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de Melo PFMV, Roever L, Mendonça TMS, da Silva Costa F, Rolnik DL, Diniz ALD. Ophthalmic artery Doppler in the complementary diagnosis of preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:343. [PMID: 37173625 PMCID: PMC10176747 DOI: 10.1186/s12884-023-05656-9] [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: 11/12/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy of different parameters of the ophthalmic artery Doppler (OAD) in the complementary diagnosis of preeclampsia (PE). METHODS This meta-analysis adhered to the PRISMA guidelines. To investigate the mean difference in OAD values, peak systolic velocity (PSV), end-diastolic velocity (EDV), second systolic velocity peak (P2), resistance index (RI), pulsatility index (PI), and peak ratio (PR), between PE cases (overall and according to severity) and controls, random-effects meta-analyses were conducted for each Doppler parameter, with overall PE and mild and severe PE subgroups. Diagnostic performance and heterogeneity were evaluated with summary receiver operating characteristic (sROC) curves and 95% confidence intervals obtained with bivariate models. RESULTS Eight studies stratified the results into mild and severe or late and early PE, involving 1,425 pregnant women. PR and P2 had better diagnostic performance than the other indexes, with the PR of AUsROC at 0.885, the sensitivity of 84%, and specificity of 92%, with a low false-positive rate of 0.08 and the P2 with AUsROC of 0.926, the sensitivity of 85% and specificity of 88%. RI, PI, and EDV showed good performance and consistency across studies but lower AUsROC values of 0.833, 0.794, and 0.772, respectively. CONCLUSION Ophthalmic artery Doppler is a complementary tool with good performance for the diagnosis of overall and severe preeclampsia, with high and best sensitivity and specificity when using PR and P2 parameters.
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Affiliation(s)
- Pollyanna F M Vaz de Melo
- Department of Obstetrics and Gynaecology, Federal University of Uberlândia - UFU, Avenida Pará, 1720, Uberlândia, 38504-320, Minas Gerais, Brasil
| | - Leonardo Roever
- Clinical Research, Federal University of Uberlândia-UFU, Uberlândia, Brazil
| | - Tânia M S Mendonça
- Medical School of Federal, University of Uberlândia-UFU, Uberlândia, Brazil
| | - Fabrício da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Angélica L D Diniz
- Clinical Research, Federal University of Uberlândia-UFU, Uberlândia, Brazil.
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Vonzun L, Ochsenbein-Kölble N, Balsyte D, Zimmermann R, Gonser M. Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion. Arch Gynecol Obstet 2023; 307:241-248. [PMID: 35348831 PMCID: PMC9837016 DOI: 10.1007/s00404-022-06517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate functional relationship between fetal circulatory response to intrauterine transfusion (IUT) as a circulatory challenge and appearance of second systolic peak (P2) in middle cerebral artery (MCA) based on hemodynamic principles. METHODS According to the concept of pulse wave (PW) propagation and reflection in adults, PWs arrive twice at cerebral circulation, as primary wave caused by left ventricle ejection and secondary after reflection in peripheral arteries. Thus adults show a biphasic contour of systolic blood flow in cerebral arteries. Similar waveforms may appear in fetal MCA-Doppler, as a response to IUT as a circulatory challenge. This is a proof-of-principle study, applying classical hemodynamic principles to fetal circulation. Accordingly, appearance of MCA-P2 may indicate vasoconstriction with increased PW reflection and timing of P2(Δt) should agree with the additional PW travel time down to reflection and return (Tr). To test this agreement, we searched our database for IUTs performed for severe fetal anemia, and compared Δt, obtained by Doppler, with Tr, obtained by hemodynamic calculation using human fetal data. Level of agreement was assessed using Bland-Altman-Plots. RESULTS We identified 21 fetuses with adequate Doppler quality for Δt evaluation. In four cases (19%) MCA-P2 was observed before the intervention, and in 17 interventions (81%) thereafter; a highly significant association between IUT and P2 appearance (p < 0.001). In these 17 interventions good agreement of P2 timing was found between Doppler assessment: Δt = 80 ± 8 ms, and hemodynamic calculation: Tr = 76 ± 4 ms. CONCLUSION P2 appearance in fetal MCA-Doppler seems to indicate PW reflection due to increased vasoconstriction after IUT. Thus hemodynamic considerations might enable Doppler monitoring of fetal vasoconstriction.
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Affiliation(s)
- Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Dalia Balsyte
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Markus Gonser
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
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Diniz ALD, Menêses VFSDC, Freitas MARD, Paes MMBM, Naves WU, Sass N. Performance of ophthalmic artery Doppler velocimetry in the complementary diagnosis of preeclampsia. J Matern Fetal Neonatal Med 2022; 35:9078-9085. [PMID: 35099350 DOI: 10.1080/14767058.2021.2014452] [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: 10/19/2022]
Abstract
OBJECTIVES To calculate the accuracy (A) and establish the best cutoff value for ophthalmic artery (OA) Doppler velocimetry indexes in patients diagnosed with preeclampsia (PE), compared with healthy pregnant women. METHODS This prospective experimental study enrolled 268 women: 133 with PE and 135 healthy pregnant women. All patients were evaluated by OA Doppler sonography, bilaterally, to assess their pulsatility index (PI), resistance index (RI), peak systolic velocity (PVS), second peak systolic velocity (P2), end-diastolic velocity (EDV), and peak ratio (PR). Means were compared using Student's T-test. Receiver Operating Characteristics (ROC) curve was used to establish the cutoff value and estimate the sensitivity (S), specificity (Sp), accuracy (A) of all variables, and a significance of 95% was adopted. RESULTS ROC curve analysis showed that P2 and PR were superior to the other parameters for PE diagnosis. We tested two cutoff values: (1) using PR ≥0.70, obtained A: 88.72%, S: 81.95%, and Sp: 95.48% and (2) using PR ≥0.75, and A: 86.24%, S: 74.43%, and Sp: 99.24%. By adopting P2 ≥ 21.5 cm/s, we obtained A: 87.59%, S: 84.96%, and Sp: 90.22% and when the cutoff point was P2 ≥ 22 cm/s, there was a slight decrease in A to 86.46% and S to 81.20%, with Sp: 91.89.3%. CONCLUSION Ophthalmic artery Doppler demonstrated to be an effective and high-performance imaging method for the diagnosis of PE and the indexes P2 and PR demonstrated superior accuracy to the other Doppler parameters assessed. Higher performance occurred when the cutoff values with greater specificity were adopted, PR ≥ 0.75 and P2 ≥ 22 cm/s, considering that the proposed OA Doppler is to be a complementary method for preeclampsia.
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Affiliation(s)
- Angélica Lemos Debs Diniz
- Department of Gynecology and Obstetrics at Federal, University of Uberlândia-UFU, Uberlândia, Brazil
| | | | | | | | - Welington Ued Naves
- Department of Obstetrics at Federal, University of São Paulo-UNIFESP, Rua Napoleão de Barros, São Paulo, Brazil
| | - Nelson Sass
- Department of Obstetrics at Federal, University of São Paulo-UNIFESP, Rua Napoleão de Barros, São Paulo, Brazil
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Paes MMBM, Martins LMM, Diniz ALD. A sex specific approach of ophthalmic and middle cerebral arteries Doppler in smokers. Sci Rep 2021; 11:21719. [PMID: 34741061 PMCID: PMC8571273 DOI: 10.1038/s41598-021-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
Vascular dysfunctions can progress and lead to stroke and cardiovascular disease, especially in smokers. The presence of particular vascular changes according to sex has been described and they can be identified by the Doppler method. This study evaluated Doppler velocimetry parameters of the Ophthalmic Artery (OA) and the Middle Cerebral Artery (MCA) according to sex in smokers regarding a non-smoker group. This cross-sectional observational study included 178 subjects: 93 women and 85 men. Doppler parameters were assessed in OA and MCA. Student's t-test was used, with p < 0.05. There were no significant differences in OA and MCA Doppler velocimetry data between male non-smokers and smokers. However, female smokers presented several differences compared with non-smokers: lower pulsatility index (PI) and higher peak ratio in OA, and higher PI and resistance index and lower end diastolic velocity in MCA. There were different brain vascular waveforms in the group of female smokers compared with non-smokers. Cigarette smoking also led to opposite arterial patterns in OA and MCA in the female group, with signs of falling impedance in OA and increased impedance in MCA. An individualized approach regarding arterial changes according to sex is desirable.
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Affiliation(s)
- Maria Marta B M Paes
- Department of Ultrasound, Clinical Hospital of the Federal University of Uberlândia, State of Minas Gerais, Brazil
| | | | - Angélica L D Diniz
- Department of Gynecology and Obstetrics, Clinical Hospital of the Federal University of Uberlândia, Av. Pará, SN - Umuarama, Uberlândia - MG, State of Minas Gerais, 38405-320, Brazil.
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Gonser M, Vonzun L, Ochsenbein-Kölble N. Ophthalmic artery Doppler in prediction of pre-eclampsia: insights from hemodynamic considerations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:145-147. [PMID: 34028931 DOI: 10.1002/uog.23665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Gonser
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
| | - L Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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ZHOU SUFEN, AN PENG, LIAN KAI, GAN LING, FENG WEI, SONG JUAN, WANG YU, LIU XINYI, LI MENGXUE, ZHANG YANTING, ZHANG XIANYA, ZHANG SHUNYU, CHEN YUTING, WAN SHUYA. PLACENTAL HEMODYNAMIC ASSESSMENT IN WOMEN WITH SEVERE PREECLAMPSIA IN SECOND- AND THIRD-TRIMESTER PREGNANCY BY 3D POWER QUANTITATIVE DOPPLER ULTRASOUND. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: The present study analyzed the fetal–placental hemodynamic parameters in women with severe preeclampsia in second- and third-trimester pregnancy with a view to developing effective predictive indicators for preeclampsia and providing support for the prenatal clinical treatment of preeclampsia. Materials and Methods: From January 2015 to January 2019, 160 pregnant women diagnosed with severe preeclampsia at Xiangyang First People’s Hospital were recruited as the study group. The diagnostic criteria for preeclampsia were in accordance with the guidelines of the International Society for the Study of Hypertension in Pregnancy (ISSHP). A sample of 160 healthy pregnant women with normal blood pressure were selected as the control group. The GE Voluson E8 and E10 four-dimensional (4D) ultrasonic diagnostic instruments and the three-dimensional (3D) power Doppler in angio-quantitative mode were used to measure the hemodynamic parameters of the placenta, left uterine artery (LUA), right uterine artery (RUA), middle cerebral artery (MCA), umbilical artery (UA), and ductus venosus (DV) in the two groups. The above parameters were analyzed statistically using SPSS 22.0. Results: The systolic/diastolic velocity ratio (S/D), pulsatility index (PI), and resistance index (RI) of the MCA in the study group were lower than those of normal subjects of the same gestational age (P < 0.05). These parameters in the UA were higher in the study group than those in normal subjects (P < 0.05). The ratios between the peak ventricular systolic velocity and the peak atrial systolic velocity (S/A), pulsatility index for the vein (PIV), pre-load index (PLI), and peak velocity index for the vein (PVIV) in the DV were significantly different between the study and normal groups (P < 0.05). The placental vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were lower in the study group than those in normal subjects of the same gestational age (P < 0.05). There were good correlations between VI, VFI and RUA, PI, with correlation coefficients of −0.697 and −0.702, respectively. FI was the indicator that had the highest diagnostic efficacy for severe preeclampsia. The predictive sensitivity of the FI with a cut-off value of 34.92 was 96.3%, and the corresponding specificity was 86.9%. Conclusions: Placental FI had the highest predictive efficacy for severe preeclampsia and provides a reliable quantitative indicator and data support for preeclampsia management. 3D power quantitative Doppler ultrasound provides a novel avenue for the study of severe preeclampsia.
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Affiliation(s)
- SUFEN ZHOU
- Department of Medical Imaging, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - PENG AN
- Department of Medical Imaging, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - KAI LIAN
- Department of Medical Imaging, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - LING GAN
- Department of Medical Imaging, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - WEI FENG
- Medical Imaging Laboratory, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - JUAN SONG
- Medical Imaging Laboratory, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - YU WANG
- Medical Imaging Laboratory, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - XINYI LIU
- Medical Imaging Laboratory, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, P. R. China
| | - MENGXUE LI
- Xiangyang Key Laboratory of Maternal-Fetal, Medicine in Fetal Heart Disease, Hubei, P. R. China
| | - YANTING ZHANG
- Xiangyang Key Laboratory of Maternal-Fetal, Medicine in Fetal Heart Disease, Hubei, P. R. China
| | - XIANYA ZHANG
- Medical College, Three Gorges University, Hubei 443002, P. R. China
| | - SHUNYU ZHANG
- Medical College, Three Gorges University, Hubei 443002, P. R. China
| | - YUTING CHEN
- Xiangyang Vocational and Technical College, Xiangyang 441000, P. R. China
| | - SHUYA WAN
- Xiangyang Vocational and Technical College, Xiangyang 441000, P. R. China
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Matias DS, Santos R, Ferreira T, Matias BS, Correia LCL. Predictive value of ophthalmic artery Doppler velocimetry in relation to hypertensive disorders of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:388-395. [PMID: 32129500 DOI: 10.1002/jcu.22823] [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: 07/31/2019] [Revised: 12/21/2019] [Accepted: 02/13/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To test the predictive value of ophthalmic artery (OA) Doppler velocimetry in relation to the occurrence of hypertensive disorders of pregnancy (HDP). METHODS We compared, by analysis of variance, the values of seven OA Doppler variables (peak systolic velocity, second systolic peak velocity [P2], mean velocity, end diastolic velocity, resistance index [RI], pulsatility index [PI], and peak ratio) of 31 women with preeclampsia and 33 women with gestational hypertension vs those of 227 women without HDP. The prognostic value of these variables in relation to the occurrence of HDP was evaluated by the area under the curve (AUC) receiver operating characteristic curve. RESULTS All OA Doppler variables except RI and PI showed significant (P < .5) differences between groups. After adjustment for confounders, only P2 was an independent predictor of HDP (P < .001), with an AUC of 0.76. The best cut-off point for predicting HDP was P2 ≥ 21.4 cm/s, with sensitivity 69%, specificity 78%, positive likelihood ratio 3.1, negative likelihood ratio 0.4, positive predictive value 47%, and negative predictive value 90%. P2 improved the predictive ability of a model based on clinical variables, incrementing AUC from 0.77 to 0.84 in the final model containing clinical and Doppler variables. CONCLUSION The elevation of OA P2 in the second trimester of pregnancy is an independent predictor of hypertensive disorders, and improves the discriminatory ability of clinical markers.
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Affiliation(s)
- Denise S Matias
- Bahiana School of Medicine and Public Health - Salvador, Bahia, Brazil
- Perinatology Institute of Bahia (IPERBA) - Salvador, Bahia, Brazil
| | - Rebeca Santos
- Perinatology Institute of Bahia (IPERBA) - Salvador, Bahia, Brazil
| | - Tatiana Ferreira
- Perinatology Institute of Bahia (IPERBA) - Salvador, Bahia, Brazil
| | - Bruno S Matias
- Santo Amaro Hospital - José Silveira Foundation - Salvador, Bahia, Brazil
| | - Luis Cláudio L Correia
- Bahiana School of Medicine and Public Health - Salvador, Bahia, Brazil
- São Rafael Hospital - Monte Tabor Association - Salvador, Bahia, Brazil
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