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Peixoto AB, Bravo-Valenzuela NJ, Martins WP, Tonni G, Moron AF, Mattar R, Ruano R, Rolo LC, Araujo Júnior E. Impact of overweight and obesity in the fetal cardiac function parameters in the second and third trimesters of pregnancy. Cardiol Young 2024; 34:319-324. [PMID: 37408451 DOI: 10.1017/s1047951123001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters. METHODS We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m2), 140 overweight (BMI 25-30 kg/m2) and 80 obese (BMI ≥ 30 kg/m2). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A'). RESULTS We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups. CONCLUSIONS We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | | | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnostic Centre, Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Rodrigo Ruano
- Department of Maternal and Fetal Medicine, Fetal Surgery Service, Obstetrics and GynecologyUniversity of Miami, Miller School of Medicine, Miami, Fl, USA
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Srisupundit K, Luewan S, Tongsong T. Prenatal Diagnosis of Fetal Heart Failure. Diagnostics (Basel) 2023; 13:diagnostics13040779. [PMID: 36832267 PMCID: PMC9955344 DOI: 10.3390/diagnostics13040779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Fetal heart failure (FHF) is a condition of inability of the fetal heart to deliver adequate blood flow for tissue perfusion in various organs, especially the brain, heart, liver and kidneys. FHF is associated with inadequate cardiac output, which is commonly encountered as the final outcome of several disorders and may lead to intrauterine fetal death or severe morbidity. Fetal echocardiography plays an important role in diagnosis of FHF as well as of the underlying causes. The main findings supporting the diagnosis of FHF include various signs of cardiac dysfunction, such as cardiomegaly, poor contractility, low cardiac output, increased central venous pressures, hydropic signs, and the findings of specific underlying disorders. This review will present a summary of the pathophysiology of fetal cardiac failure and practical points in fetal echocardiography for diagnosis of FHF, focusing on essential diagnostic techniques used in daily practice for evaluation of fetal cardiac function, such as myocardial performance index, arterial and systemic venous Doppler waveforms, shortening fraction, and cardiovascular profile score (CVPs), a combination of five echocardiographic markers indicative of fetal cardiovascular health. The common causes of FHF are reviewed and updated in detail, including fetal dysrhythmia, fetal anemia (e.g., alpha-thalassemia, parvovirus B19 infection, and twin anemia-polycythemia sequence), non-anemic volume load (e.g., twin-to-twin transfusion, arteriovenous malformations, and sacrococcygeal teratoma, etc.), increased afterload (intrauterine growth restriction and outflow tract obstruction, such as critical aortic stenosis), intrinsic myocardial disease (cardiomyopathies), congenital heart defects (Ebstein anomaly, hypoplastic heart, pulmonary stenosis with intact interventricular septum, etc.) and external cardiac compression. Understanding the pathophysiology and clinical courses of various etiologies of FHF can help physicians make prenatal diagnoses and serve as a guide for counseling, surveillance and management.
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Lucas E, Ribeiro CL, Bravo-Valenzuela NJ, Araujo Júnior E, Mello RRD. Right ventricular myocardial performance index (Tei) in premature infants. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221215. [PMID: 37075365 PMCID: PMC10176660 DOI: 10.1590/1806-9282.20221215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.
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Affiliation(s)
- Eliane Lucas
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswald Cruz Foundation, Department of Pediatrics - Rio de Janeiro (RJ), Brazil
- Bonsucesso Federal Hospital, Service of Cardiology - Rio de Janeiro (RJ), Brazil
| | - Carmem Lucia Ribeiro
- Bonsucesso Federal Hospital, Service of Cardiology - Rio de Janeiro (RJ), Brazil
| | | | - Edward Araujo Júnior
- Federal University of São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
- Municipal University of São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Rosane Reis de Mello
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswald Cruz Foundation, Department of Pediatrics - Rio de Janeiro (RJ), Brazil
- Bonsucesso Federal Hospital, Service of Cardiology - Rio de Janeiro (RJ), Brazil
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Lu DF, Tong XM, Liu YF, Zhang H. Reference Values for Point-of-Care Echocardiographic Measurements of Preterm Infants in China. Front Pediatr 2022; 10:894152. [PMID: 35844737 PMCID: PMC9280336 DOI: 10.3389/fped.2022.894152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have examined the reference value of the left ventricular structure and function in preterm infants. This study was designed to establish a point-of-care echocardiographic reference range of left ventricular structure and function based on different gestational age, weight, and body surface area (BSA) for preterm infants within 7 days after birth. METHODS We retrospectively studied 489 patients with traditional echocardiographic data of left ventricular (LV) M-mode: LV end diastolic dimensions (LVED), LV end systolic dimension (LVES), end-diastolic interventricular septal thickness (IVSd), end diastolic LV posterior wall thickness (LVPWd), left atrial (LA) and aortic root (AO) diameters, and index of LA/AO, LV ejection fraction (LVEF), LV fractional shortening (LVFS), and pulsed wave Doppler: aortic valve flow rate (AV), peak mitral valve flow rate E(MV-E), peak mitral valve flow rate A(MV-A), and MV-E/A. The LV dimensions and the maximum blood flow velocities of the aortic valves and mitral valves according to gestational age, birth weight, and body surface area (BSA) are presented in percentiles tables. Percentile curves of aforesaid four cardiac measurements (LVED, LA diameter (LAD), MV-E, MV-E/A) using the R language Generalized Additive Models for Location, Scale and Shape (GAMLSS) method were developed according to different gestational ages and weights. RESULTS Measurements of all cardiac dimensions and Doppler maximum velocities of AV, MV-E, and MV-E/A showed a correlation with gestational age, weight, and BSA. LVED, LAD, MV-E, and MV-E/A showed a trend of increasing values with gestational age and weight on the percentile curves. CONCLUSION The percentile tables and graphs of these point-of-care echocardiographic data can provide reliable reference data for Chinese neonates. Normative values are recommended as a source of reference data for the identification of potentially abnormal echocardiography.
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Affiliation(s)
- Dan-Fang Lu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yun-Feng Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Department of Epidemiology Center, Peking University Third Hospital, Beijing, China
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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.
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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
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Reference values for fetal Doppler-based cardiocirculatory indices in monochorionic-diamniotic twin pregnancy. BMC Pregnancy Childbirth 2021; 21:797. [PMID: 34847869 PMCID: PMC8630902 DOI: 10.1186/s12884-021-04255-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/08/2021] [Indexed: 12/05/2022] Open
Abstract
Background Placental anastomoses in monochorionic diamniotic (MCDA) twin pregnancy have a major impact on fetal circulation. This study was designed to define reference ranges of cardiac and vascular Doppler indices in MCDA twin pregnancies. Methods This cross-sectional study included 442 uncomplicated MCDA twin fetuses undergoing Doppler ultrasonography at 18–35 weeks of gestation. Left and right myocardial performance index (LV-MPI, RV-MPI), E/A ratio of atrioventricular valves, pulsatility indices of umbilical artery, middle cerebral artery (MCA), and ductus venosus (DV), cerebroplacental ratio, peak systolic velocity of MCA, S/a ratio of DV, and early diastolic filling time of ductus venosus (DV-E) were evaluated under standardized settings. The equation models between Doppler indices and gestational age (GA) were fitted. After adjustment for GA, the correlations between MPI and fetal heart rate (FHR), and between MPI and DV indices were analyzed. Results Estimated centiles of Doppler indices were derived as a function of GA, being distinct in values from those of singletons. There was no correlation between GA-adjusted MPI and FHR. DV-E was inversely related to LV-MPI. Conclusions MCDA twins showed significant changes in some Doppler indices throughout gestation with quantitative differences from singletons, emphasizing the importance of MC twin-specific reference values for clinical application. Further adjustment of MPI for FHR was unnecessary. DV-E is a vascular index indirectly representing fetal diastolic function. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04255-w.
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Sun L, Wang J, Su X, Chen X, Zhou Y, Zhang X, Lu H, Niu J, Yu L, Sun C, Zhang W, Han J, Zhang L, Wang Z, Chen P, Chen T, Hong H, Zhou L, Ye B, Guo W, Zhao W, Zhang N, Li Z, Zhao S, Wu Q, Tian J, Jiang Y. Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study. BMJ Open 2021; 11:e049640. [PMID: 34233998 PMCID: PMC8264880 DOI: 10.1136/bmjopen-2021-049640] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The primary aim of this study was to establish the normal reference ranges of the fetal left ventricular (LV) Modified Myocardial Performance Index (Mod-MPI). A secondary aim was to evaluate the agreement between manual and automatic measurements for fetal Mod-MPI. DESIGN A prospective, multicentre, cross-sectional study. PARTICIPANTS Normal singleton pregnancies. METHODS The LV functions of normal singleton pregnancies were assessed in nine centres covering eight provinces in China using unified ultrasound protocols and settings and standardised measurements by pulsed Doppler at 20-24, 28-32 and 34-38 weeks of gestation. The isovolumetric relaxation time (IRT), isovolumetric contraction time, ejection time (ET) and Mod-MPI were measured both automatically and manually. RESULTS This cross-sectional study included 2081 fetuses, and there was a linear correlation between gestational age (GA) and Mod-MPI (0.416+0.001×GA (weeks), p<0.001, r2=0.013), IRT (36.201+0.162× GA (weeks), p<0.001, r2=0.021) and ET (171.418-0.078*GA (weeks), p<0.001, r2=0.002). This finding was verified using longitudinal data in a subgroup of 610 women. The agreement between the manual and automated measurements for Mod-MPI was good. CONCLUSIONS We constructed normal reference values of fetal LV Mod-MPI. Automatic measurement can be considered for ease of measurement in view of the good agreement between the automatic and manual values.
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Affiliation(s)
- Lijuan Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Jingjing Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Xiaoting Su
- Department of Ultrasound, Qingdao Women and Children's Hospital, Shandong, China
| | - Xinlin Chen
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Hubei, China
| | - Yuqing Zhou
- Department of Ultrasound, Shanghai Changning Maternity & Infant Health Hospital, Shanghai, China
| | - Xiaoming Zhang
- Department of Ultrasound, Inner Mongolia people's hospital, Inner Mongolia, China
| | - Hong Lu
- Department of Ultrasound, Women's Hospital School of Medicine Zhejiang University, Zhejiang, China
| | - Jianmei Niu
- Department of Ultrasound, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Yu
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Congxin Sun
- Department of Ultrasound, Shijiazhuang Obstetrics and Gynecology Hospital, Hebei, China
| | - Wenjun Zhang
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Hubei, China
| | - Jijing Han
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Lina Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Zhenna Wang
- Department of Ultrasound, Qingdao Women and Children's Hospital, Shandong, China
| | - Peiwen Chen
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Hubei, China
| | - Tiantian Chen
- Department of Ultrasound, Shanghai Changning Maternity & Infant Health Hospital, Shanghai, China
| | - Hua Hong
- Department of Ultrasound, Inner Mongolia people's hospital, Inner Mongolia, China
| | - Lulu Zhou
- Department of Ultrasound, Women's Hospital School of Medicine Zhejiang University, Zhejiang, China
| | - Baoying Ye
- Department of Ultrasound, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Guo
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Wei Zhao
- Department of Ultrasound, Shijiazhuang Obstetrics and Gynecology Hospital, Hebei, China
| | - Na Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Sheng Zhao
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Hubei, China
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medicine University, Heilongjiang, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Reference values for left and right ventricular systolic-to-diastolic duration ratio (SDR) found using both spectral and tissue Doppler of fetal heart between 20 and 36+6 weeks of gestation. Int J Cardiovasc Imaging 2021; 37:2717-2726. [PMID: 33844115 DOI: 10.1007/s10554-021-02239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To establish reference values for the systolic-to-diastolic duration ratio (SDR) of the left ventricle (LV) using spectral Doppler, as well as for the SDR' of the interventricular septum (SEP), LV, and right ventricles (RV) using tissue Doppler of the fetal heart. METHOD This prospective and cross-sectional study evaluated 374 low-risk singleton pregnancies from 20 to 36 + 6 weeks of gestation. The ventricular filling time (FT) was obtained from LV inflow using spectral Doppler. Tissue Doppler was used to assess the FT of each ventricle by placing the cursor at the atrioventricular junction marked by the mitral and tricuspid valves, respectively. SDR was calculated as the sum of the isovolumic contraction time (ICT) and the ejection time (ET) divided by the sum of the isovolumic relaxation time (IRT) and the ventricular FT. We used regression analysis to obtain the best-fit model polynomial equation for the parameters. The concordance correlation coefficient (CCC) was used to assess intra- and inter-observer reproducibility. RESULTS SDR and SDR' LV showed a progressive decrease with gestational age (GA); the SDR' RV and SDR' SEP did not show a significant decrease with advancing GA. The SDR LV (r = 0.29, p < 0.0001), SDR' RV (r = 0.21, p < 0.0001), SDR' LV (r = 0.20, p = 0.0001), and SDR' SEP (r = 0.25, p < 0.0001) showed a significant weak positive correlation with fetal heart rate. The inter-observer SDR' SEP measurements demonstrated poor reproducibility (CCC: 0.50), whereas intra-observer SRD LV measurements demonstrated moderate reproducibility (CCC: 0.78). CONCLUSIONS Reference values for SDR SEP, LV, and RV using spectral and tissue Doppler of fetal heart were established between 20 and 36+6 weeks of gestation.
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Peixoto AB, Bravo-Valenzuela NJ, Rocha LA, Araujo Júnior E. Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update. Radiol Bras 2021; 54:99-106. [PMID: 33854264 PMCID: PMC8029930 DOI: 10.1590/0100-3984.2020.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Clinic, Hospital Universitário Mário Palmério - Universidade de Uberaba (Uniube), Uberaba, MG, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Division of Pediatrics (Pediatric Cardiology), Department of Internal Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luciane Alves Rocha
- Graduate Program in Health Sciences, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Bravo-Valenzuela NJ, Peixoto AB, Carrilho MC, Siqueira Pontes AL, Chagas CC, Simioni C, Araujo Júnior E. Fetal cardiac function by three-dimensional ultrasound using 4D-STIC and VOCAL - an update. J Ultrason 2019; 19:287-294. [PMID: 32021711 PMCID: PMC6988455 DOI: 10.15557/jou.2019.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023] Open
Abstract
Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.
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Affiliation(s)
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Milene Carvalho Carrilho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Caroline Cevante Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Christiane Simioni
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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