1
|
Avnet H, Thomas S, Beirne G, Alphonse J, Welsh A. Poor Correlation between Fetal Tissue Doppler Imaging and Pulsed Wave Myocardial Performance Indices. Fetal Diagn Ther 2023; 50:225-235. [PMID: 36948159 DOI: 10.1159/000529945] [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] [Received: 11/07/2022] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Both tissue Doppler imaging (TDI) and pulsed wave Doppler (PWD) Myocardial Performance Indices (MPIs) have been proposed as tools for functional fetal cardiology. We wished to determine if there was any correlation between TDI-MPI and PWD-MPI. METHODS A cohort of uncomplicated women with morphologically normal singleton fetuses between 22 and 39 weeks of gestation was recruited. A single sonologist acquired Doppler waveforms for evaluation of both left and right TDI-MPI and PWD-MPI. The PWD-MPI values were calculated using a previously published algorithm and the TDI-MPI time intervals were measured manually by a single operator. RESULTS Achievability and repeatability were high for both modalities. TDI produced significantly lower right MPI values yet significantly higher left MPI values, potentially reflecting their evaluation of physiologically different events, blood flow versus myocardial contraction. CONCLUSION This study demonstrates that MPIs measured from PWD and TDI have a weak correlation and cannot be used interchangeably, even with the exclusion of suboptimal TDI-MPI scans from the analysis. Given the lack of correlation between the two methods, the high variation in TDI waveform, and the lack of unified approach to TDI analysis, we feel further research is needed before adoption of this technique.
Collapse
Affiliation(s)
- Hagai Avnet
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women Sydney, Randwick, New South Wales, Australia
| | - Samantha Thomas
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Geraldene Beirne
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Alphonse
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women Sydney, Randwick, New South Wales, Australia
| |
Collapse
|
2
|
DeVore GR, Klas B, Satou G, Sklansky M. Measuring the Area of the Interventricular Septum in the 4-Chamber View: A New Technique to Evaluate the Fetus at Risk for Septal Hypertrophy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2939-2953. [PMID: 35305032 DOI: 10.1002/jum.15980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES One of the problems for the clinician who desires to measure the interventricular septum (IVS) in a high-risk fetus is to know where to make the measurement. The purpose of this study was to use speckle-tracking analysis to measure the IVS area, 24-segment widths, and length at end-diastole (ED) and end-systole (ES) in normal fetuses. METHODS From the 4-chamber view, speckle-tracking analysis was performed at ED and ES on the IVS in 200 normal fetuses. The following were computed and regressed against gestational age (GA) and fetal biometric (FB) measurements: area, length, and the 24-segment transverse widths from the apex to the crux. The 24-segment width/length ratio was also measured. The speckle-tracking measurements of the ED area and length were compared using a point-to-point measurement tool available on all ultrasound machines. RESULTS The ED and ES areas, lengths, and 24-segment widths increased with GA and FB. The ED and ES areas were virtually identical. The 24-segment width/length ratio decreased from the apex to the crux of the septum. There was no significant difference in the measurement of the ED area and the length between speckle-tracking and the point-to-point measurements. CONCLUSIONS Measurement of the area and length of the IVS are simple to obtain and provide a new diagnostic tool to evaluate the fetus at risk for IVS hypertrophy which may be observed in fetuses of mothers with pregestational and gestational diabetes.
Collapse
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, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, Pasadena, CA, USA
| | | | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
3
|
Maduro C, Castro LFD, Moleiro ML, Guedes-Martins L. Pregestational Diabetes and Congenital Heart Defects. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:953-961. [PMID: 36446562 PMCID: PMC9708403 DOI: 10.1055/s-0042-1755458] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
Collapse
Affiliation(s)
- Catarina Maduro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Address for correspondence Catarina Maduro, MSc Rua Jorge de Viterbo Ferreira 228, 4050-313, PortoPortugal
| | - Luís Ferreira de Castro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal,Unidade de Investigação e Formação, Centro Materno Infantil do Norte, Porto, Portugal,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| |
Collapse
|
4
|
Darwish A, Abdel-Raouf M, Kamel R, Salah E, Salah M, Okasha A. Fetal echocardiographic parameters in pregnancies complicated by diabetes: a case control study. BMC Pregnancy Childbirth 2022; 22:650. [PMID: 35982412 PMCID: PMC9386926 DOI: 10.1186/s12884-022-04969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background At present, the prevalence of pregestational diabetes is 2.2% with an overall prevalence of hyperglycaemia in pregnancy of about 16.2%. Fetuses of diabetic mothers are at risk of functional cardiac abnormalities without structural cardiac anomalies especially in the third trimester. The main aim of this study was to assess the association of diabetes with different fetal echocardiographic parameters. Methods A case control study comprising a total of 120 pregnant women (60 cases and 60 controls). The cases group included fetuses of mothers known to have pre-gestational type 2 diabetes (DM group) while the control group included fetuses of euglycaemic healthy pregnant women. They were examined twice at 23–24 weeks' gestation (visit 1) and followed up at 27–28 weeks’ gestation (visit 2). The Modified Myocardial Performance Index (Mod MPI) was obtained in all fetuses. Also, M-mode echocardiography was used to measure the interventricular septum thickness at diastole in a transverse four chamber view. Results There was a significant increase in Iso-volumetric contraction time (ICT) (45.4 ms ± 8.9), Iso-volumetric relaxation time (IRT) (54.7 ms ± 11.22), Interventricular septal thickness (IVST) (4.08 mm ± 0.8), aortic acceleration time (AAT) (54.16 ms ± 12.77) and MPI (0.64 ± 0.09) in the diabetic group compared to the normal control group ICT (38.5 ms ± 9.59), IRT (46.13 ms ± 10.29), IVST (3.17 mm ± 0.6), AAT (49.73 ms ± 10.68) and MPI (0.5 ± 0.1) (all P values were < 0.001). When comparing parameters assessed at both visits among diabetic patients, there was a significant increase in IVST in the second visit (4.74 ± 0.78 mm) compared to the first visit (4.08 ± 0.8 mm) (P value < 0.05). The incidence of hypertrophic cardiomyopathy (HCM) was significantly higher in diabetic patients than in the control group. This is was observed in both first and second visit (33.4% and 56.7%) (P value < 0.001). Conclusions Fetuses of diabetic pregnant females show a significant increase in MPI, decrease in E\A ratio and HCM. These alterations in cardiac functions and structure were found to be continuous throughout the period of time between the two visits. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04969-5.
Collapse
Affiliation(s)
- Amal Darwish
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
| | - Maged Abdel-Raouf
- High Risk Pregnancy Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
| | - Rasha Kamel
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
| | - Emad Salah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
| | - Mai Salah
- Department of Obstetrics and Gynecology, Embaba General Hospital, Egyptian Ministry of Health and Population, Giza, Egypt
| | - Ahmed Okasha
- Department of Reproductive Health and Family Planning, Medical Research Institute, National Research Centre, Cairo, Egypt.
| |
Collapse
|
5
|
Oliveira M, Dias JP, Guedes-Martins L. Fetal Cardiac Function: Myocardial Performance Index. Curr Cardiol Rev 2022; 18:e271221199505. [PMID: 34961451 PMCID: PMC9893141 DOI: 10.2174/1573403x18666211227145856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
The Myocardial Performance Index (MPI) or Tei index, presented by Tei in 1995, is the ratio of the sum of the duration of the isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) to the duration of the ejection time (ET). The Modified Myocardial Performance Index (Mod-MPI), proposed in 2005, is considered a reliable and useful tool in the study of fetal heart function in several conditions, such as growth restriction, twin-twin transfusion syndrome, maternal diabetes, preeclampsia, intrahepatic cholestasis of pregnancy, and adverse perinatal outcomes. Nevertheless, clinical translation is currently limited by poorly standardised methodology as variations in the technique, machine settings, caliper placement, and specific training required can result in significantly different MPI values. This review aims to provide a survey of the relevant literature on MPI, present a strict methodology and technical considerations, and propose future research.
Collapse
Affiliation(s)
- Mariana Oliveira
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Joana Portela Dias
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação, Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação, Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal
| |
Collapse
|
6
|
Sirico A, Raffone A, Maruotti GM, Travaglino A, Paciullo C, Diterlizzi A, Mollo A, Rizzo G, Zullo F, Lanzone A. Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN 2021; 44:e99-e107. [PMID: 34425601 DOI: 10.1055/a-1499-7265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The myocardial performance index (MPI) has been proposed to evaluate cardiac dysfunction in newborns from diabetic mothers. Although MPI is routinely assessed in newborns, its role in the evaluation of fetuses from women with hyperglycemia in pregnancy (HIP) is still under evaluation. We aimed to evaluate the differences in third trimester fetal MPI in pregnant women with hyperglycemia compared to healthy controls. MATERIALS AND METHODS Seven electronic databases were searched for all studies assessing women with HIP who underwent evaluation of fetal left MPI during pregnancy compared to a control group. The summary measures were reported as mean differences (MD) in the mean fetal left MPI between women with HIP and healthy controls, with a 95 % confidence interval (CI). A post hoc subgroup analysis based on the type of HIP - pregestational diabetes, GDM, or gestational impaired glucose tolerance (GIGT) - was performed as an additional analysis. RESULTS 14 studies assessing 1326 fetuses (580 from women with HIP and 746 from controls) were included. Women with HIP had a significantly higher mean left fetal MPI compared to controls (MD 0.08; 95 %CI: 0.05 to 0.11; p < 0.00 001). Subgroup analysis according to the type of HIP concurred with the overall analysis for women with DM (MD 0.07; 95 %CI: 0.01 to 0.13; p = 0.02) and for women with GDM (MD 0.012; 95 %CI: 0.07 to 0.17; p < 0.00 001) but not for women with GIGT (MD -0.01, 95 % CI -0.28 to 0.27; p = 0.96). CONCLUSION Fetal left MPI is increased in pregnancies with HIP appearing as a potential marker of cardiac dysfunction.
Collapse
Affiliation(s)
- Angelo Sirico
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carmela Paciullo
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alice Diterlizzi
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re - University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Lanzone
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
7
|
Özalp M, Demir O, Dinç G, Şal H, Aran T, Osmanağaoğlu MA, Dilber E. Fetal cardiac Doppler changes in gestational diabetic pregnancies and its relationship with perinatal outcomes. J Obstet Gynaecol Res 2021; 47:3480-3487. [PMID: 34254402 DOI: 10.1111/jog.14941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/03/2021] [Accepted: 06/25/2021] [Indexed: 12/22/2022]
Abstract
AIM To examine the structural and functional changes of the fetal heart in gestational diabetes mellitus (GDM) and to evaluate the power of fetal cardiac Doppler parameters in predicting adverse perinatal outcomes in this group of pregnancy. METHODS Within the study's scope, 36 cases in the A1 GDM group, 33 cases in the A2 GDM group, and 124 cases in the control group were evaluated. The relationship between structural and functional fetal cardiac parameters and perinatal outcomes was evaluated via fetal echocardiography. RESULTS Fetal left ventricular myocardial performance index (MPI) values were found to be statistically significantly higher when compared between the A1 GDM and A2 GDM groups and the control group (p = 0.000 and p = 0.000, respectively), while the E/A ratio was found to be significantly lower (p = 0.000 and p = 0.000, respectively). It was determined that the maternal blood HbA1c level showed a significant negative correlation with the fetal cardiac E/A ratio and a significant positive correlation with isovolumetric relaxation time and MPI (p = 0.000, p = 0.000, and p = 0.000, respectively). Adverse perinatal outcome rate was higher in the diabetic group (46.4%-22.6%). When the cases with GDM were examined in terms of perinatal outcomes, it was observed that there was a significant difference in HbA1c levels, E/A ratio, and MPI values between the cases in the group with adverse perinatal outcomes and the group with normal results (p = 0.001, p = 0.000, and p = 0.000, respectively). CONCLUSIONS The strong relationship between abnormal cardiac function and adverse perinatal outcomes suggest that cardiac Doppler may be a valuable tool for fetal monitoring and management for the GDM patient group.
Collapse
Affiliation(s)
- Miraç Özalp
- Department of Perinatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Omer Demir
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gülseren Dinç
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hidayet Şal
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Turhan Aran
- Department of Perinatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | | | - Embiya Dilber
- Department of Pediatric Cardiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| |
Collapse
|
8
|
Depla AL, De Wit L, Steenhuis TJ, Slieker MG, Voormolen DN, Scheffer PG, De Heus R, Van Rijn BB, Bekker MN. Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:539-550. [PMID: 32730637 PMCID: PMC8048940 DOI: 10.1002/uog.22163] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/20/2020] [Accepted: 07/22/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Maternal diabetes in pregnancy is associated with structural anomalies of the fetal heart, as well as hypertrophy and functional impairment. This systematic review and meta-analysis aimed to estimate the effect of maternal diabetes on fetal cardiac function as measured by prenatal echocardiography. METHODS We performed a search of the EMBASE, PubMed and The Cochrane Library databases, from inception to 4 July 2019, for studies evaluating fetal cardiac function using echocardiography in pregnancies affected by diabetes compared with uncomplicated pregnancies. Outcome measures were cardiac hypertrophy and diastolic, systolic and overall cardiac function as assessed by various ultrasound parameters. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Data on interventricular septal (IVS) thickness, myocardial performance index (MPI) and E/A ratio were pooled for the meta-analysis using random-effects models. For pregnancies with diabetes, results were reported overall and according to whether diabetes was pregestational (PDM) or gestational (GDM). Results were also stratified according to the trimester in which fetal cardiac assessment was performed. RESULTS Thirty-nine studies were included, comprising data for 2276 controls and 1925 women with pregnancy affected by diabetes mellitus (DM). Of these, 1120 had GDM, 671 had PDM and in 134 cases diabetes type was not specified. Fetal cardiac hypertrophy was more prevalent in diabetic pregnancies than in non-diabetic controls in 21/26 studies, and impaired diastolic function was observed in diabetic pregnancies in 22/28 studies. The association between DM and systolic function was inconsistent, with 10/25 studies reporting no difference between cases and controls, although more recent studies measuring cardiac deformation, i.e. strain, did show decreased systolic function in diabetic pregnancies. Of the studies measuring overall fetal cardiac function, the majority (14/21) found significant impairment in diabetic pregnancies. Results were similar when stratified according to GDM or PDM. These effects were already present in the first trimester, but were most profound in the third trimester. Meta-analysis of studies performed in the third trimester showed, compared with controls, increased IVS thickness in both PDM (mean difference, 0.75 mm (95% CI, 0.56-0.94 mm)) and GDM (mean difference, 0.65 mm (95% CI, 0.39-0.91 mm)) pregnancies, decreased E/A ratio in PDM pregnancies (mean difference, -0.09 (95% CI, -0.15 to -0.03)), no difference in E/A ratio in GDM pregnancies (mean difference, -0.01 (95% CI, -0.02 to 0.01)) and no difference in MPI in either PDM (mean difference, 0.04 (95% CI, -0.01 to 0.09)) or GDM (mean difference, 0.03 (95% CI, -0.01 to 0.06)) pregnancies. CONCLUSIONS The findings of this review show that maternal diabetes is associated with fetal cardiac hypertrophy, diastolic dysfunction and overall impaired myocardial performance on prenatal ultrasound, irrespective of whether diabetes is pregestational or gestational. Further studies are needed to demonstrate the relationship with long-term outcomes. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- A. L. Depla
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - L. De Wit
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - T. J. Steenhuis
- Department of Pediatric Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - M. G. Slieker
- Department of Pediatric Cardiology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - D. N. Voormolen
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - P. G. Scheffer
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - R. De Heus
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - B. B. Van Rijn
- Department of Obstetrics and Fetal Medicine, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - M. N. Bekker
- Department of Obstetrics and Gynaecology, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| |
Collapse
|
9
|
Ali S, Okasha A, Elsirgany S, Abdel-Rasheed M, Khalil A, El-Anwary S, Elsheikhah A. Normal reference ranges for fetal cardiac function: Assessed by modified Doppler myocardial performance index (Mod MPI) in the Egyptian population. Eur J Obstet Gynecol Reprod Biol 2020; 251:66-72. [PMID: 32502771 DOI: 10.1016/j.ejogrb.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
AIM To develop gestational age-based reference ranges for the modified Doppler myocardial performance index (Mod MPI) and to examine the maternal characteristics that affect this measurement. METHODS This was a cross-sectional study, comprised of 1021 healthy pregnancies between 20+0 to 35+6 weeks' gestation. They were all undergoing ultrasound examination in Cairo Fetal Medicine Unit (CAIFM) in Cairo University, Egypt from 1st April 2017 till 1st April 2019. Mod MPI was obtained used method described by Friedman et al. (2003). Median and SD models were fitted between Mod MPI and gestational age. The distributions of Mod MPI Z-scores were examined in relation to maternal characteristics RESULTS: The normal Mod MPI in second and third trimester (20 + 1 to 35 + 6 weeks' gestation) was 0.408 ± 0.08. Mod MPI was not affected by maternal age, body mass index (BMI) or parity (p value 0.5, 0.6 and 0.2 respectively). CONCLUSION This study established normal reference ranges for Mod MPI according to gestational age and generated a graph with 5th,10th, 90th and 95th centiles. Maternal characteristics as age, BMI or parity do not affect value of Mod MPI.
Collapse
Affiliation(s)
- Sief Ali
- Department of Obstetrics & Gynecology, Assiut University, Egypt
| | - Ahmed Okasha
- Reproductive Health Research Department, National Research Centre, Egypt
| | - Sherif Elsirgany
- Reproductive Health Research Department, National Research Centre, Egypt
| | | | - Ahmed Khalil
- Department of Obstetrics & Gynecology, Benha University, Egypt.
| | | | | |
Collapse
|
10
|
Liao J, Chen X, Xu S, Li Y, Zhang B, Cao Z, Zhang Y, Liang S, Hu K, Xia W. Effect of residential exposure to green space on maternal blood glucose levels, impaired glucose tolerance, and gestational diabetes mellitus. ENVIRONMENTAL RESEARCH 2019; 176:108526. [PMID: 31202042 DOI: 10.1016/j.envres.2019.108526] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Residential surrounding green spaces can affect human health. However, limited studies have examined their impacts on maternal blood glucose homeostasis outcomes. OBJECTIVE We examined the associations of residential exposure to green space with maternal blood glucose levels, gestational impaired glucose tolerance (IGT), and gestational diabetes mellitus (GDM). METHODS Pregnant women were recruited from a prospective birth cohort between October 2012 and September 2015. Exposure to green space was calculated as the mean value of the normalized difference vegetation index (NDVI) within a 300-m circular buffer area surrounding each residence. Maternal glucose was measured between 24 and 28 weeks of gestation, and gestational IGT and GDM were diagnosed using valid methods. We estimated the associations of residential NDVI with maternal glucose levels using multiple linear regression models with adjustment for age, education, BMI, passive smoking during pregnancy, parity, season of conception, income, and urbancity. We estimated the relative risks of residential NDVI with IGT and GDM using a generalized estimating equation model with modified Poisson regression. The mediation effects of residential exposure to air pollution and maternal physical activity were assessed using causal mediation analysis. RESULTS Of 6807 pregnant women, 751 (11.3%) and 604 (8.8%) were diagnosed with IGT and GDM, respectively. One SD increment of residential NDVI was associated with a decrease of 0.06 mmol/L (95% CI: -0.07, -0.05), 0.09 mmol/L (95% CI: -0.13, -0.05), and 0.06 mmol/L (95% CI: -0.09, -0.03) in maternal fasting glucose levels, 1-h glucose levels, and 2-h glucose levels, respectively, as well as reduced risks of incident IGT (RR: 0.92, 95% CI: 0.86, 0.99) and GDM (RR: 0.85, 95% CI: 0.79, 0.92). The association between residential NDVI and maternal fasting glucose levels was partly mediated by maternal exposure to PM2.5. CONCLUSION Living with higher levels of green space was significantly associated with decreased maternal glucose levels and attenuated risks of incident maternal IGT and GDM. Our findings provide evidence linking green space to better maternal glucose outcomes. More studies are needed to further explore the maternal and child health benefits related to our findings.
Collapse
Affiliation(s)
- Jiaqiang Liao
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xinmei Chen
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bin Zhang
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan, Hubei, People's Republic of China
| | - Zhongqiang Cao
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan, Hubei, People's Republic of China
| | - Yiming Zhang
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan, Hubei, People's Republic of China
| | - Shengwen Liang
- Wuhan Environmental Monitoring Center, Wuhan, Hubei Province, 430000, China
| | - Ke Hu
- Wuhan Environmental Monitoring Center, Wuhan, Hubei Province, 430000, China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| |
Collapse
|
11
|
Moodley S, Arunamata A, Stauffer KJ, Nourse SE, Chen A, Quirin A, Selamet Tierney ES. Maternal arterial stiffness and fetal cardiovascular physiology in diabetic pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:654-661. [PMID: 28508434 DOI: 10.1002/uog.17528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 04/12/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES In mothers with pregestational or gestational diabetes, abnormal arterial stiffness (stiffer arteries) has been reported. The impact of abnormal maternal arterial stiffness on placental and fetal cardiovascular physiology is unknown. The purpose of this study was to determine the impact of maternal diabetes on maternal arterial stiffness and the association with fetal cardiovascular physiology as measured by fetal echocardiography. METHODS Between December 2013 and January 2017 a prospective study was conducted on diabetic (but otherwise healthy) and non-diabetic, healthy pregnant mothers aged 18-40 years at 20-28 weeks' gestation who had a normal fetal cardiac echocardiogram and obstetric ultrasound. Clinical data were collected by means of a patient questionnaire and measurement of blood pressure, height, weight, arterial augmentation index (AIx) and placental and fetal cardiovascular parameters were collected by fetal echocardiography. Descriptive statistics were calculated. Comparisons were made using parametric and non-parametric tests between controls and diabetic mothers. RESULTS Twenty-three healthy pregnant controls and 43 diabetic pregnant women (22 with pregestational and 21 with gestational diabetes) were included in the study. Maternal AIx was higher in those with diabetes than in healthy controls (12.4 ± 10.6% vs 4.6 ± 7.9%; P = 0.003). Fetal aortic valve (AoV) velocity time integral (VTI) was higher in fetuses whose mothers had diabetes than in those with non-diabetic mothers (7.7 ± 1.9 cm vs 6.3 ± 3.0 cm; P = 0.022). Left ventricular (LV) myocardial performance index (MPI) was lower in diabetic pregnancies than in controls (0.40 ± 0.09 vs 0.46 ± 0.11; P = 0.021). Umbilical artery (UA) resistance index (RI) was lower in diabetic pregnancies with glycated hemoglobin (HbA1c) levels ≥ 6.5% than in those with HbA1c levels < 6.5% (0.69 ± 0.06, n = 15 vs 0.76 ± 0.08, n = 21; P = 0.009) but not at higher HbA1C cut-offs. No correlation between AIx and AoV-VTI, LV-MPI or UA-RI was found. CONCLUSIONS Arterial stiffness is higher in pregnant women with diabetes than in controls. Fetuses of diabetic mothers show altered cardiovascular parameters, with higher AoV-VTI and lower LV-MPI, which are markers of myocardial function. Placental function assessed by UA-RI was normal despite differences between groups. Arterial stiffness did not correlate with placental or fetal cardiovascular variables. Instead, the findings are likely to represent a shared response to the environment of abnormal glucose metabolism. The clinical significance of these findings is yet to be determined. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- S Moodley
- Department of Pediatrics, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Arunamata
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University - School of Medicine, Palo Alto, CA, USA
| | - K J Stauffer
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University - School of Medicine, Palo Alto, CA, USA
| | - S E Nourse
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University - School of Medicine, Palo Alto, CA, USA
| | - A Chen
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University - School of Medicine, Palo Alto, CA, USA
| | - A Quirin
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University - School of Medicine, Palo Alto, CA, USA
| | - E S Selamet Tierney
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University - School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
12
|
Asoglu MR, Gabbay-Benziv R, Turan OM, Turan S. Exposure of the developing heart to diabetic environment and early cardiac assessment: A review. Echocardiography 2018; 35:244-257. [DOI: 10.1111/echo.13811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mehmet R. Asoglu
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology; Hillel Yaffe Medical Center; Hadera Israel
| | - Ozhan M. Turan
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| | - Sifa Turan
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| |
Collapse
|
13
|
Dervisoglu P, Kosecik M, Kumbasar S. Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study. J OBSTET GYNAECOL 2018; 38:408-412. [DOI: 10.1080/01443615.2017.1410536] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pinar Dervisoglu
- Department of Pediatric Cardiology, Sakarya University School of Medicine, Sakarya Research and Education Hospital, Sakarya, Turkey
| | - Mustafa Kosecik
- Department of Pediatric Cardiology, Sakarya University School of Medicine, Sakarya Research and Education Hospital, Sakarya, Turkey
| | - Serkan Kumbasar
- Department of Obstetrics and Gynecology, Sakarya University School of Medicine, Sakarya Research and Education Hospital, Sakarya, Turkey
| |
Collapse
|
14
|
Lee MY, Won HS, Shim JY, Lee PR, Kim A, Kil EM, Kim MJ. Novel Technique for Measurement of Fetal Right Myocardial Performance Index Using Dual Gate Pulsed-Wave Doppler. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1585-1594. [PMID: 28503785 DOI: 10.7863/ultra.16.07079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/11/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the reproducibility of the fetal right myocardial performance index determined by simultaneous recording of inflow and outflow using a dual gate pulsed-wave Doppler (DD). METHODS This was a prospective study of 39 normal singleton fetuses. Two experienced operators each measured the right myocardial performance index in three ways, twice: (1) separate recording of the inflow and outflow using single-gate pulsed-wave Doppler (PD), (2) simultaneous recordings of the inflow and outflow using tissue Doppler (TD), and (3) simultaneous recordings of the inflow and outflow using DD. Intra- and interoperator reproducibility were assessed with intraclass correlation coefficients. The measurements from all three methods taken by the more experienced operator were compared using Bland-Altman plots and mean differences. RESULTS For both operators, intra-operator reproducibility was the highest when using DD, followed by PD, and TD. Interoperator agreement was the highest for PD measurements, followed by DD, and TD. The smallest mean difference was between the PD and DD measurements by the more experienced operator. There was a positive correlation between PD and DD values (r = 0.369, P < .001). CONCLUSIONS Dual gate pulsed-wave Doppler may be an effective alternative to the PD or TD methods, and can separately evaluate systolic and diastolic myocardial function.
Collapse
Affiliation(s)
- Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Pil-Ryang Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ahm Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Eun-Mi Kil
- Clinical Support Team, Hitachi Aloka Medical Korea Ltd, Seoul, South Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| |
Collapse
|
15
|
Bhorat I, Pillay M, Reddy T. Determination of the fetal myocardial performance index in women with gestational impaired glucose tolerance and to assess whether this parameter is a possible prognostic indicator of adverse fetal outcome. J Matern Fetal Neonatal Med 2017; 31:2019-2026. [PMID: 28532199 DOI: 10.1080/14767058.2017.1334047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to investigate if the myocardial performance index (MPI) is altered in fetuses in women with gestational impaired glucose tolerance (GIGT), controlled on diet and whether this parameter is also predictive of adverse outcome in this group, as in poorly controlled gestational diabetes. METHODS In a prospective cross-sectional study, 32 women with GIGT on diet in the 3rd trimester were recruited and matched with 32 women with normal pregnancies (control group). Using Doppler echocardiography, the MPI was calculated. Placental resistance Doppler markers in both groups were also determined. An abnormal outcome was defined as any of the following: stillbirth, neonatal death, neonatal intensive care unit (NICU) admissions, tachypnea with pulmonary oedema, neonatal cord pH <7.15, five minute Apgar score <7, and cardiomyopathy. RESULTS The cases had a significantly higher median MPI compared to controls, p value <.0001. There were eight abnormal outcomes recorded in the 32 fetuses in the study group, corresponding to an adverse outcome rate of 25%. Fetuses with an adverse outcome had significantly higher MPI measurements compared to the GIGT fetuses with normal outcome. The MPI served as an excellent predictor of adverse outcome in the GIGT fetuses, with a total area under the ROC curve of 0.96. An MPI z-score greater than 4.0 conferred a sensitivity of 100% and specificity of 80%. No abnormal outcomes were noted in the control group. CONCLUSIONS The MPI is impaired in fetuses in GIGT women, with fetuses with an adverse outcome having significantly higher MPI measurements compared to the fetuses with normal outcome in the GIGT group. MPI has the potential to improve fetal surveillance in gestational diabetes.
Collapse
Affiliation(s)
- Ismail Bhorat
- a Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine , University of Kwa-Zulu Natal , Durban , South Africa
| | - Morgan Pillay
- a Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine , University of Kwa-Zulu Natal , Durban , South Africa
| | - Tarylee Reddy
- b Biostatistics Unit , South African Medical Research Council of South Africa , Durban , South Africa
| |
Collapse
|
16
|
Atiq M, Ikram A, Hussain BM, Saleem B. Assessment of Cardiac Function in Fetuses of Gestational Diabetic Mothers During the Second Trimester. Pediatr Cardiol 2017; 38:941-945. [PMID: 28337515 DOI: 10.1007/s00246-017-1600-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Abstract
Fetuses of diabetic mothers may have structural or functional cardiac abnormalities which increase morbidity and mortality. Isolated functional abnormalities have been identified in the third trimester. The aim of the present study was to assess fetal cardiac function (systolic, diastolic, and global myocardial performance) in the second trimester in mothers with gestational diabetes, and also to relate cardiac function with glycemic control. Mothers with gestational diabetes mellitus referred for fetal cardiac evaluation in the second trimester (between 19 and 24 weeks) from March 2015 to February 2016 were enrolled as case subjects in this study. Non-diabetic mothers who had a fetal echocardiogram done between 19 and 24 weeks for other indications were enrolled as controls. Functional cardiac variables showed a statistically significant difference in isovolumetric relaxation and contraction times and the myocardial performance index and mitral E/A ratios in the gestational diabetic group (p = 0.003). Mitral annular plane systolic excursion was significantly less in the diabetic group (p = 0.01). The only functional cardiac variable found abnormal in mothers with poor glycemic control was the prolonged isovolumetric relaxation time. Functional cardiac abnormalities can be detected in the second trimester in fetuses of gestational diabetic mothers and timely intervention can improve postnatal outcomes.
Collapse
Affiliation(s)
- Mehnaz Atiq
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Anum Ikram
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Batool M Hussain
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Bakhtawar Saleem
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| |
Collapse
|
17
|
Kulkarni A, Li L, Craft M, Nanda M, Lorenzo JMM, Danford D, Kutty S. Fetal myocardial deformation in maternal diabetes mellitus and obesity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:630-636. [PMID: 27218437 DOI: 10.1002/uog.15971] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/14/2016] [Accepted: 05/16/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Experimental evidence suggests that changes in the fetal myocardium result from intrauterine effects of maternal diabetes mellitus and obesity. The aim of this study was to assess fetal cardiac function using two-dimensional speckle-tracking echocardiography to determine the effects of maternal diabetes and obesity on the fetal myocardium. METHODS Comparative cross-sectional evaluation of myocardial function in fetuses of mothers with diabetes mellitus (FDM) or obesity (FO) and normal gestational age-matched control fetuses (FC) was performed using two-dimensional speckle-tracking echocardiography at two centers. RESULTS In total, 178 fetuses (82 FDM, 26 FO and 70 FC) met the enrolment criteria. Mean gestational age at assessment was similar among groups: 25.3 ± 5.1 weeks for FDM, 25.0 ± 4.6 weeks for FO and 25.1 ± 4.9 weeks for FC. Mean maternal body mass index was significantly higher in FDM and FO groups compared with the FC group. Statistically significant differences in fetal cardiac function were detected between FDM and FC for global longitudinal strain (mean ± SD, -21.4 ± 6.5% vs -27.0 ± 5.2%; P < 0.001), global circumferential strain (mean ± SD, -22.6 ± 6.5% vs -26.2 ± 6.8%; P = 0.002), average longitudinal systolic strain rate (median, -1.4 (interquartile range (IQR), -1.7 to -1.1)/s vs -1.6 (IQR, -2.0 to -1.4)/s; P = 0.001) and average circumferential systolic strain rate (median, -1.4 (IQR, -1.9 to -1.1)/s vs -1.6 (IQR, -2.1 to -1.3)/s; P = 0.006). Cases of non-obese FDM also had abnormal strain parameters compared with FC. Global longitudinal strain (mean ± SD, -21.1 ± 7.5%) and average circumferential systolic strain rate (median, -1.3 (IQR, -1.8 to -1.1)/s) were significantly lower in FO compared with FC. CONCLUSIONS Unfavorable changes occur in the fetal myocardium in response to both maternal diabetes mellitus and obesity. The long-term prognostic implications of these changes require further study. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A Kulkarni
- Department of Pediatrics, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - L Li
- Children's Hospital and Medical Center, Omaha, NE, USA
| | - M Craft
- Children's Hospital and Medical Center, Omaha, NE, USA
| | - M Nanda
- Department of Pediatrics, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - J M M Lorenzo
- Department of Pediatrics, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - D Danford
- Children's Hospital and Medical Center, Omaha, NE, USA
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, NE, USA
| |
Collapse
|
18
|
Maheshwari P, Henry A, Welsh AW. The Fetal Modified Myocardial Performance Index: Is Automation the Future? BIOMED RESEARCH INTERNATIONAL 2015; 2015:215910. [PMID: 26185751 PMCID: PMC4491561 DOI: 10.1155/2015/215910] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Abstract
The fetal modified myocardial performance index (Mod-MPI) is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1) a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3) ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.
Collapse
Affiliation(s)
- Priya Maheshwari
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Amanda Henry
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Women's and Children's Health, St George Hospital, Kogarah, NSW 2217, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia
| | - Alec W. Welsh
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia
| |
Collapse
|
19
|
Welsh AW, Henry A, Meriki N, Mahajan A, Wu L, Alphonse J. Is There a Measurable Difference between the Left and Right Modified Myocardial Performance Indices, and Does This Change to Reflect Unilateral Myocardial Dysfunction in Pathology? Fetal Diagn Ther 2015; 38:288-95. [DOI: 10.1159/000381709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022]
Abstract
Introduction: Fetal cardiac dysfunction may manifest itself unilaterally as right and left ventricles differing in design, function and load, measurable as differing in myocardial performance indices (MPIs). We wished to define this difference (‘delta-MPI' or DMPI), present its normal range and pilot its use in pathological pregnancy. Material and Methods: Prospective cross-sectional study of 324 normal singleton fetuses (16-38 weeks of gestation). Left and right modified MPI (LMPI and RMPI) were performed during a single examination using the ‘peak' valve click technique. Thirty-seven pathological singleton and monochorionic diamniotic twin pregnancies were compared as pilot data. Results: Modified MPIs (mean ± SD) were 0.45 ± 0.06 (LMPI) and 0.47 ± 0.09 (RMPI), being similar at 18 weeks' gestation with DMPI increasing slightly throughout pregnancy (0.02 ± 0.08). Both singleton intrauterine growth restriction (IUGR) and recipient twin-twin transfusion syndrome (TTTS) showed significantly elevated RMPI, LMPI and DMPI, most pronounced for DMPI (450 and 500% increase, respectively; p < 0.01). DMPI acquisition rates were 83.3% normal and 87.0% pathological. Discussion: We demonstrate for the first time differing intrafetal LMPI and RMPI in a large gestational cohort, with this difference increasing with gestational age. Pilot data confirm the potential for DMPI as a tool to assess unilateral myocardial function in singleton IUGR and recipient twins in TTTS, and further studies are under way to evaluate its clinical utility.
Collapse
|
20
|
Mahajan A, Henry A, Meriki N, Hernandez-Andrade E, Crispi F, Wu L, Welsh AW. The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research. Fetal Diagn Ther 2015; 38:1-13. [DOI: 10.1159/000363181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.
Collapse
|
21
|
Meriki N, Henry A, Sanderson J, Majajan A, Wu L, Welsh AW. Development of Normal Gestational Ranges for the Right Myocardial Performance Index in the Australian Population with Three Alternative Caliper Placements. Fetal Diagn Ther 2014; 36:272-81. [DOI: 10.1159/000362388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/18/2014] [Indexed: 11/19/2022]
|
22
|
Bhorat IE, Bagratee JS, Pillay M, Reddy T. Use of the myocardial performance index as a prognostic indicator of adverse fetal outcome in poorly controlled gestational diabetic pregnancies. Prenat Diagn 2014; 34:1301-6. [DOI: 10.1002/pd.4471] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/26/2014] [Accepted: 07/27/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Ismail E. Bhorat
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine; University of KwaZulu-Natal; Durban South Africa
| | - Jayanthilall S. Bagratee
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine; University of KwaZulu-Natal; Durban South Africa
| | - Morgan Pillay
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine; University of KwaZulu-Natal; Durban South Africa
| | - Tarylee Reddy
- Biostatistics Unit; Medical Research Council; Durban South Africa
| |
Collapse
|
23
|
Ghawi H, Gendi S, Mallula K, Zghouzi M, Faza N, Awad S. Fetal left and right ventricle myocardial performance index: defining normal values for the second and third trimesters--single tertiary center experience. Pediatr Cardiol 2014; 34:1808-15. [PMID: 23681419 DOI: 10.1007/s00246-013-0709-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/10/2013] [Indexed: 11/24/2022]
Abstract
Myocardial performance index (MPI), or Tei index, has become a commonly used parameter for the noninvasive, Doppler-derived assessment of global systolic and diastolic performance of the heart in both adults and children. Normal values have been established in adults and children; however, limited data exist in fetal hearts. The aim of this study was to further elucidate normal values of fetal left (LV) and right ventricle (RV) MPI values in second- and third-trimester fetuses and compare these values with other previously published data. This was a retrospective study to measure MPI in healthy fetuses. After Institutional Review Board approval, 2000 fetal echocardiography studies (FES) were acquired during a period of 4 years. Demographic parameters examined included gestational age (GA), maternal age (MA), and indication for fetal echocardiography. Fetuses with congenital heart disease, arrhythmias, or significant noncardiac fetal anomalies were excluded. The following echocardiography parameters were collected: LV ejection time (LVET), mitral valve close-to-open time (MVCO), RVET, tricuspid valve CO (TVCO), and fetal heart rate. For simplicity, LV and RV MPI values were calculated as follows: LV MPI = MVCO - LVET/LVET and RV MPI = TVCO - RVET/RVET. Four hundred twenty FES met the study criteria. LV MPI was evaluated in 230 and 190 FES in the second and third trimester, respectively. Of the 420 FES, 250 (150 in the second trimester and 100 in the third trimester) had all of the measurements required for RV MPI calculation. MA ranged between 16 and 49 years. Indications for FES included diabetes mellitus (N = 140; 33 %), suspected fetal anomalies on routine obstetrical ultrasound (N = 80; 20 %), autoimmune disorder (N = 60; 14 %), family history of CHD (N = 76; 18 %), medication exposure (N = 22; 5 %), increase nuchal thickness (N = 13; 3 %), and other indications (N = 29; 6 %). Averaged LV and RV MPI values were 0.464 ± 0.08 and 0.466 ± 0.09, respectively. Further analysis based on gestational period showed slightly greater LV and RV MPI values during the third compared with the second trimester, i.e., 0.48 and 0.49, respectively, with no statistically significant difference. There was no significant association of LV and RV MPI with heart rate. To our knowledge, this is the first study to establish normal values of fetal MPI based on a large fetal population from a single tertiary center. LV and RV MPI values were independent of GA and fetal heart rate. MPI is a useful parameter for the assessment of global cardiac function in the fetus and demonstrates good reproducibility with narrow interobserver and intraobserver variability. Its usefulness should be studied in fetal hearts with complex congenital anomalies.
Collapse
Affiliation(s)
- Hani Ghawi
- Rush Center for Congenital & Structural Heart Disease, Rush University Medical Center, 1653 West Congress Parkway, Jones 770, Chicago, IL, 60612, USA
| | | | | | | | | | | |
Collapse
|
24
|
Assessment of cardiac functions in fetuses of gestational diabetic mothers. Pediatr Cardiol 2014; 35:30-7. [PMID: 23780554 DOI: 10.1007/s00246-013-0734-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E a-wave (p = 0.02), A a-wave (p = 0.04), and S a-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E a (p = 0.02) and A a (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E a/A a ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E a ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.
Collapse
|
25
|
Figueroa H, Silva MC, Kottmann C, Viguera S, Valenzuela I, Hernandez-Andrade E, Gratacos E, Arraztoa JA, Illanes SE. Fetal evaluation of the modified-myocardial performance index in pregnancies complicated by diabetes. Prenat Diagn 2012; 32:943-8. [DOI: 10.1002/pd.3937] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/12/2012] [Accepted: 06/12/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Horacio Figueroa
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| | - Maria Carolna Silva
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
| | - Cristian Kottmann
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| | - Sebastian Viguera
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
| | - Ignacio Valenzuela
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
| | - Edgar Hernandez-Andrade
- Clinic Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, and Fetal and Perinatal Medicine Group, Institutd' Investigacions Biomediques Augus Pii Sunyer (IDIBAPS); Universidad de Barcelona; Spain
| | - Eduard Gratacos
- Clinic Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, and Fetal and Perinatal Medicine Group, Institutd' Investigacions Biomediques Augus Pii Sunyer (IDIBAPS); Universidad de Barcelona; Spain
| | - Jose Antonio Arraztoa
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| | - Sebastián E. Illanes
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| |
Collapse
|
26
|
Meriki N, Izurieta A, Welsh AW. Fetal left modified myocardial performance index: technical refinements in obtaining pulsed-Doppler waveforms. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:421-429. [PMID: 21728210 DOI: 10.1002/uog.9090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the influence of machine settings (wall motion filter (WMF), angle of insonation, Doppler aliasing) and phase of valve clicks on repeatability of measurement of the fetal left modified myocardial performance index (Mod-MPI). METHODS Fetal left Mod-MPI was evaluated prospectively in 157 morphologically normal fetuses at 19-36 weeks' gestation. In a baseline cohort, a previously published technique and settings were used for measurement of Mod-MPI. In a second cohort, the influence of WMF, angle of insonation, Doppler aliasing and selection of the phase of the valve clicks on repeatability of measurement of Mod-MPI was assessed. RESULTS The intraclass correlation coefficient (ICC) for measurement repeatability in the baseline cohort was 0.22. Increase in WMF to 300 Hz or 500 Hz was associated with an increase in ICC to 0.60 and 0.55, respectively. An angle of insonation of < 15° was associated with an increase in ICC to 0.79 and 0.78 at a WMF of 300 and 500 Hz, respectively. A WMF of 300 Hz, angle of insonation of < 15° and absence of aliasing was associated with an increase in ICC to 0.85 and 0.87 at the beginning and peak of the valve click, respectively. Mod-MPI ranged from 0.35 to 0.48. An increase in calculated MPI was associated with increasing WMF, selection of the beginning vs. peak of the valve clicks and increase in angle of insonation. The presence or absence of aliasing had no effect. CONCLUSIONS Refinement of machine settings improves repeatability of Mod-MPI, as does selection of the peak of the valve click. We suggest a consensus be reached as to the precise measurement of MPI, but for the moment would suggest: WMF, 300 Hz; angle of insonation, < 15°; avoiding Doppler aliasing; and selection of valve click peak. Systematic variation in measurement of time intervals may be responsible for the widely varying published normal ranges for Mod-MPI.
Collapse
Affiliation(s)
- N Meriki
- Department of Obstetrics and Gynaecology, King Saud University, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
27
|
Liu F, Liu S, Ma Z, Zhan X, Tao G, Cheng L, Song X. Assessment of left ventricular systolic function in fetuses without myocardial hypertrophy of gestational diabetes mellitus mothers using velocity vector imaging. J OBSTET GYNAECOL 2012; 32:252-6. [DOI: 10.3109/01443615.2011.645092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
28
|
Cruz-Martínez R, Figueras F, Bennasar M, García-Posadas R, Crispi F, Hernández-Andrade E, Gratacós E. Normal Reference Ranges from 11 to 41 Weeks Gestation of Fetal Left Modified Myocardial Performance Index by Conventional Doppler with the Use of Stringent Criteria for Delimitation of the Time Periods. Fetal Diagn Ther 2012; 32:79-86. [DOI: 10.1159/000330798] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/09/2011] [Indexed: 11/19/2022]
|
29
|
Cruz-Martinez R, Figueras F, Jaramillo JJ, Meler E, Méndez A, Hernandez-Andrade E, Gratacos E. Learning curve for Doppler measurement of fetal modified myocardial performance index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:158-162. [PMID: 20922780 DOI: 10.1002/uog.7765] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the learning curve for measurement of the fetal modified myocardial performance index (MPI). METHODS Three trainees with the theoretical knowledge of but without prior experience in performing MPI measurement were selected. Each trainee and one experienced examiner measured MPI in a cohort of 90 consecutive fetuses. The average difference between the three trainees and the expert in the MPI measurements was calculated; a difference below 10% was considered to indicate an accurate measurement. Individual and averaged learning curves were delineated using cumulative sum analysis (CUSUM). RESULTS The gestational age at evaluation ranged from 20 + 4 to 41 + 4 (mean, 33 + 3) weeks. The CUSUM plots demonstrated that, on average, competence in performing fetal MPI measurement was achieved by 65 cases. The average number of attempts to achieve competence were 42, 77 and 83 for the ejection time, isovolumetric contraction time and isovolumetric relaxation time, respectively. CONCLUSIONS Evaluation of fetal MPI by an inexperienced trainee requires on average 65 measurements to achieve competence.
Collapse
Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
30
|
Garcia-Flores J, Jañez M, Gonzalez MC, Martinez N, Espada M, Gonzalez A. Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2011; 154:24-6. [DOI: 10.1016/j.ejogrb.2010.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 07/04/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022]
|
31
|
Köşüş A, Köşüş N, Turhan NÖ. Assessment of cardiomyopathy in fetuses of women with false positive oral glucose loading test. Eur J Obstet Gynecol Reprod Biol 2010; 154:37-9. [PMID: 20855145 DOI: 10.1016/j.ejogrb.2010.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/28/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate fetal asymmetric septal hypertrophy in women with a false positive oral glucose loading test (OGL). STUDY DESIGN OGL was applied to 79 pregnant women at gestational age between 24 and 28 weeks. The first study group consisted of patients with a normal OGL. Cases having glucose levels above 130 mg/dL after 50 g OGL but a normal 100g oral glucose tolerance test (OGTT) formed a second group. M-mode echocardiography was then performed. Fetal septal and left ventricular posterior wall (LVPW) thicknesses in Group 1 and Group 2 were compared. RESULTS Mean septal and LVPW thickness was slightly higher in the second group but there was no statistically significant difference between the two groups. CONCLUSIONS Although statistically not significant, there is some increase in septal and ventricular wall thickness in cases with high OGL but normal OGTT. The study also provides evidence of the absence of prominent septal and ventricular thickening in these cases with minimal glucose intolerance.
Collapse
Affiliation(s)
- Aydin Köşüş
- Dept of ObGyn, Fatih University, Faculty of Medicine, Ankara, Turkey
| | | | | |
Collapse
|
32
|
Abstract
Maternal hyperglycemia is responsible for many fetal adverse outcomes. Ultrasound examination of these pregnancies aims at an early detection of congenital malformations, assessment of fetal well-being, and fetal growth. This evaluation will influence clinical decision in determining the best time and mode of delivery. We reviewed data from the literature on accuracy, usefulness, and indications of ultrasound examinations in pregnancies complicated with diabetes mellitus, whether pregestational or gestational.
Collapse
Affiliation(s)
- Jacky Nizard
- CHI Poissy-Saint-Germain en Laye, Poissy, France
| | | |
Collapse
|
33
|
Zielinsky P, Luchese S, Manica JL, Piccoli AL, Nicoloso LH, Leite MF, Hagemann L, Busato A, Moraes MR. Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:182-187. [PMID: 19012275 DOI: 10.1002/uog.6154] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers. METHODS Fetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks' gestation and term. LASF was calculated using the formula: (end-systolic diameter-end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls. RESULTS The study population comprised 53 diabetic women and 45 controls. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age at the time of examination did not differ significantly between the control group and the two diabetic subgroups (P = 0.57). Fetuses with myocardial hypertrophy presented a mean ( +/- SD) LASF of 0.32 +/- 0.11, those without myocardial hypertrophy 0.46 +/- 0.12, and those of normal mothers 0.53 +/- 0.09 (P < 0.001). A significant inverse linear correlation was observed between LASF and septal thickness (r = - 0.51, P < 0.001). CONCLUSIONS In diabetic pregnancies, LASF is lower in fetuses with myocardial hypertrophy than it is in those without hypertrophy and in fetuses of non-diabetic women, suggesting that LASF could be a useful alternative parameter in the assessment of fetal diastolic function.
Collapse
Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology of Rio Grande do Sul/Porto Alegre, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|