001) postnatally; tricuspid annular plane systolic excursion: 7.2 vs 6.8 mm (P = 0.015) prenatally and 16.0 vs 14.2 mm (P < 0.001) postnatally) and diastolic dysfunction (left isovolumetric relaxation time: 46 vs 52 ms (P < 0.001) prenatally and 50 vs 57 ms (P = 0.034) postnatally). In addition, infants in the SGA group had increased mean blood pressure (mean: 61 vs 70 mmHg, P < 0.001) and maximum aIMT (0.57 vs 0.66 mm; P < 0.001). CONCLUSIONS Primary cardiovascular changes are already present in the SGA fetus and persist at 6 months of age. These data support prenatal cardiovascular remodeling as a mechanistic pathway of increased risk later in life in cases of SGA, regardless of Doppler abnormalities. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Cruz-Lemini
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Valenzuela-Alcaraz
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Sitges
- Department of Cardiology (Institut Clínic del Tòrax), Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - B Bijnens
- ICREA - Universitat Pompeu Fabra, Barcelona, Spain
| | - E Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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48
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Terada T, Mori K, Inoue M, Yasunobu H. Mitral annular plane systolic excursion/left ventricular length (MAPSE/L) as a simple index for assessing left ventricular longitudinal function in children. Echocardiography 2016; 33:1703-1709. [PMID: 27545275 DOI: 10.1111/echo.13325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Assessment of longitudinal left ventricular (LV) function is important for early detection of cardiac dysfunction. Although mitral annular plane systolic excursion (MAPSE) obtained by M-mode echocardiography offers a simple method for assessing longitudinal LV function, normal values of MAPSE for children change according to body size. METHODS To minimize the effects of body size, MAPSE was divided by LV long-axis length (MAPSE/L). MAPSE/L was measured in 210 healthy children from birth to 15 years of age and classified into five subgroups. MAPSE/L was then compared with 10 parameters in 136 children (age, heart rate, mean blood pressure, ejection fraction of the LV (EF), peak atrial flow velocity/peak early diastolic flow velocity of mitral flow, tissue Doppler velocity during systole (s') and early diastole (e'), E/e' ratio, Tei index, and global longitudinal strain (GLS) of the LV by the speckle tracking method). RESULTS MAPSE/L was significantly lower in the neonate group than in the remaining four groups. MAPSE/L then increased with age to peak at 1-5 years and gradually decreased thereafter. In all cases beyond the neonatal period, MAPSE/L was more than 0.17. Among various parameters, GLS, age, EF, Tei index and s' were significantly associated with MAPSE/L in that order. In univariate analysis, GLS was most significantly associated with MAPSE/L (r=.56). CONCLUSIONS We have established normal reference values for MPSE/L in healthy children. MAPSE/L is expected to offer a simple parameter to evaluate LV longitudinal systolic function during daily routine echocardiography in children.
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Affiliation(s)
- Tomomasa Terada
- Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kazuhiro Mori
- Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Miki Inoue
- Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Hayabuchi Yasunobu
- Department of Pediatrics, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
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49
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Human fetal growth restriction: a cardiovascular journey through to adolescence. J Dev Orig Health Dis 2016; 7:626-635. [DOI: 10.1017/s2040174416000337] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Intrauterine growth restriction has been noted to adversely impact morbidity and mortality in the neonatal period as well as cardiovascular well-being in adolescence and adulthood. Recent data based on a wide range of ultrasound parameters during fetal and neonatal life has noted early and persistent involvement of the cardiovascular system. Some of these measures are predictive of long-term morbidities. Assessment of vascular mechanics is a new and novel concept in this population, and opens up avenues for diagnosis, monitoring and evaluation of the likely effectiveness of interventions. Prevention of these adverse vascular and cardiac outcomes secondary to fetal growth restriction may be feasible and of clinical relevance. This review focuses on growth restriction in humans with respect to cardiovascular remodeling and dysfunction during fetal life, persistence of functional cardiac impairment during early childhood and adolescence, and possible preventive strategies.
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50
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Ingul CB, Lorås L, Tegnander E, Eik-Nes SH, Brantberg A. Maternal obesity affects fetal myocardial function as early as in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:433-442. [PMID: 25761057 DOI: 10.1002/uog.14841] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/14/2015] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate cardiac function from 14 weeks' gestation in fetuses of obese pregnant women (FOW). Animal studies have shown that maternal obesity induces fibrosis in fetal myocardium. We hypothesized that fetal cardiac function would be impaired among FOW. METHODS A case-control study with longitudinal follow-up was performed at Trondheim University Hospital, Norway. In total, 80 pregnant women were included and the final population comprised 52 obese and 24 of normal weight (mean body mass index before pregnancy, 34.8 ± 4.1 vs 21.0 ± 2.2 kg/m(2) ; P < 0.001). The main outcome measures were global strain rate (GSR) and strain by tissue Doppler imaging, tissue Doppler velocities (TDVs) and interventricular septal thickness assessed by fetal echocardiography at gestational ages of 14, 20 and 32 weeks. RESULTS In FOW, fetal left ventricle (LV) and right ventricle (RV) GSR and strain were significantly lower than in fetuses of normal-weight pregnant women: LV GSR was 33.3% lower at 14 weeks, 22.4% lower at 20 weeks and 22.8% lower at 32 weeks of gestation (P < 0.001) with no difference in fetal heart rate. Systolic and late diastolic TDVs for LV were significantly lower from 20 weeks' gestation and remained lower throughout pregnancy. Fetal interventricular septum was 26.6% (P < 0.001) thicker in late pregnancy in FOW compared with normal-weight pregnancies. CONCLUSIONS At 14 weeks of gestation, we detected fetal myocardial dysfunction with reduced LV and RV GSR and strain in FOW compared with fetuses of women with normal weight. Our finding is alarming considering the high prevalence of obesity and may partly explain the predisposition of offspring to cardiovascular disease later in life.
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Affiliation(s)
- C B Ingul
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Lorås
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E Tegnander
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - S H Eik-Nes
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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