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Serafin K, Nocun AA, Zawisza K, Dudzik MM, Wiechec MT. Comparison of Left Ventricular Stroke Volume in 2nd- and 3rd Trimester Fetuses Measured by the Product of VTI and Aortic Annular Area With That Assessed by Simpson's Single-Plane Rule Using the STE Technique. J Ultrasound Med 2024. [PMID: 38567690 DOI: 10.1002/jum.16456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/02/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The aim of the study was to compare left ventricle stroke volume in healthy, eutrophic fetuses in the 2nd and 3rd trimesters evaluated using the velocity time integral and aortic annulus area with left ventricular stroke volume measured using Simpson's single-plane rule and to determine the discrepancy equation. METHODS The study included 354 fetuses. In each fetus, during the same examination, simultaneous assessment of stroke volume was performed by pulsed-wave Doppler using the product of the velocity time integral and aortic annulus area and by the fetalHQ® software using Simpson's single-plane rule. The Mann-Whitney U test was used to compare the "product-derived" stroke volume and stroke volume using fetalHQ® software values in the 2nd and 3rd trimesters separately. The agreement between the two methods were verified using Bland-Altman analysis. A linear regression model was used to obtain the discrepancy equation. RESULTS In the 2nd trimester, the mean percentage difference between both the techniques showed that the stroke volume values determined using pulsed-wave Doppler were, on average, 88% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 146% and the lower limit of agreement was equal to 29.6%. In the 3rd trimester, the results indicated that the stroke volume values determined using pulsed-wave Doppler were, on average, 76% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 129% and the lower limit of agreement was 23%. Based on the results of the linear regression models, discrepancy formulas of the stroke volume values were obtained. The equations to calculate the predicted mean and standard deviations were used to compute the reference intervals for the mean, 5th and 95th centiles. CONCLUSION The calculation of left ventricular stroke volume using pulsed Doppler has higher result in relation to stroke volume determined using Simpson's rule significantly. The aortic annulus area showed a higher correlation regarding stroke volume than the velocity time integral in both the 2nd and 3rd trimesters. Stroke volume increased with the increase in aortic annulus area, whereas the velocity time integral remained relatively constant. The retrospective analysis of the collected material enabled the determination of the discrepancy equation.
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Affiliation(s)
- Krzysztof Serafin
- Chair of Gynecology and Obstetrics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
- Ultrasound Laboratory, ARS MEDICA Specialist Gynecology and Obstetrics Clinic, Tarnow, Poland
| | - Agnieszka A Nocun
- Ultrasound Laboratory, MWU DOBRE USG Center of Ultrasound Diagnostics, Cracow, Poland
| | - Katarzyna Zawisza
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Magdalena M Dudzik
- Ultrasound Laboratory, MWU DOBRE USG Center of Ultrasound Diagnostics, Cracow, Poland
| | - Marcin T Wiechec
- Chair of Gynecology and Obstetrics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
- Ultrasound Laboratory, MWU DOBRE USG Center of Ultrasound Diagnostics, Cracow, Poland
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Domínguez-Gallardo C, Ginjaume-García N, Ullmo J, Parra J, Vázquez A, Cruz-Lemini M, Llurba E. Fetal Left Ventricle Function Evaluated by Two-Dimensional Speckle-Tracking Echocardiography across Clinical Stages of Severity in Growth-Restricted Fetuses. Diagnostics (Basel) 2024; 14:548. [PMID: 38473020 DOI: 10.3390/diagnostics14050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Fetal growth restriction (FGR) can result in adverse perinatal outcomes due to cardiac dysfunction. This study used 2D speckle-tracking echocardiography to assess left ventricle (LV) longitudinal strain across FGR severity stages. A prospective longitudinal cohort study measured global (GLS) and segmental LV longitudinal strain in FGR fetuses, with evaluations conducted at various time points. FGR was classified into subtypes based on published criteria using fetal weight centile and Doppler parameters. A linear mixed model was employed to analyze repeated measures and compare Z-score measurements between groups throughout gestational age. The study included 40 FGR fetuses and a total of 107 evaluations were performed: 21 from small for gestational age (SGA), 74 from the FGR stage I, and 12 from the FGR stage ≥ II. The results indicate that SGA and stage I FGR fetuses exhibit higher LV GLS than stages ≥ II. Throughout gestation, SGA and FGR stage I fetuses showed similar behavior with consistently better LV GLS values when compared to FGR stages ≥ II. No significant differences were observed in LV GLS strain behavior between SGA and FGR stage I. In conclusion, all FGRs show signs of early cardiac dysfunction, with severe cases demonstrating significantly a lower LV GLS when compared to mild cases, suggesting deterioration of cardiac dysfunction with progression of fetal compromise.
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Affiliation(s)
- Carla Domínguez-Gallardo
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Nuria Ginjaume-García
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Johana Ullmo
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan Parra
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Vázquez
- Applied Statistics Department, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Mónica Cruz-Lemini
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Prats P, Izquierdo MT, Rodríguez MÁ, Rodríguez I, Rodríguez-Melcón A, Serra B, Albaiges G. Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms. AJOG Glob Rep 2024; 4:100325. [PMID: 38586615 PMCID: PMC10994973 DOI: 10.1016/j.xagr.2024.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks. OBJECTIVE This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks. STUDY DESIGN We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated. RESULTS A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks. CONCLUSION The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.
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Affiliation(s)
- Pilar Prats
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - M. Teresa Izquierdo
- Gynecologic and Obstetric Ultrasound Unit, Hospital VITHAS 9 Octubre, Valencia, Spain (Dr Izquierdo)
| | - M. Ángeles Rodríguez
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
| | - Ignacio Rodríguez
- Epidemiological Unit, Department Obstetrics, Gynecology, Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Mr Rodríguez)
| | - Alberto Rodríguez-Melcón
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - Bernat Serra
- Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez-Melcón, and Serra)
| | - Gerard Albaiges
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain (Drs Prats, Rodríguez, and Albaiges)
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Zamprakou A, Söderhult I, Ferm‐Widlund K, Ajne G, Johnson J, Herling L. Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion before and after intrauterine blood transfusion in pregnancies affected by red blood cell alloimmunization. Acta Obstet Gynecol Scand 2024; 103:313-321. [PMID: 37984405 PMCID: PMC10823390 DOI: 10.1111/aogs.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/15/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Maternal red blood cell alloimmunization during pregnancy can lead to hemolysis and various degrees of fetal anemia, which can be treated with intrauterine blood transfusion (IUT) to prevent adverse outcomes. Knowledge about fetal myocardial function and adaptation is limited. The aim of the present study was to measure fetal atrioventricular plane displacement before and after IUT and compare these measurements with previously established reference ranges. MATERIAL AND METHODS An observational study was conducted on pregnant women affected by red blood cell alloimmunization. Fetal echocardiography was performed before and after IUT. The atrioventricular plane displacement of the left and right ventricular walls and interventricular septum, described as mitral, septal, and tricuspid annular plane systolic excursion (MAPSE, SAPSE, and TAPSE, respectively), was assessed using color tissue Doppler imaging with automated analysis software. A Mann-Whitney U test was used to compare the z scores to the normal mean before and after IUT. RESULTS Twenty-seven fetuses were included. The mean z score for pre-IUT MAPSE was significantly increased compared with the reference ranges, +0.46 (95% confidence interval [CI] +0.17 to +0.75; p = 0.039), while the mean z scores for post-IUT SAPSE and TAPSE were significantly decreased, -0.65 (95% CI -1.11 to -0.19; p < 0.001) and -0.60 (95% CI -1.04 to -0.17; p = 0.003), respectively. The difference in atrioventricular plane displacement z scores before and after IUT was statistically significant in all three locations. The median difference between the pre-IUT and post-IUT z scores was -0.66 (95% CI -1.03 to -0.33, p < 0.001) for MAPSE, -1.05 (95% CI -1.43 to -0.61, p < 0.001) for SAPSE, and -0.60 (95% CI -1.19 to -0.01, p = 0.046) for TAPSE. CONCLUSIONS This study suggests that atrioventricular plane displacement, when determined using automated analysis software, may represent a quantitative parameter, describing fetal myocardial function and adaptation before and after IUT.
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Affiliation(s)
- Aikaterini Zamprakou
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Ingrid Söderhult
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
| | - Kjerstin Ferm‐Widlund
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
| | - Gunilla Ajne
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
| | - Jonas Johnson
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Lotta Herling
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
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Tartaglia S, Paciullo C, Visconti D, Lanzone A, De Santis M. Cardiovascular Effects of a Thoracoamniotic Shunt in a Fetus Affected by Isolated Right Congenital Diaphragmatic Hernia and Hydrops. Cureus 2024; 16:e54279. [PMID: 38371432 PMCID: PMC10870193 DOI: 10.7759/cureus.54279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 02/20/2024] Open
Abstract
A thoracoamniotic shunt was placed in a fetus affected by a right congenital diaphragmatic hernia (RCDH) complicated by voluminous nonimmune hydrops (NIH) at 30 weeks of gestation. The fetus showed congestive cardiac failure with a combined cardiac output (CCO) of 460.7 ml/min (Z-score: -1.2). After seven days, no edema, ascites, or pleural effusion was present. CCO increased significantly, reaching a Z-score of -0.2, as well as right and left cardiac output (Z-scores: -0.3 and -0.8, respectively). Two weeks later, the cardiac function and the ascites got worse despite the correct shunt placement, suggesting a possible occlusion. At 33 weeks, a C-section was performed due to labor in breech presentation. Despite the intensive care provided, the newborn died due to pulmonary hypertension and respiratory insufficiency. The thoracoamniotic shunt's effect on fetal circulation and the mechanisms of NIH in the event of RCDH are still unclear. Due to the high mortality rate of this condition and its poorer outcomes compared to left-sided defects, shunting cannot be considered an efficient attempt to improve fetal and neonatal survival rates to date. A close relationship between the amount of lymphatic effacement and cardiac function is clear, but further studies are needed to provide more information about this severe condition and its treatment.
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Affiliation(s)
- Silvio Tartaglia
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, ITA
| | - Carmela Paciullo
- Department of Gynecology and Obstetrics, Università Cattolica del Sacro Cuore, Rome, ITA
| | - Daniela Visconti
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, ITA
| | - Antonio Lanzone
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, ITA
| | - Marco De Santis
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, ITA
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Murillo C, Rueda C, Larroya M, Boada D, Grau L, Ponce J, Herranz A, Gómez O, Ferrero S, Andreu-Fernández V, Gratacós E, Crispi F, Palacio M, Cobo T. Intra-amniotic infection and/or inflammation is associated with fetal cardiac concentric hypertrophy and diastolic dysfunction in preterm labor and preterm prelabor rupture of membranes. Am J Obstet Gynecol 2024:S0002-9378(23)00747-0. [PMID: 38290925 DOI: 10.1016/j.ajog.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Preterm delivery is associated with cardiovascular remodeling and dysfunction in children and adults. However, it is unknown whether these effects are caused by the neonatal consequences of preterm birth or if these are already present in utero. OBJECTIVE We evaluated fetal cardiac morphology and function in fetuses of mothers admitted for preterm labor or preterm prelabor rupture of membranes and the association of these changes with the presence of intra-amniotic infection and/or inflammation. STUDY DESIGN In this prospective cohort study, fetal echocardiography and amniocentesis were performed at admission in singleton pregnant women with preterm labor and/or preterm prelabor rupture of membranes between 24.0 and 34.0 weeks' gestation with (intra-amniotic infection and/or inflammation group, n=41) and without intra-amniotic infection and/or inflammation (non-intra-amniotic infection and/or inflammation, n=54). Controls (n=48) were outpatient pregnant women without preterm labor or preterm prelabor rupture of membranes. Intra-amniotic infection was defined by a positive amniotic fluid culture or positive 16S ribosomal RNA gene. Intra-amniotic inflammation was defined by using the amniotic fluid interleukin-6 cutoff levels previously reported by our group being >1.43 ng/mL in preterm prelabor rupture of membranes and >13.4 ng/mL in preterm labor. Fetal cardiac morphology and function was evaluated using echocardiography, and troponin-I and N-terminal pro-brain natriuretic peptide concentrations were measured in amniotic fluid from women with preterm labor or preterm prelabor rupture of membranes and compared with 20 amniotic fluid Biobank samples obtained for reasons other than preterm labor or preterm prelabor rupture of membranes or cardiac pathology. The data were adjusted for the estimated fetal weight below the 10th percentile and for preterm prelabor rupture of membranes at admission and also for gestational age at amniocentesis when amniotic fluid biomarkers were compared. RESULTS From 2018 to 2021, 143 fetuses were included; 95 fetuses were from mothers admitted with a diagnosis of preterm labor or preterm prelabor rupture of membranes, and among those, 41 (28.7%) were in the intra-amniotic infection and/or inflammation group and 54 (37.8%) were in the non-intra-amniotic infection and/or inflammation group. A total of 48 (33.6%) fetuses were included in the control group. Fetuses with preterm labor and/or preterm prelabor rupture of membranes had signs of subclinical cardiac concentric hypertrophy (median left wall thickness of 0.93 [interquartile range, 0.72-1.16] in the intra-amniotic infection and/or inflammation group; 0.79 [0.66-0.92] in the non-intra-amniotic infection and/or inflammation group; and 0.69 [0.56-0.83] in controls; P<.001) and diastolic dysfunction (tricuspid A duration 0.23 seconds [0.21-0.25], 0.24 [0.22-0.25], and 0.21 [0.2-0.23]; P=.007). Systolic function was similar among groups. Higher values of amniotic fluid troponin I (1413 pg/mL [927-2334], 1190 [829-1636], and 841 [671-959]; P<.001) and N-terminal pro-brain natriuretic peptide were detected (35.0%, 17%, and 0%; P=.005) in fetuses with preterm labor or preterm prelabor rupture of membranes when compared with the control group. The highest N-terminal pro-brain natriuretic peptide concentrations were found in the intra-amniotic infection and/or inflammation group. CONCLUSION Fetuses with preterm labor or preterm prelabor rupture of membranes showed signs of cardiac remodeling and subclinical dysfunction, which were more pronounced in those exposed to intra-amniotic infection and/or inflammation. These findings support that the cardiovascular effects observed in children and adults born preterm have, at least in part, a prenatal origin.
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Affiliation(s)
- Clara Murillo
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clinic and Hospital Sant Joan de Déu, Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Claudia Rueda
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clinic and Hospital Sant Joan de Déu, Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Marta Larroya
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clinic and Hospital Sant Joan de Déu, Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - David Boada
- Fundació de Recerca Clínica Barcelona – Institut d’Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Laia Grau
- Fundació de Recerca Clínica Barcelona – Institut d’Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Júlia Ponce
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clinic and Hospital Sant Joan de Déu, Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Ana Herranz
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clinic and Hospital Sant Joan de Déu, Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Olga Gómez
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Silvia Ferrero
- Fundació de Recerca Clínica Barcelona – Institut d’Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Vicente Andreu-Fernández
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain. Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Eduard Gratacós
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Fàtima Crispi
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Montse Palacio
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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Hendem DU, Oluklu D, Beser DM, Yildirim M, Turgut E, Tanacan A, Sahin D. Evaluation of Fetal Cardiac Functions in Preeclampsia: Does the Severity or Proteinuria Affect Fetal Cardiac Functions? J Ultrasound Med 2023; 42:2415-2424. [PMID: 37310112 DOI: 10.1002/jum.16268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the fetal cardiac functions in preeclampsia and control group, and determine whether the severity or amount of proteinuria affects fetal cardiac functions. METHODS This prospective case-control study involves 48 pregnant women with preeclampsia and 48 healthy women. Pulsed wave Doppler, M-mode, and tissue Doppler imaging were used to measure the cardiac function between the 32 and 34 gestational weeks in each group. All Doppler indices and cardiac function parameters were also compared in subgroups with mild and severe preeclampsia and between subgroups with proteinuria >3 g/24 hours and <3 g/24 hours. RESULTS Decreased diastolic function (decreased E, A, E', and A' values in mitral/tricuspid valves and increased isovolumetric relaxation time) and decreased systolic functions (decreased mitral and tricuspid annular plane systolic excursion and S' value in mitral/tricuspid valves) were detected in the preeclampsia group. Decreased tricuspid E value in severe preeclampsia compared with mild preeclampsia was shown in the present study. CONCLUSION Preeclampsia may cause changes in systolic and diastolic functions in the fetal heart. Subclinical functional changes of these fetuses can be detected earlier and more sensitively with the help of tissue Doppler imaging. Biventricular diastolic functional changes are more prominent in preeclamptic cases with proteinuria >3 g/24 hours.
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Affiliation(s)
- Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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8
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Yao S, Yang T, Kong X, Dang Y, Chen P, Lyu M. The Influence of Maternal Condition on Fetal Cardiac Function during the Second Trimester. Diagnostics (Basel) 2023; 13:2755. [PMID: 37685293 PMCID: PMC10486346 DOI: 10.3390/diagnostics13172755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE Maternal health has a direct, profound and lasting effect on the formation and development of the fetal cardiovascular system. The aim of this research was to find whether maternal age, BMI hypertension (GH) or gestational diabetic mellitus (GDM) would affect fetal cardiac function in the second trimester. METHOD 329 mothers who had a fetal echocardiogram examination at the International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China, from 1 January 2020 to 30 April 2020 were enrolled at the gestational age of 21 to 26 weeks (mean 22.78 ± 1.13 weeks). Single-factor analysis and multi-factor line regression analysis were used to find the contribution values of each factor to fetal cardiac function. RESULTS at the second trimester, maternal age had a minor influence on the fetal left ventricle diastolic function. Higher maternal BMI could cause a decrease in the fetal diastolic function of both the left and right ventricle and the systolic function of the left ventricle. Maternal hypertension and gestational diabetic mellitus had a profound influence on both the left and right fetal heart ventricles of both systolic and diastolic function. CONCLUSION maternal condition will have a profound influence on fetal cardiac function as early as the second trimester.
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Affiliation(s)
- Shifa Yao
- Ultrasound Department, The International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (S.Y.); (T.Y.); (X.K.); (Y.D.); (P.C.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Tian Yang
- Ultrasound Department, The International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (S.Y.); (T.Y.); (X.K.); (Y.D.); (P.C.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Xiaoxiao Kong
- Ultrasound Department, The International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (S.Y.); (T.Y.); (X.K.); (Y.D.); (P.C.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Yuanyuan Dang
- Ultrasound Department, The International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (S.Y.); (T.Y.); (X.K.); (Y.D.); (P.C.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Ping Chen
- Ultrasound Department, The International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (S.Y.); (T.Y.); (X.K.); (Y.D.); (P.C.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Mingli Lyu
- Ultrasound Department, The International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (S.Y.); (T.Y.); (X.K.); (Y.D.); (P.C.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
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9
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Kühle H, Cho SKS, Barber N, Goolaub DS, Darby JRT, Morrison JL, Haller C, Sun L, Seed M. Advanced imaging of fetal cardiac function. Front Cardiovasc Med 2023; 10:1206138. [PMID: 37288263 PMCID: PMC10242056 DOI: 10.3389/fcvm.2023.1206138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Over recent decades, a variety of advanced imaging techniques for assessing cardiovascular physiology and cardiac function in adults and children have been applied in the fetus. In many cases, technical development has been required to allow feasibility in the fetus, while an appreciation of the unique physiology of the fetal circulation is required for proper interpretation of the findings. This review will focus on recent advances in fetal echocardiography and cardiovascular magnetic resonance (CMR), providing examples of their application in research and clinical settings. We will also consider future directions for these technologies, including their ongoing technical development and potential clinical value.
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Affiliation(s)
- Henriette Kühle
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Cardiac and Thoracic Surgery, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Division of Cardiac Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Steven K. S. Cho
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Nathaniel Barber
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Datta Singh Goolaub
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jack R. T. Darby
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Janna L. Morrison
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiac Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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10
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Yamamoto Y, Takahashi K, Takamizu A, Ogawa T, Yoshida K, Itakura A. Normative change with gestation in fetal intraventricular pressure difference with color M-mode Doppler echocardiography. J Obstet Gynaecol Res 2023. [PMID: 37190899 DOI: 10.1111/jog.15672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
AIM The intraventricular pressure difference (IVPD) is the pressure difference in early diastole from the base to the apex of the ventricle. It is a useful marker for evaluating diastolic function because of its role as a suction force. This study investigated the changes in total and segmental IVPDs in normal fetuses throughout gestation to obtain normative data equations. METHODS One hundred thirty-seven healthy pregnant women at 12-40 weeks of gestation were prospectively enrolled to evaluate IVPD. The color M mode was performed, and the image was evaluated using our own code to calculate the IVPD. Segmental IVPD was divided into mid to apex and base. Pearson's correlation coefficient was used to evaluate this relationship. RESULTS There was a significant, positive relationship between IVPD and gestational age in both ventricles (right ventricle [RV]: r = 0.800, left ventricle [LV]: r = 0.818). As for segmental IVPD, basal and mid-apical IVPD also increased with gestation in both ventricles (RV: basal, r = 0.627; mid-apical, r = 0.705; LV: basal r = 0.758; mid-apical, r = 0.756). IVPG, which was calculated as IVPD/ventricular length, also showed a weak, positive relationship with gestation in both ventricles (RV r = 0.351, p < 0.001; LV r = 0.373, p < 0.001). CONCLUSION The total and segmental IVPDs significantly increased linearly through time.
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Affiliation(s)
- Yuka Yamamoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ai Takamizu
- Department Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takahisa Ogawa
- Department of Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Koyo Yoshida
- Department Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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11
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Laleli Koc B, Oluklu D, Hendem DU, Beser DM, Besimoglu B, Tanacan A, Ocal FD, Sahin D. Assessment of fetal cardiac functions in pregnant women with asthma. Echocardiography 2023. [PMID: 37138454 DOI: 10.1111/echo.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
AIM This study aims to investigate the effects of maternal asthma on fetal cardiac functions. METHODS The study was planned with 30 pregnant women who presented to a tertiary health center and were diagnosed with asthma and 60 healthy controls with similar gestational ages. The fetal echocardiographic assessment was assessed between 33 and 35 weeks of gestation with pulsed-wave Doppler (PW), M-mode, and tissue Doppler imaging (TDI). Fetal cardiac functions were compared between maternal asthma and the control group. Cardiac functions were assessed according to the duration of maternal asthma diagnosis, as well. RESULTS Early diastolic function parameters, tricuspid E wave (p = .001), and tricuspid E/A ratio (p = .005) were significantly lower in the group with maternal asthma. Tricuspid annular plane systolic excursion (TAPSE) and measurements of mitral annular plane systolic excursion (MAPSE) values were statistically lower in the study group than in the control group; p = .010 and p = .012, respectively. Parameters assessed with TDI (E', A', S', E/E', and MPI' of tricuspid valves) and global cardiac function parameters assessed with PW like myocardial performance index (MPI) and left cardiac output (LCO) were similar between groups (p > .05). Although, MPI did not change between groups, and the isovolumetric relaxation time (IVRT) value was prolonged in maternal asthma cases (p = .025). CONCLUSION We found that maternal asthma disease causes alteration in fetal diastolic and early systolic cardiac functions, but the global fetal cardiac function does not change. Diastolic heart function values also varied with the duration of maternal asthma. Prospective studies are needed to compare fetal cardiac functions with additional patient groups according to disease severity and type of medical treatment.
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Affiliation(s)
- Bergen Laleli Koc
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Berchan Besimoglu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Fatma Doga Ocal
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara Bilkent City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Bilkent City Hospital, Turkish Ministry of Health, University of Health Sciences, Ankara, Turkey
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12
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Menekse Beser D, Oluklu D, Uyan Hendem D, Yildirim M, Tugrul Ersak D, Goncu Ayhan S, Sahin D. Fetal echocardiographic evaluation before and after nifedipine treatment in preterm labor. Echocardiography 2022; 39:1245-1251. [PMID: 36029144 DOI: 10.1111/echo.15444] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/06/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the effect of nifedipine used for tocolysis on cardiac morphology and functions. METHODS The study included 47 pregnant women diagnosed with preterm labor at 32-33 weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI) before and after the 48th hour of nifedipine treatment. RESULTS No significant change was observed in Doppler parameters (pulsatility indices of the umbilical artery, middle cerebral artery, ductus venosus) and cardiac morphology (cardiothoracic ratio, end-diastolic longitudinal diameters, sphericity indices, wall thickness) after nifedipine treatment. The parameters obtained with TDI (e', a', s', e'/a', E/e' of mitral and tricuspid valves), M- mode (TAPSE, MAPSE), pulsed Doppler (myocardial performance index, left cardiac output, right cardiac output, tricuspid E, A waves, tricuspid E/A ratio, mitral E, A waves, mitral E/A ratio) did not change after nifedipine treatment. CONCLUSION To date, this is the first study to examine the effects of nifedipine on the fetal heart using the TDI. Since nifedipine is a drug that is frequently used and well-tolerated in the prevention of preterm labor, it is crucial that it does not cause changes in fetal cardiac parameters during tocolysis. Therefore, we used TDI in addition to conventional methods to evaluate the effect of nifedipine, which is frequently used in obstetrics, on cardiac functions in the early period. Nifedipine treatment seems not to affect systolic or diastolic functions. This indicates that nifedipine is reliable on cardiac functions and morphology in pregnancies treated for preterm labor.
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Affiliation(s)
- Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Duygu Tugrul Ersak
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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13
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Gireadă R, Socolov D, Mihălceanu E, Lazăr IT, Luca A, Matasariu R, Ursache A, Bujor I, Gireadă T, Boiculese VL, Socolov R. Evaluation of Fetal Cardiac Geometry and Contractility in Gestational Diabetes Mellitus by Two-Dimensional Speckle-Tracking Technology. Diagnostics (Basel) 2022; 12. [PMID: 36140456 DOI: 10.3390/diagnostics12092053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The most commonly known cardiac effect of gestational diabetes mellitus (GD) in the fetus is hypertrophic cardiomyopathy, but recent studies show that it is preceded by subclinical cardiac dysfunction. This study aimed to assess the effect of GD on fetal cardiac geometry and contractility by two-dimensional speckle-tracking technology. Methods: We performed a prospective observational study that included 33 pregnant patients with GD and 30 healthy individuals. For all fetuses, a four-chamber 3 s cine-loop was recorded and analyzed with Fetal Heart Quantification (FetalHQ®), a novel proprietary speckle-tracking software. The following cardiac indices were calculated: global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), and 24-segment end-diastolic diameter (EDD), fractional shortening (FS), and sphericity index (SI) for both ventricles. Demographic and cardiac differences between the two groups were analyzed, as well as intra-rater and inter-rater reliability. Results: There were significant changes in right ventricular FAC and FS for segments 4−24 in fetuses exposed to GD (−1 SD, p < 0.05). No significant differences were detected for GSI, GLS, EDD, or SI for either ventricle. Conclusions: Fetuses exposed to GD present impaired right ventricular contractility, especially in the mid and apical segments.
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14
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Goncu Ayhan S, Turgut E, Ozden Tokalioglu E, Oluklu D, Sakcak B, Uyan Hendem D, Tanacan A, Moraloglu Tekin O, Sahin D. Post-COVID-19 fetal cardiac evaluation in moderate infection group of pregnant women. J Clin Ultrasound 2022; 50:630-635. [PMID: 35524502 PMCID: PMC9348261 DOI: 10.1002/jcu.23220] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To determine the long-term fetal cardiac effects of the SARS-CoV-2 infection in pregnant women recovered from moderate COVID-19 with fetal echocardiography (ECHO). METHODS Forty-five pregnant women that recovered from moderate COVID-19 (CRG) 4 weeks after the infection confirmation, were compared with 45 gestational and maternal age-matched control groups (CG) in terms of demographic features fetal cardiac morphological (sphericity index, cardiothoracic ratio), and functional (myocardial performance index, mitral E/A, tricuspid E/A, mitral and tricuspid annular plane systolic excursion) parameters. RESULTS There was no difference in demographic features between the groups. Fetal cardiac morphologic parameters were found to be similar between the two groups. When the fetal cardiac functional assessment of the two groups was compared, only mitral E/A ratio results were found to be statistically significantly lower in the CRG than in the control group (p = 0.030). CONCLUSION The fetal heart does not seem to be negatively affected by COVID-19 after recovery from moderate infection. These results about the fetal effect of SARS-CoV-2 may improve our limited knowledge of the utility of fetal ECHO in pregnant women who recovered from COVID-19.
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Affiliation(s)
- Sule Goncu Ayhan
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Ezgi Turgut
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Eda Ozden Tokalioglu
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Deniz Oluklu
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Bedri Sakcak
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Derya Uyan Hendem
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Atakan Tanacan
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
- Department of Obstetrics and GynecologyUniversity of Health SciencesIstanbulTurkey
| | - Dilek Sahin
- Department of Obstetrics and GynecologyMinistry of Health Ankara City HospitalAnkaraTurkey
- Department of Obstetrics and GynecologyUniversity of Health SciencesIstanbulTurkey
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15
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Turgut E, Özdemir H, Turan G, Bayram M, Karcaaltincaba D. Comparison of cardiac morphology and function in small for gestational age fetuses and fetuses with late-onset fetal growth retardation. J Perinat Med 2022; 50:391-397. [PMID: 34905668 DOI: 10.1515/jpm-2021-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare cardiac structural and functional findings of fetuses with fetal growth restriction (FGR) and small for gestational age (SGA). METHODS In this prospective cohort study, patients were classified into three groups using Delphi procedure according to fetal weight, umbilical, uterine artery Doppler and cerebroplacental ratio. Fetal cardiac ultrasonographic morphology and Doppler examination was performed to all pregnant women at 36 weeks of gestation. RESULTS Seventy three patients were included in the study. There were one (6.7%) patient in the control group, 2 (13.3%) in the SGA group and 12 (80%) in the FGR group who needed neonatal intensive care unit (NICU) and NICU requirement was significantly higher in FGR fetuses (p<0.001). Left spherical index was found to be lower only among FGR fetuses (p=0.046). Left ventricular wall thickness was decreased and the right/left ventricular wall ratio was increased in FGR fetuses (p=0.006, p<0.001). Tricuspid/mitral valve ratio and mitral annular plane systolic excursion value was lower in FGR fetuses (p=0.034, p=0.024 respectively). Also, myocardial performance index was remarkably higher in FGR group (p=0.002). CONCLUSIONS We detected cardiac morphological changes in cases of both SGA and FGR-more pronounced in the FGR cases. Findings related to morphological changes on the left side in FGR cases were considered secondary to volume increase in FGR cases as an indicator of a brain-protective effect. In the FGR group, both systolic and diastolic dysfunctions were detected in the left heart.
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Affiliation(s)
- Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Halis Özdemir
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Gökçe Turan
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Merih Bayram
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Deniz Karcaaltincaba
- Department of Obstetrics and Gynecology, Division of Perinatology, Gazi University Medical Faculty, Ankara, Turkey
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16
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Rizzo G, Mappa I, Pietrolucci ME, Lu JLA, Makatsarya A, D'Antonio F. Effect of SARS-CoV-2 infection on fetal umbilical vein flow and cardiac function: a prospective study. J Perinat Med 2022; 50:398-403. [PMID: 35073616 DOI: 10.1515/jpm-2021-0657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/08/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect umbilical vein blood flow (UVBF) and fetal cardiac function. METHODS Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. Measurements of UVBF normalized for fetal abdominal circumference (UVBF/AC), atrial area (AA) and ventricular sphericity indices (SI) were compared between the two study groups. Chi-square and Mann-Whitney U tests were sued to analyze the data. RESULTS Fifty-four consecutive pregnancies complicated and 108 not complicated by SARS-CoV-2 infection were included. The median gestational age at infection was 30.2 (interquartile range [IQR] 26.2 34.1). General baseline and pregnancy characteristics were similar between pregnant women with compared to those without SARS-CoV-2 infection. There was no difference in UVBF/AC (study groups z value -0.11 vs. 0.14 control p 0.751) values between pregnancies complicated compared to those not complicated by SARS-CoV-2 infection. Likewise, there was no difference in the left and right AA (left 1.30 vs. 1.28 p=0.221 and right 1.33 vs. 1.31 p=0.324) and SI (left 1.75 vs. 1.77 p=0.208 and right 1.51 vs. 1.54 p=0.121) between the two groups. CONCLUSIONS SARS-CoV-2 infection does not affect UVBF and fetal cardiac function in uncomplicated pregnancies.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
- The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
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17
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Graupner O, Ried C, Wildner NK, Ortiz JU, Kuschel B, Haller B, Oberhoffer R, Wacker-Gußmann A, Lobmaier SM. Myocardial deformation analysis in late-onset small-for-gestational-age and growth-restricted fetuses using two-dimensional speckle tracking echocardiography: a prospective cohort study. J Perinat Med 2022; 50:305-312. [PMID: 34529908 DOI: 10.1515/jpm-2021-0162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES An association between fetal growth restriction (FGR) and increased predisposition to cardiovascular disease (CVD) is suggested. The aim of this study was to evaluate subclinical signs of fetal cardiac remodeling in late-onset small-for-gestational-age (SGA) and growth-restricted fetuses using two-dimensional speckle tracking echocardiography (2D-STE). METHODS This is a prospective cohort study, including 117 late-onset (≥32 weeks) SGA (birthweight≤10th centile) fetuses and 102 gestational age matched controls. A subgroup analysis was performed: FGR was defined based on either BW (<third centile) or the presence of feto-maternal Doppler abnormalities, the remaining cases were called SGA centile 3-10. 2D-STE based myocardial deformation analyses included longitudinal peak systolic strain (LPSS) and strain rate (LSR) of the global left (LV) or right (RV) ventricle and its individual segments. RESULTS Global and segmental LPSS and LSR values showed no significant difference between late-onset SGA and control fetuses for both ventricles (p>0.05). Regarding global and segmental LPSS and LSR values of LV/RV, subgroup analysis revealed no significant difference between the FGR (n=81), SGA centile 3-10 (n=36) and control group. CONCLUSIONS A mild degree of placental dysfunction seems not to influence myocardial deformation properties measured by 2D-STE.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Christina Ried
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Nadia K Wildner
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Javier U Ortiz
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Bettina Kuschel
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Statistics and Epidemiology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Institute of Medical Informatics, Munich, Germany
| | - Renate Oberhoffer
- Faculty of Sport and Health Science, Institute of Preventive Pediatrics, Munich, Germany.,Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Annette Wacker-Gußmann
- Faculty of Sport and Health Science, Institute of Preventive Pediatrics, Munich, Germany.,Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
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Nogué L, Gómez O, Izquierdo N, Mula C, Masoller N, Martínez JM, Gratacós E, Devore G, Crispi F, Bennasar M. Feasibility of 4D-Spatio Temporal Image Correlation (STIC) in the Comprehensive Assessment of the Fetal Heart Using FetalHQ(®). J Clin Med 2022; 11. [PMID: 35268505 DOI: 10.3390/jcm11051414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Fetal Heart Quantification (FetalHQ®) is a novel speckle tracking software that permits the study of global and regional ventricular shape and function from a 2D four-chamber-view loop. The 4D-Spatio Temporal Image Correlation (STIC) modality enables the offline analysis of optimized and perfectly aligned cardiac planes. We aimed to evaluate the feasibility and reproducibility of 4D-STIC speckle tracking echocardiography (STE) using FetalHQ® and to compare it to 2D STE. We conducted a prospective study including 31 low-risk singleton pregnancies between 20 and 40 weeks of gestation. Four-chamber view volumes and 2D clips were acquired with an apex pointing at 45° and with a frame rate higher than 60 Hz. Morphometric and functional echocardiography was performed by FetalHQ®. Intra- and interobserver reproducibility were evaluated by the intraclass correlation coefficient (ICC). Our results showed excellent reproducibility (ICC > 0.900) for morphometric evaluation (biventricular area, longitudinal and transverse diameters). Reproducibility was also good (ICC > 0.800) for functional evaluation (biventricular strain, Fractional Area Change, left ventricle volumes, ejection fraction and cardiac output). On the contrary, the study of the sphericity index and shortening fraction of the different ventricular segments showed lower reproducibility (ICC < 0.800). To conclude, 4D-STIC is feasible, reproducible and comparable to 2D echocardiography for the assessment of cardiac morphometry and function.
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Rizzo G, Mappa I, Pietrolucci ME, Lu JLA, Makatsarya A, D'Antonio F. Effect of SARS-CoV-2 infection on fetal umbilical vein flow and cardiac function: a prospective study. J Perinat Med 2022. [PMID: 35073616 DOI: 10.1515/jpm-2021-0657.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect umbilical vein blood flow (UVBF) and fetal cardiac function. METHODS Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. Measurements of UVBF normalized for fetal abdominal circumference (UVBF/AC), atrial area (AA) and ventricular sphericity indices (SI) were compared between the two study groups. Chi-square and Mann-Whitney U tests were sued to analyze the data. RESULTS Fifty-four consecutive pregnancies complicated and 108 not complicated by SARS-CoV-2 infection were included. The median gestational age at infection was 30.2 (interquartile range [IQR] 26.2 34.1). General baseline and pregnancy characteristics were similar between pregnant women with compared to those without SARS-CoV-2 infection. There was no difference in UVBF/AC (study groups z value -0.11 vs. 0.14 control p 0.751) values between pregnancies complicated compared to those not complicated by SARS-CoV-2 infection. Likewise, there was no difference in the left and right AA (left 1.30 vs. 1.28 p=0.221 and right 1.33 vs. 1.31 p=0.324) and SI (left 1.75 vs. 1.77 p=0.208 and right 1.51 vs. 1.54 p=0.121) between the two groups. CONCLUSIONS SARS-CoV-2 infection does not affect UVBF and fetal cardiac function in uncomplicated pregnancies.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy.,The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
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20
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Herling L, Johnson J, Ferm-Widlund K, Zamprakou A, Westgren M, Acharya G. Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion. Ultrasound Obstet Gynecol 2021; 58:853-863. [PMID: 34096674 DOI: 10.1002/uog.23703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The primary aim of this study was to evaluate the feasibility of automated measurement of fetal atrioventricular (AV) plane displacement (AVPD) over several cardiac cycles using myocardial velocity traces obtained by color tissue Doppler imaging (cTDI). The secondary objectives were to establish reference ranges for AVPD during the second half of normal pregnancy, to assess fetal AVPD in prolonged pregnancy in relation to adverse perinatal outcome and to evaluate AVPD in fetuses with a suspicion of intrauterine growth restriction (IUGR). METHODS The population used to develop the reference ranges consisted of women with an uncomplicated singleton pregnancy at 18-42 weeks of gestation (n = 201). The prolonged-pregnancy group comprised women with an uncomplicated singleton pregnancy at ≥ 41 + 0 weeks of gestation (n = 107). The third study cohort comprised women with a singleton pregnancy and suspicion of IUGR, defined as an estimated fetal weight < 2.5th centile or an estimated fetal weight < 10th centile and umbilical artery pulsatility index > 97.5th centile (n = 35). Cineloops of the four-chamber view of the fetal heart were recorded using cTDI. Regions of interest were placed at the AV plane in the left and right ventricular walls and the interventricular septum, and myocardial velocity traces were integrated and analyzed using an automated algorithm developed in-house to obtain mitral (MAPSE), tricuspid (TAPSE) and septal (SAPSE) annular plane systolic excursion. Gestational-age specific reference ranges were constructed and normalized for cardiac size. The correlation between AVPD measurements obtained using cTDI and those obtained by anatomic M-mode were evaluated, and agreement between these two methods was assessed using Bland-Altman analysis. The mean Z-scores of fetal AVPD in the cohort of prolonged pregnancies were compared between cases with normal and those with adverse outcome using Mann-Whitney U-test. The mean Z-scores of fetal AVPD in IUGR fetuses were compared with those in the normal reference population using Mann-Whitney U-test. Inter- and intraobserver variability for acquisition of cTDI recordings and offline analysis was assessed by calculating coefficients of variation (CV) using the root mean square method. RESULTS Fetal MAPSE, SAPSE and TAPSE increased with gestational age but did not change significantly when normalized for cardiac size. The fitted mean was highest for TAPSE throughout the second half of gestation, followed by SAPSE and MAPSE. There was a significant correlation between MAPSE (r = 0.64; P < 0.001), SAPSE (r = 0.72; P < 0.001) and TAPSE (r = 0.84; P < 0.001) measurements obtained by M-mode and those obtained by cTDI. The geometric means of ratios between AVPD measured by cTDI and by M-mode were 1.38 (95% limits of agreement (LoA), 0.84-2.25) for MAPSE, 1.00 (95% LoA, 0.72-1.40) for SAPSE and 1.20 (95% LoA, 0.92-1.57) for TAPSE. In the prolonged-pregnancy group, the mean ± SD Z-scores for MAPSE (0.14 ± 0.97), SAPSE (0.09 ± 1.02) and TAPSE (0.15 ± 0.90) did not show any significant difference compared to the reference ranges. Twenty-one of the 107 (19.6%) prolonged pregnancies had adverse perinatal outcome. The AVPD Z-scores were not significantly different between pregnancies with normal and those with adverse outcome in the prolonged-pregnancy cohort. The mean ± SD Z-scores for SAPSE (-0.62 ± 1.07; P = 0.006) and TAPSE (-0.60 ± 0.89; P = 0.002) were significantly lower in the IUGR group compared to those in the normal reference population, but the differences were not significant when the values were corrected for cardiac size. The interobserver CVs for the automated measurement of MAPSE, SAPSE and TAPSE were 28.1%, 17.7% and 15.3%, respectively, and the respective intraobserver CVs were 33.5%, 15.0% and 17.9%. CONCLUSIONS This study showed that fetal AVPD can be measured automatically by integrating cTDI velocities over several cardiac cycles. Automated analysis of AVPD could potentially help gather larger datasets to facilitate use of machine-learning models to study fetal cardiac function. The gestational-age associated increase in AVPD is most likely a result of increasing cardiac size, as the AVPD normalized for cardiac size did not change significantly between 18 and 42 weeks. A decrease was seen in TAPSE and SAPSE in IUGR fetuses, but not after correction for cardiac size. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Herling
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - J Johnson
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - K Ferm-Widlund
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - A Zamprakou
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Pregnancy and Delivery Medical Unit, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - M Westgren
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - G Acharya
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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21
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Lee-Tannock A, Hay K, Kumar S. Differences in biomarkers of cardiac dysfunction in cord blood between normal pregnancies and pregnancies complicated by maternal diabetes. Aust N Z J Obstet Gynaecol 2021; 62:79-85. [PMID: 34370294 DOI: 10.1111/ajo.13415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/25/2021] [Accepted: 07/13/2021] [Indexed: 01/05/2023]
Abstract
AIMS The aim of this study was to compare biomarkers of cardiac dysfunction in cord blood in women with uncomplicated pregnancies and pregnancies complicated by maternal pre-gestational and gestational diabetes and to correlate these findings with fetal echocardiography parameters of cardiac function. MATERIAL AND METHODS Fetal echocardiographic assessment was performed longitudinally on 78 fetuses in the normal cohort and 32 in the diabetic cohort by measuring tricuspid annular plane systolic excursion, mitral annular plane systolic excursion, myocardial performance index, interventricular septum (IVS) thickness and left fractional shortening between July 2015 and December 2017. Cord blood samples were obtained at birth and levels of troponin I (TnI), B-type natriuretic peptide (BNP) and the amnio terminal segment of its prohormone measured. RESULTS Women with diabetes had significantly higher median body mass index and mean z-scores for BNP. Significant associations were observed between maternal diabetes and obesity and cord-blood BNP z-scores. The effect of diabetes on TnI levels were similar, with mean values higher in women with gestational diabetes compared to normal pregnancies; however, this difference did not reach statistical significance. These biomarker findings correlated with an increased IVS thickness in the diabetic group. No difference was demonstrated in the other cardiac function parameters measured. CONCLUSION Biochemical markers of cardiac dysfunction are elevated in infants of diabetic and obese mothers and correlated with increased IVS thickness.
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Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Mater Health Services, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Health Services, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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22
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Hata T, Koyanagi A, Yamanishi T, Bouno S, Takayoshi R, Mostafa AboEllail MA, Miyake T. A 24-segment fractional shortening of the fetal heart using FetalHQ. J Perinat Med 2021; 49:371-376. [PMID: 33085638 DOI: 10.1515/jpm-2020-0246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/22/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate 24-segment fractional shortening (FS) of the fetal heart using FetalHQ by speckle-tracking regarding reproducibility and the change with advancing gestation. METHODS Eighty-one pregnant women at 18-21+6 and 28-31+6 weeks of gestation were studied using FetalHQ with the speckle-tracking technique to calculate 24-segment FS of left and right ventricles. Intra- and inter-class correlation coefficients and intra- and inter-observer agreements of measurements for FS were assessed in each segment. RESULTS With respect to intra-observer reproducibility, all FS values showed correlations between 0.575 and 0.862 for the left ventricle, with good intra-observer agreements except for left ventricular segments 14-24. Right ventricular FS values showed correlations between 0.334 and 0.685, with good intra-observer agreements. With respect to inter-observer reproducibility, all FS values showed correlations between 0.491 and 0.801 for the left ventricle, with good intra-observer agreements except for left ventricular segments 16-22. Right ventricular FS values showed correlations between 0.375 and 0.575, with good inter-observer agreements. There were significant differences in the mean FS values in the basal segment (segments 1-5) of the left ventricle between 18 and 21+6 and 28-31+6 weeks of gestation (p<0.05), whereas there were significant differences in all mean FS values in the right ventricle between both gestational ages (p<0.05). CONCLUSIONS These results suggest that the reproducibility of the 24-segment FS of the fetal heart using FetalHQ is fair. However, there may be significant differences in FS values with advancing gestational age, especially for the right ventricle.
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Affiliation(s)
- Toshiyuki Hata
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Aya Koyanagi
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | - Tomomi Yamanishi
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | - Saori Bouno
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | - Riko Takayoshi
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
| | | | - Takahito Miyake
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
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23
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Palalioglu RM, Erbiyik HI, Kaya B, Kiyak H, Gedikbasi A. Investigation of fetal cardiac function using tissue doppler imaging in fetuses compromised by growth restriction. Ginekol Pol 2021; 92:195-204. [PMID: 33751512 DOI: 10.5603/gp.a2020.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The primary aim of this study was to evaluate fetal cardiac systolic and diastolic function using the tissue Doppler technique in pregnancies with complications of fetal growth restriction (FGR) and to examine the relationship between FGR with umbilical artery Doppler parameters and fetal cardiac function in complicated pregnancies. MATERIAL AND METHODS This study included 30 pregnant women with FGR complications and 46 pregnant women without FGR complications. Both groups were at 24-34 gestational weeks. Fetal cardiac examination was performed using pulsed Doppler and tissue Doppler imaging (TDI) in all pregnancies. In the analysis of myocardial tissue by tissue Doppler, the tracing obtained from the junction of the tricuspid valve annulus with the right ventricle was recorded by measuring the duration of the isovolumetric contraction wave (IVC), ejection time (ET), and isovolumetric relaxation time (IVR). Furthermore, we calculated the myocardial performance index (MPI) and then measured and recorded the early diastolic annular rate. RESULTS Based on the TDI studies, the mean IVC and IVR values were significantly longer and the ET values were significantly shorter in the study group than those in the control group. The study group also had significantly longer MPI measurements. CONCLUSIONS Because TDI is a considerably more sensitive method than cardiac sonographic evaluation using pulsed Doppler, tissue Doppler parameters facilitate the detection of cardiac dysfunction at a relatively early stage. In addition, TDI and myocardial evaluation in fetuses with FGR can be noninvasively performed in clinical practice.
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Affiliation(s)
- Rabia Merve Palalioglu
- Department of Obstetrics and Gynecology, University of Health Sciences, Umraniye Training and Research Hospital, Elmalıkent Mah. Adem Yavuz Cad. Trt Sok. Umraniye, Istanbul, Turkey.
| | | | - Basak Kaya
- Department of Obstetrics and Gynecology, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Kiyak
- Department of Obstetrics and Gynecology, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Gedikbasi
- Department of Obstetrics and Gynecology, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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24
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Semmler J, Garcia-Gonzalez C, Sanchez Sierra A, Gallardo Arozena M, Nicolaides KH, Charakida M. Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia. Ultrasound Obstet Gynecol 2021; 57:417-422. [PMID: 33098138 DOI: 10.1002/uog.23521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia (PE) and those that remained normotensive. METHODS This was a prospective observational study in 1574 pregnancies at 35-37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle-tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. RESULTS In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt-1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt-1 which becomes apparent in the interval of 2-4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia-induced redistribution in the fetal circulation, reflected in the low CPR. CONCLUSION Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Semmler
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - C Garcia-Gonzalez
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Sanchez Sierra
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Gallardo Arozena
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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25
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Soveral I, Crispi F, Walter C, Guirado L, García-Cañadilla P, Cook A, Bonnin A, Dejea H, Rovira-Zurriaga C, Sánchez de Toledo J, Gratacós E, Martínez JM, Bijnens B, Gómez O. Early cardiac remodeling in aortic coarctation: insights from fetal and neonatal functional and structural assessment. Ultrasound Obstet Gynecol 2020; 56:837-849. [PMID: 31909552 DOI: 10.1002/uog.21970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Coarctation of the aorta (CoA) is associated with left ventricular (LV) dysfunction in neonates and adults. Cardiac structure and function in fetal CoA and cardiac adaptation to early neonatal life have not been described. We aimed to investigate the presence of cardiovascular structural remodeling and dysfunction in fetuses with CoA and their early postnatal cardiac adaptation. METHODS This was a prospective observational case-control study, conducted between 2011 and 2018 in a single tertiary referral center, of fetuses with CoA and gestational age-matched normal controls. All fetuses/neonates underwent comprehensive echocardiographic evaluation in the third trimester of pregnancy and after birth. Additionally, myocardial microstructure was assessed in one fetal and one neonatal CoA-affected heart specimen, using synchrotron radiation-based X-ray phase-contrast microcomputed tomography and histology, respectively. RESULTS We included 30 fetuses with CoA and 60 gestational age-matched controls. Of these, 20 CoA neonates and 44 controls were also evaluated postnatally. Fetuses with CoA showed significant left-to-right volume redistribution, with right ventricular (RV) size and output dominance and significant geometry alterations with an abnormally elongated LV, compared with controls (LV midventricular sphericity index (median (interquartile range; IQR), 2.4 (2.0-2.7) vs 1.8 (1.7-2.0); P < 0.001). Biventricular function was preserved and no ventricular hypertrophy was observed. Synchrotron tomography and histological assessment revealed normal myocyte organization in the fetal and neonatal specimens, respectively. Postnatally, the LV in CoA cases showed prompt remodeling, becoming more globular (LV midventricular sphericity index (mean ± SD), 1.5 ± 0.3 in CoA vs 1.8 ± 0.2 in controls; P < 0.001) with preserved systolic and normalized output, but altered diastolic, parameters compared with controls (LV inflow peak velocity in early diastole (mean ± SD), 97.8 ± 14.5 vs 56.5 ± 12.9 cm/s; LV inflow peak velocity in atrial contraction (median (IQR), 70.5 (60.1-84.9) vs 47.0 (43.0-55.0) cm/s; LV peak myocardial velocity in atrial contraction (mean ± SD), 5.1 ± 2.6 vs 6.3 ± 2.2 cm/s; P < 0.05). The neonatal RV showed increased longitudinal function in the presence of a patent arterial duct. CONCLUSIONS Our results suggest unique fetal cardiac remodeling in CoA, in which the LV stays smaller from the decreased growth stimulus of reduced volume load. Postnatally, the LV is acutely volume-loaded, resulting in an overall geometry change with higher filling velocities and preserved systolic function. These findings improve our understanding of the evolution of CoA from fetal to neonatal life. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Soveral
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
| | - F Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - C Walter
- Pediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - L Guirado
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
| | - P García-Cañadilla
- PhySense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- Institute of Cardiovascular Science, University College London, London, UK
| | - A Cook
- Institute of Cardiovascular Science, University College London, London, UK
| | - A Bonnin
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland
| | - H Dejea
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland
- Institute for Biomedical Engineering, ETH Zürich, Zürich, Switzerland
| | - C Rovira-Zurriaga
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - E Gratacós
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - J M Martínez
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- PhySense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - O Gómez
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Lee-Tannock A, Hay K, Gooi A, Kumar S. Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy. J Clin Ultrasound 2020; 48:396-404. [PMID: 32191357 DOI: 10.1002/jcu.22826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To construct longitudinal fetal reference ranges for global longitudinal myocardial deformation (strain and strain rate) of the left and right ventricles in the second half of pregnancy. METHODS A prospective, observational, longitudinal study of 120 women with uncomplicated singleton pregnancies. The participants underwent ultrasonographic scans every 4 weeks from enrolment (18-28 weeks) until delivery. Strain and strain rate were measured at each examination using velocity vector imaging. Changes in strain and strain rate as functions of gestational age (GA) were modeled using Bayesian mixed effects models. RESULTS A total of 406 assessments of global longitudinal strain and strain rate were performed for 120 women. Global longitudinal strain and strain rate decreased with increasing GA in the left ventricle. There was, however, no change in strain measurements of the right ventricle over the same gestational time frame. Posterior predictive distributions were used to derive reference centiles for each week of GA. CONCLUSION Assessment of myocardial deformation of the fetal heart is easily performed and may be useful for quantitative assessment of heart function, particularly in fetuses at risk of cardiac dysfunction.
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Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
| | - Karen Hay
- QMIR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alex Gooi
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Health Services, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
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Lee-Tannock A, Hay K, Gooi A, Kumar S. Longitudinal Reference Ranges for Tricuspid Annular Plane Systolic Excursion and Mitral Annular Plane Systolic Excursion in Normally Grown Fetuses. J Ultrasound Med 2020; 39:929-937. [PMID: 31737932 DOI: 10.1002/jum.15177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to construct reference ranges for fetal tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) using conventional M-mode ultrasound (US) in the second half of pregnancy. METHODS Participants underwent US scans every 4 weeks from 18 weeks' gestation until delivery. The TAPSE and MAPSE were measured by conventional M-mode US at each examination. The relationships between TAPSE and MAPSE and gestational age and estimated fetal weight were modeled by Bayesian mixed effects linear regression. RESULTS Positive linear relationships were observed between both MAPSE and TAPSE and gestational age and estimated fetal weight. Reference centiles for TAPSE and MAPSE were developed. CONCLUSIONS This simple technique is a useful tool for assessing cardiac function and could be used for quantitative assessments of fetal cardiac function, particularly in high-risk pregnancies such as those complicated by maternal diabetes.
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Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Karen Hay
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alex Gooi
- Mater Health Services, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
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Ozawa K, Davey MG, Tian Z, Hornick MA, Mejaddam AY, McGovern PE, Flake AW, Rychik J. Fetal echocardiographic assessment of cardiovascular impact of prolonged support on EXTrauterine Environment for Neonatal Development (EXTEND) system. Ultrasound Obstet Gynecol 2020; 55:516-522. [PMID: 30989734 PMCID: PMC7187205 DOI: 10.1002/uog.20295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE EXTrauterine Environment for Neonatal Development (EXTEND) is a system to support ongoing fetal growth and organ development in an extrauterine environment, utilizing a pumpless low-resistance oxygenator circuit. The aim of this study was to evaluate hemodynamics and cardiac function in fetal sheep sustained on the EXTEND system. METHODS This was a prospective study of fetal sheep supported for a minimum of 3 weeks on EXTEND. Hemodynamic parameters were assessed weekly and included heart rate, mean arterial pressure (MAP), Doppler-echocardiography-derived cardiac output (CO), pulsatility indices (PIs) of the fetal middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus and cardiac function, as assessed by speckle-tracking-derived global longitudinal strain and strain rate in the right (RV) and left (LV) ventricles. Parameters were compared at 0 days and 1, 2 and 3 weeks following placement on EXTEND. RESULTS Of 10 fetal sheep enrolled, seven survived for 3 weeks and were included in the analysis. Median gestational age at cannulation was 107 (range, 95-109) days. Heart rate decreased and MAP increased significantly, but within acceptable ranges, during the study period. The quantities and relative ratios of right and left CO remained stable within the anticipated physiological range throughout the study period. Vascular tracings and PIs appeared to be similar to those seen normally in the natural in-utero state, with MCA-PI being higher than UA-PI. UA tracings demonstrated maintained abundant diastolic flow despite the absence of placental circulation. In both the RV and LV, strain decreased significantly at 1 and 2 weeks relative to baseline but returned to baseline values by week 3. CONCLUSIONS The EXTEND mechanical support system replicates natural physiology and creates a stable and sustainable cardiovascular construct that supports growth over a 3-week period. However, there is a period of depressed contractility within the first week with subsequent improvement by week 3. This may reflect a period of physiological accommodation that warrants further investigation. This study lays the foundation for further exploration as the EXTEND system moves towards human application. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K. Ozawa
- Center for Fetal Research, Department of SurgeryThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Fetal Heart ProgramCardiac Center at The Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Center of Maternal–FetalNeonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD)TokyoJapan
| | - M. G. Davey
- Center for Fetal Research, Department of SurgeryThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Z. Tian
- Fetal Heart ProgramCardiac Center at The Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - M. A. Hornick
- Center for Fetal Research, Department of SurgeryThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - A. Y. Mejaddam
- Center for Fetal Research, Department of SurgeryThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - P. E. McGovern
- Center for Fetal Research, Department of SurgeryThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - A. W. Flake
- Center for Fetal Research, Department of SurgeryThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - J. Rychik
- Fetal Heart ProgramCardiac Center at The Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
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Sun L, Zhang L, Zhang N, Han J, Li Z, Zhang T, Yao L, Ma Y, Wang L, Liu Y, Guo C, Wu Q. Evaluation of Hemodynamic Changes in Fetuses With Isolated Mild-to-Moderate Ventriculomegaly by Transabdominal Ultrasound. J Ultrasound Med 2020; 39:453-461. [PMID: 31448445 PMCID: PMC7065132 DOI: 10.1002/jum.15121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/25/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To investigate fetal hemodynamic alterations using transabdominal ultrasound in fetuses with isolated mild-to-moderate ventriculomegaly (VM). METHODS Fetuses diagnosed with isolated mild-to-moderate VM by transabdominal ultrasound were evaluated for hemodynamic changes, including changes in fetal cardiac function, the umbilical artery, the ductus venosus, and the middle cerebral artery. The fetuses with isolated mild-to-moderate VM were divided into 2 groups, namely, before 32 weeks' gestation (20 weeks-31 weeks 6 days) and after 32 weeks' gestation (32-38 weeks), and matched to corresponding healthy control fetuses. RESULTS The 53 fetuses with VM before 32 weeks had a longer mean isovolumetric relaxation time (IRT; mean ± SD, 42.9 ± 6.8 versus 40.4 ± 5.0 milliseconds; P < .05) and an apparently higher modified myocardial performance index 0.46 ± 0.06 versus 0.43 ± 0.05; P < .01) than the healthy control fetuses. The 43 fetuses with VM after 32 weeks had a significantly longer mean IRT (45.5 ± 6.7 versus 40.9 ± 7.2 milliseconds; P < .01) and a lower UA pulsatility index (0.81 ± 0.13 versus 0.89 ± 0.11; P < .01). The optimal cutoff levels for the IRT in the prediction of adverse perinatal outcomes were 40 and 43 milliseconds before and after 32 weeks, respectively (sensitivity, 100% versus 100%; specificity, 40.4% versus 50.0%; area under the curve, 0.601 versus 0.748; 95% confidence interval, 0.457-0.733 versus 0.590-0.869; P = .291 versus .005). CONCLUSIONS Some fetuses with isolated mild-to-moderate VM may have impaired cardiac function, characterized by a higher modified myocardial performance index or longer IRT. This finding might be useful for improving fetal surveillance.
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Affiliation(s)
- Lijuan Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Lina Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Na Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Jijing Han
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Zhen Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Tiejuan Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Ling Yao
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Yuqing Ma
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Li Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Yan Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Cuixia Guo
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
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Kolding L, Pedersen LH, Petersen OB, Uldbjerg N, Sandager P. Sertraline use during pregnancy and effect on fetal cardiac function. J Matern Fetal Neonatal Med 2019; 34:3631-3638. [PMID: 31718339 DOI: 10.1080/14767058.2019.1688297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: The objective of this study was to evaluate the fetal cardiac function in human pregnancies exposed to sertraline (a selective serotonin reuptake inhibitor) compared to unexposed pregnancies.Method: We included 44 women in gestational week 25 + 0 days to week 26 + 6 days. Fifteen women used sertraline (50-150 mg per day), and 29 women used no daily medication. We assessed fetal cardiac function by Myocardial Performance Index (MPI), E/A ratios and by tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE) measured by 2D M-mode and by 4D eSTIC M-mode.Results: There were no differences between the sertraline exposed and the unexposed. The mean difference of MPI was 0.03 (95% CI -0.08-0.03), of tricuspid and mitral E/A ratios 0.00 (95% CI -0.03-0.05) and 0.03 (95% CI -0.07-0.01), respectively. The mean difference of TAPSE, by 2D and eSTIC, was 0.07 mm (95% CI -0.56-0.41) and 0.10 mm (95% CI -0.55-0.34). Mean difference of MAPSE, by 2D and eSTIC was 0.16 mm (95% CI -0.22-0.53) and 0.24 mm (95% CI -0.16-0.65), respectively. Serum levels of sertraline in exposed participants ranged from 33-266, median 92 nmol/L.Conclusions: We found no significant differences in fetal cardiac function, assessed by TAPSE, MAPSE, MPI and E/A ratios, in pregnancies exposed to sertraline compared to the unexposed.
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Affiliation(s)
- Line Kolding
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Vadivelu P, Keepanasseril A, Plakkal N. Improvement of cardiac function in fetuses with growth restriction following antenatal betamethasone administration: fact or artifact? J Matern Fetal Neonatal Med 2019; 34:3306-3312. [PMID: 31711333 DOI: 10.1080/14767058.2019.1683538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Use of corticosteroids for fetal lung maturation has reduced the perinatal mortality/morbidity from prematurity related complications. There is a paucity of studies evaluating the effect of steroid administration on the fetal circulation and cardiac function in fetal growth restriction (FGR). The aim of the study was to assess changes in fetal Doppler indices and cardiovascular function in pregnancies complicated with FGR after administration of betamethasone. METHODS This was a prospective study conducted in a tertiary care research center between July 2017 and May 2018. Pregnant women with FGR between 28 and 36 weeks' gestation, who were scheduled to receive betamethasone (two doses of 12 mg, 24 h apart) were recruited. Fetal cardiovascular function in fetuses FGR was assessed immediately before first dose and once between 6 and 24 h after the second dose of betamethasone by the same operator. Wilcoxon matched-pairs signed-rank test or paired t-tests were used to compare parameters before and after corticosteroid exposure. RESULTS Fifty cases with FGR were evaluated before and after administration of betamethasone, at mean gestational age of 34.6 ± 2.0 weeks. Fetal heart rate (148.78 ± 9.10 versus 144.73 ± 9.61, p < .001), left heart myocardial performance index ([MPI], 0.66 ± 0.06 versus 0.55 ± 0.09, p ≤ .001) and right heart MPI (0.65 ± 0.04 versus 0.63 ± 0.04, p .016) showed improvement after steroids. Left heart isovolumic relaxation and contraction indices along with ejection time of both sides showed a small but statistically significant improvement (p < .001), but other fetal cardiac functional and Doppler indices remain unchanged after steroids. CONCLUSIONS Fetal heart rate, cardiac MPI, left sided isovolumic indices showed an improvement after betamethasone administration. Follow up studies are needed to ascertain whether these effects persist in the long term and to determine whether these are beneficial to a growth restricted fetuses.
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Affiliation(s)
- Priyadarshini Vadivelu
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post Graduate Medical Education, Pondicherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post Graduate Medical Education, Pondicherry, India
| | - Nishad Plakkal
- Neonatology, Jawaharlal Institute of Post Graduate Medical Education, Pondicherry, India
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Kaya B, Tayyar A, Açar DK, Kaya S. Comparison of fetal cardiac functions between small-for-gestational age fetuses and late-onset growth-restricted fetuses. J Perinat Med 2019; 47:879-884. [PMID: 31393834 DOI: 10.1515/jpm-2019-0206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/21/2019] [Indexed: 11/15/2022]
Abstract
Background This study aimed to investigate fetal cardiac functions by spectral tissue Doppler imaging (s-TDI) in pregnancies complicated with late-onset fetal growth restriction (LO-FGR) and small-for-gestational age (SGA). Methods Forty pregnancies complicated with late-onset FGR and 40 pregnancies complicated with SGA between the 34th and 37th weeks of gestation were enrolled in this study. Forty gestational age-matched pregnant women with no obstetrics complication were randomly selected as a control group. Small fetuses were classified as fetal growth restriction or SGA according to estimated fetal weight (EFW), umbilical artery pulsatility index (PI), cerebroplacental ratio (CPR) and uterine artery PI. s-TDI measurements were obtained at the right atrioventricular valve annulus. Results SGA and LO-FGR fetuses had significantly lower A' and S' values, and higher E'/A' ratio than the control group (P < 0.001). In comparison to controls, significantly prolonged isovolumetric contraction time (ICT') and isovolumetric relaxation time (IRT') and, significantly shortened ejection time (ET') were observed in fetuses with SGA and LO-FGR. Increased myocardial performance index (MPI') values were also found in fetuses with SGA and LO-FGR compared to controls. Conclusion The signs of cardiac dysfunction were observed both in fetuses with SGA and LO-FGR. The fetal cardiac function assessment with s-TDI could be a valuable method in the diagnosis of true growth restricted fetuses and in the management of these fetuses.
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Affiliation(s)
- Başak Kaya
- Department of Maternal-Fetal Medicine, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Ahmet Tayyar
- Department of Maternal-Fetal Medicine, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Deniz Kanber Açar
- Department of Maternal-Fetal Medicine, Health Sciences University, Bakırköy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Serdar Kaya
- Department of Maternal-Fetal Medicine, Akdeniz University, Antalya, Turkey
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Kaya B, Tayyar A, Sezer S, Kaya S. The assessment of cardiac function with tissue Doppler imaging in fetuses with congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2019; 33:1233-1238. [PMID: 31588831 DOI: 10.1080/14767058.2019.1674806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: This study aimed to evaluate the cardiac function of fetuses with congenital diaphragmatic hernia by conventional echocardiography and spectral tissue Doppler imaging (s-TDI) and to evaluate the relationship between cardiac function and the severity of pulmonary hypoplasia. We also aimed to investigate the effect of diaphragmatic hernia side on fetal cardiac function.Methods: Fetal cardiac function were evaluated in 28 fetuses (20 with left-sided and 8 with right-sided) complicated with isolated congenital diaphragmatic hernia (CDH) and 56 gestational age matched control in this single center prospective study. s-TDI measurements were obtained at the right atrioventricular valve annulus. The annular peak velocities and their ratios, the time periods of cardiac cycle and myocardial performance index were calculated.Results: In comparison to controls, significantly prolonged isovolumetric contraction time (ICT') and isovolumetric relaxation time (IRT') and, significantly shortened ejection time (ET') were observed in fetuses with CDH by s-TDI. Fetuses with CDH also had higher myocardial performance index (MPI') z-scores compared to controls. There were no significant differences in terms of s-TDI cardiac function parameters between fetuses with right- and left-sided CDH. In correlation analysis, a significant positive correlation was found between ET' value and o/e LHR.Conclusion: The signs of both systolic and diastolic altered function were observed in fetuses with CDH with s-TDI independent of the side of the hernia, and a significant positive correlation was observed between fetal cardiac systolic function and the severity of pulmonary hypoplasia.
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Affiliation(s)
- Başak Kaya
- Department of Maternal Fetal Medicine, İstanbul Medipol University Hospital, İstanbul, Turkey
| | - Ahmet Tayyar
- Department of Maternal Fetal Medicine, İstanbul Medipol University Hospital, İstanbul, Turkey
| | - Salim Sezer
- Department of Maternal Fetal Medicine, Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Serdar Kaya
- Department of Maternal Fetal Medicine, Akdeniz University, Antalya, Turkey
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Graupner O, Enzensberger C, Axt-Fliedner R. New Aspects in the Diagnosis and Therapy of Fetal Hypoplastic Left Heart Syndrome. Geburtshilfe Frauenheilkd 2019; 79:863-872. [PMID: 31423021 PMCID: PMC6690741 DOI: 10.1055/a-0828-7968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 12/26/2022] Open
Abstract
Fetal hypoplastic left heart syndrome (HLHS) is a severe congenital heart disease with a lethal prognosis without postnatal therapeutic intervention or surgery. The aim of this article is to give a brief overview of new findings in the field of prenatal diagnosis and the therapy of HLHS. As cardiac output in HLHS children depends on the right ventricle (RV), prenatal assessment of fetal RV function is of interest to predict poor functional RV status before the RV becomes the systemic ventricle. Prenatal cardiac interventions such as fetal aortic valvuloplasty and non-invasive procedures such as maternal hyperoxygenation seem to be promising treatment options but will need to be evaluated with regard to long-term outcomes. Novel approaches such as stem cell therapy or neuroprotection provide important clues about the complexity of the disease. New aspects in diagnostics and therapy of HLHS show the potential of a targeted prenatal treatment planning. This could be used to optimize parental counseling as well as pre- and postnatal management of affected children.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
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Yu L, Zhou Q, Peng Q, Zeng S, Yang Z. Velocity vector imaging echocardiography and NT-proBNP study of fetal cardiac function in pregnancy-induced maternal hypertension. J Clin Ultrasound 2019; 47:285-291. [PMID: 30883813 DOI: 10.1002/jcu.22720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/03/2019] [Accepted: 02/17/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate whether acute and transient pressure overload in patients with pregnancy-induced hypertension affects cardiac function in fetuses. METHODS We enrolled 104 singleton pregnant women with gestational ages ranging 30 to 33 weeks, visiting for prenatal care. Among them, 34 had gestational hypertension (GH), 32 had preeclampsia (PE), and 38 were healthy and formed the control group. Conventional echocardiographic and velocity vector imaging (VVI) variables were prospectively collected. Blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from cord blood drawn at birth. RESULTS The fetuses of mothers with preeclampsia had significantly lower left (LV) and right ventricle (RV) diastolic strain rate (SRd) and RV strain (S) and systolic strain rate (SRs) than controls. LV and RV S, SRd, and SRS were not different in fetuses of mothers with GH and controls. The NT-proBNP levels were higher in fetuses of patients with PE than in GH and controls. CONCLUSIONS In the third trimester of pregnancy, fetal biventricular function and NT-proBNP levels are not significantly influenced by GH. Fetuses of mothers with PE present signs of LV and RV diastolic dysfunction, right ventricular systolic dysfunction, and elevated NT-pro-BNP levels. VVI echocardiography appears more sensitive than conventional echocardiography to evaluate fetal cardiac function.
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MESH Headings
- Adult
- Biomarkers/blood
- Case-Control Studies
- Cross-Sectional Studies
- Echocardiography/methods
- Female
- Fetal Blood/metabolism
- Fetal Heart/diagnostic imaging
- Fetal Heart/physiopathology
- Gestational Age
- Heart Ventricles/diagnostic imaging
- Humans
- Hypertension, Pregnancy-Induced/physiopathology
- Infant, Newborn
- Male
- Natriuretic Peptide, Brain/blood
- Observer Variation
- Peptide Fragments/blood
- Pregnancy
- Pregnancy Trimester, Third
- Prospective Studies
- Single-Blind Method
- Ultrasonography, Prenatal/methods
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/blood
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/physiopathology
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Affiliation(s)
- Li Yu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qinghai Peng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zurong Yang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
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36
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Brik M, Fernández-Buhigas I, Martin-Arias A, Vargas-Terrones M, Barakat R, Santacruz B. Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial. Ultrasound Obstet Gynecol 2019; 53:583-589. [PMID: 30328169 DOI: 10.1002/uog.20147] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the association between physical exercise during pregnancy and maternal gestational weight gain and fetal cardiac function. METHODS This was a randomized controlled trial of women with a singleton pregnancy managed from the first trimester at the Hospital de Torrejón, Madrid, between November 2014 and June 2015. Women were randomized to either follow a supervised physical conditioning program, consisting of a 60-min session 3 days per week for the duration of pregnancy, or not attend any exercise program (controls). The primary outcome was maternal weight gain during pregnancy. Secondary outcomes included fetal cardiac function parameters evaluated at 20, 28 and 36 weeks' gestation, Cesarean section, preterm delivery, induction of labor and birth weight. A sample size of 45 in each group was planned to detect differences in maternal weight gain of at least 1 kg, with a power of > 80% and α of 0.05. RESULTS During the study period, 120 women were randomized into the exercise (n = 75) and control (n = 45) groups. Following exclusions, the final cohort consisted of 42 women in the exercise group and 43 in the control group. Baseline characteristics (maternal age, prepregnancy body mass index, parity, conception by in-vitro fertilization, Caucasian ethnicity, physical exercise prior to pregnancy and smoker) were similar between the two groups. No differences were found between the groups in maternal weight at 20, 28, 36 and 38 weeks' gestation or in weight gain at 38 weeks. However, the proportion of women with weight loss ≥ 9 kg at 6 weeks postpartum was higher in the exercise compared with the control group (68.2% vs 42.8%; relative risk 1.593; P = 0.02). The ductus arteriosus pulsatility index (DA-PI) at 20 weeks (2.43 ± 0.40 vs 2.26 ± 0.33, P < 0.05) and the ejection fraction (EF) at 36 weeks (0.85 ± 0.13 vs 0.81 ± 0.11, P < 0.05) were higher in the exercise compared with the control group. All other evaluated fetal cardiac function parameters were similar between the two groups. CONCLUSIONS Performing exercise during pregnancy is not associated with a reduction in maternal weight gain but increases weight loss at 6 weeks postpartum. Physical exercise during pregnancy is associated with increased fetal DA-PI at 20 weeks and EF at 36 weeks, which could reflect adaptive mechanisms. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Brik
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - I Fernández-Buhigas
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Martin-Arias
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M Vargas-Terrones
- Facultad de Ciencias del Deporte INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - R Barakat
- Facultad de Ciencias del Deporte INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - B Santacruz
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
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37
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Herling L, Johnson J, Ferm-Widlund K, Bergholm F, Elmstedt N, Lindgren P, Sonesson SE, Acharya G, Westgren M. Automated analysis of fetal cardiac function using color tissue Doppler imaging in second half of normal pregnancy. Ultrasound Obstet Gynecol 2019; 53:348-357. [PMID: 29484743 DOI: 10.1002/uog.19037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/18/2017] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Color tissue Doppler imaging (cTDI) is a promising tool for the assessment of fetal cardiac function. However, the analysis of myocardial velocity traces is cumbersome and time-consuming, limiting its application in clinical practice. The aim of this study was to evaluate fetal cardiac function during the second half of pregnancy and to develop reference ranges using an automated method to analyze cTDI recordings from a cardiac four-chamber view. METHODS This was a cross-sectional study including 201 normal singleton pregnancies between 18 and 42 weeks of gestation. During fetal echocardiography, a four-chamber view of the heart was visualized and cTDI was performed. Regions of interest were positioned at the level of the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls of the fetal heart, to obtain myocardial velocity traces that were analyzed offline using the automated algorithm. Peak myocardial velocities during atrial contraction (Am), ventricular ejection (Sm) and rapid ventricular filling, i.e. early diastole (Em), as well as the Em/Am ratio, mechanical cardiac time intervals and myocardial performance index (cMPI) were evaluated, and gestational age-specific reference ranges were constructed. RESULTS At 18 weeks of gestation, the peak myocardial velocities, presented as fitted mean with 95% CI, were: LV Am, 3.39 (3.09-3.70) cm/s; LV Sm, 1.62 (1.46-1.79) cm/s; LV Em, 1.95 (1.75-2.15) cm/s; septal Am, 3.07 (2.80-3.36) cm/s; septal Sm, 1.93 (1.81-2.06) cm/s; septal Em, 2.57 (2.32-2.84) cm/s; RV Am, 4.89 (4.59-5.20) cm/s; RV Sm, 2.31 (2.16-2.46) cm/s; and RV Em, 2.94 (2.69-3.21) cm/s. At 42 weeks of gestation, the peak myocardial velocities had increased to: LV Am, 4.25 (3.87-4.65) cm/s; LV Sm, 3.53 (3.19-3.89) cm/s; LV Em, 4.55 (4.18-4.94) cm/s; septal Am, 4.49 (4.17-4.82) cm/s; septal Sm, 3.36 (3.17-3.55) cm/s; septal Em, 3.76 (3.51-4.03) cm/s; RV Am, 6.52 (6.09-6.96) cm/s; RV Sm, 4.95 (4.59-5.32) cm/s; and RV Em, 5.42 (4.99-5.88) cm/s. The mechanical cardiac time intervals generally remained more stable throughout the second half of pregnancy, although, with increased gestational age, there was an increase in duration of septal and RV atrial contraction, LV pre-ejection and septal and RV ventricular ejection, while there was a decrease in duration of septal postejection. Regression equations used for the construction of gestational age-specific reference ranges for peak myocardial velocities, Em/Am ratios, mechanical cardiac time intervals and cMPI are presented. CONCLUSION Peak myocardial velocities increase with gestational age, while the mechanical time intervals remain more stable throughout the second half of pregnancy. Using an automated method to analyze cTDI-derived myocardial velocity traces, it was possible to construct reference ranges, which could be used in distinguishing between normal and abnormal fetal cardiac function. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Herling
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - J Johnson
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - K Ferm-Widlund
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - F Bergholm
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - N Elmstedt
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - P Lindgren
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - S-E Sonesson
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - G Acharya
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - M Westgren
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
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Herling L, Johnson J, Ferm-Widlund K, Bergholm F, Lindgren P, Sonesson SE, Acharya G, Westgren M. Automated analysis of fetal cardiac function using color tissue Doppler imaging. Ultrasound Obstet Gynecol 2018; 52:599-608. [PMID: 28715153 DOI: 10.1002/uog.18812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/11/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the feasibility of automated analysis of fetal myocardial velocity recordings obtained by color tissue Doppler imaging (cTDI). METHODS This was a prospective cross-sectional observational study of 107 singleton pregnancies ≥ 41 weeks of gestation. Myocardial velocity recordings were obtained by cTDI in a long-axis four-chamber view of the fetal heart. Regions of interest were placed in the septum and the right (RV) and left (LV) ventricular walls at the level of the atrioventricular plane. Peak myocardial velocities and mechanical cardiac time intervals were measured both manually and by an automated algorithm and agreement between the two methods was evaluated. RESULTS In total, 321 myocardial velocity traces were analyzed using each method. It was possible to analyze all velocity traces obtained from the LV, RV and septal walls with the automated algorithm, and myocardial velocities and cardiac mechanical time intervals could be measured in 96% of all traces. The same results were obtained when the algorithm was run repeatedly. The myocardial velocities measured using the automated method correlated significantly with those measured manually. The agreement between methods was not consistent and some cTDI parameters had considerable bias and poor precision. CONCLUSIONS Automated analysis of myocardial velocity recordings obtained by cTDI was feasible, suggesting that this technique could simplify and facilitate the use of cTDI in the evaluation of fetal cardiac function, both in research and in clinical practice. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Herling
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - J Johnson
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - K Ferm-Widlund
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - F Bergholm
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - P Lindgren
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - S-E Sonesson
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - G Acharya
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - M Westgren
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
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Lee SM, Suh DH, Kim SY, Kim MK, Oh S, Song SH, Kim HY, Park CW, Park JS, Jun JK. Antenatal Prediction of Neonatal Survival in Sacrococcygeal Teratoma. J Ultrasound Med 2018; 37:2003-2009. [PMID: 29399854 DOI: 10.1002/jum.14553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES In sacrococcygeal teratoma, the presence of high-output cardiac failure resulting from arteriovenous shunting through the large tumor has been associated with an adverse outcome. The objective of this study was to determine whether the tumor size and cardiac biomarkers in cord blood can predict neonatal survival in sacrococcygeal teratoma. METHODS The study population consisted of 25 neonates with sacrococcygeal teratoma. Tumor size was calculated by the ellipsoid formula using dimensions measured by antenatal ultrasound ([length × width × depth in cm] × 0.52= volume in cm3 ). To adjust the gestational age, the tumor volume index (tumor volume/biparietal diameter) was adopted in the analysis. Cardiac biomarkers for heart failure (N-terminal pro-B-type natriuretic peptide [NT-pro-BNP] and cardiac troponin T [cTnT]) were measured in cord blood taken at the time of delivery. RESULTS The rate of neonatal death was 24% (6 of 25). The cases that resulted in neonatal death had a higher tumor volume index and higher concentrations of NT-pro-BNP and cTnT than those with survival. A tumor volume index of greater than 60 cm3 /cm, elevated NT-pro-BNP (>2000 pg/mL), and elevated cTnT (>0.08 ng/mL) had sensitivity of 100% for prediction of neonatal death. CONCLUSIONS The tumor volume index and cord blood biomarkers for heart failure can be promising prognostic markers for neonatal survival in sacrococcygeal teratoma.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Kim
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Kim
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
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Takano M, Nakata M, Nagasaki S, Ueyama R, Morita M. Assessment of diastolic function of normal fetal heart using dual-gate Doppler. Ultrasound Obstet Gynecol 2018; 52:238-242. [PMID: 28741751 DOI: 10.1002/uog.18821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/09/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The ratio of mitral peak early diastolic filling to early diastolic mitral annular velocity (E/e') reflects diastolic cardiac function in adults. Dual-gate Doppler (DD) enables measurements of E/e' in the same heart beat. This study was designed to assess the utility of the DD method for measurement of fetal E/e' and determine reference ranges for normal fetuses. METHODS This prospective study comprised normal singleton pregnancies undergoing fetal echocardiography between 16 and 36 weeks of gestation. According to the DD method, E-wave velocity on pulsed-wave Doppler and e'-wave on tissue Doppler imaging were measured simultaneously on an apical or basal four-chamber view, and fetal E/e' was calculated. Spearman's correlation coefficient was used to assess the relationship between gestational age (GA) and E-wave and e'-wave velocities and E/e'. RESULTS A total of 133 pregnancies were included in this study and all E/e' measurements were successful. Significant correlation was observed between GA and both left ventricular (LV) E/e' (r s = -0.666, P < 0.001) and right ventricular (RV) E/e' (r s = -0.607, P < 0.001). The regression equations for bilateral E/e' were: LV-E/e' = 17.341 - 0.631GA + 0.008 × GA2 (mean ± SD, R 2 = 0.440 ± 1.333); and RV-E/e' = 19.156 - 0.794GA + 0.012GA2 (R 2 = 0.419 ± 1.329). CONCLUSIONS Bilateral E/e' of normal fetuses, measured using the DD method, decreased with GA, which is considered to be related to myocardial maturity. DD is a useful and convenient method for evaluating fetal E/e' in order to assess diastolic function in the prenatal period. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Takano
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - M Nakata
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - S Nagasaki
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - R Ueyama
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - M Morita
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
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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. J Ultrasound Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Ingul CB, Lorås L, Tegnander E, Eik-Nes SH, Brantberg A. Maternal obesity affects fetal myocardial function as early as in the first trimester. Ultrasound Obstet Gynecol 2016; 47:433-442. [PMID: 25761057 DOI: 10.1002/uog.14841] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/14/2015] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate cardiac function from 14 weeks' gestation in fetuses of obese pregnant women (FOW). Animal studies have shown that maternal obesity induces fibrosis in fetal myocardium. We hypothesized that fetal cardiac function would be impaired among FOW. METHODS A case-control study with longitudinal follow-up was performed at Trondheim University Hospital, Norway. In total, 80 pregnant women were included and the final population comprised 52 obese and 24 of normal weight (mean body mass index before pregnancy, 34.8 ± 4.1 vs 21.0 ± 2.2 kg/m(2) ; P < 0.001). The main outcome measures were global strain rate (GSR) and strain by tissue Doppler imaging, tissue Doppler velocities (TDVs) and interventricular septal thickness assessed by fetal echocardiography at gestational ages of 14, 20 and 32 weeks. RESULTS In FOW, fetal left ventricle (LV) and right ventricle (RV) GSR and strain were significantly lower than in fetuses of normal-weight pregnant women: LV GSR was 33.3% lower at 14 weeks, 22.4% lower at 20 weeks and 22.8% lower at 32 weeks of gestation (P < 0.001) with no difference in fetal heart rate. Systolic and late diastolic TDVs for LV were significantly lower from 20 weeks' gestation and remained lower throughout pregnancy. Fetal interventricular septum was 26.6% (P < 0.001) thicker in late pregnancy in FOW compared with normal-weight pregnancies. CONCLUSIONS At 14 weeks of gestation, we detected fetal myocardial dysfunction with reduced LV and RV GSR and strain in FOW compared with fetuses of women with normal weight. Our finding is alarming considering the high prevalence of obesity and may partly explain the predisposition of offspring to cardiovascular disease later in life.
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Affiliation(s)
- C B Ingul
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Lorås
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E Tegnander
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - S H Eik-Nes
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
Introduction: Fetal heart evaluation with US is feasible and reproducible, although challenging due to the smallness of the heart, the high heart rate and limited access to the fetus. However, some cardiac parameters have already shown a strong correlation with outcomes and may soon be incorporated into clinical practice. Materials and Methods: Cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction or congenital diaphragmatic hernia. Conclusion: Cardiac function can be adequately evaluated in most fetuses when appropriate expertise, equipment and time are available. Fetal cardiac function assessment is a promising tool that may soon be incorporated into clinical practice to diagnose, monitor or predict outcome in some fetal conditions. Thus, more research is warranted to further define specific protocols for each fetal condition that may affect cardiac function.
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Affiliation(s)
- Fàtima Crispi
- Fetal and Perinatal Medicine Research GroupInstitut d'Investigacions Biomèdiques August Pi i SunyerUniversity of BarcelonaBarcelonaSpain; Department of Maternal-Fetal MedicineInstitut Clínic de Ginecologia, Obstetrícia i Neonatologia Hospital ClinicBarcelonaSpain; Centro de Investigación Biomédica en Red en Enfermedades RarasBarcelonaSpain
| | - Brenda Valenzuela-Alcaraz
- Fetal and Perinatal Medicine Research GroupInstitut d'Investigacions Biomèdiques August Pi i SunyerUniversity of BarcelonaBarcelonaSpain; Department of Maternal-Fetal MedicineInstitut Clínic de Ginecologia, Obstetrícia i Neonatologia Hospital ClinicBarcelonaSpain; Centro de Investigación Biomédica en Red en Enfermedades RarasBarcelonaSpain
| | - Monica Cruz-Lemini
- Fetal and Perinatal Medicine Research GroupInstitut d'Investigacions Biomèdiques August Pi i SunyerUniversity of BarcelonaBarcelonaSpain; Department of Maternal-Fetal MedicineInstitut Clínic de Ginecologia, Obstetrícia i Neonatologia Hospital ClinicBarcelonaSpain; Centro de Investigación Biomédica en Red en Enfermedades RarasBarcelonaSpain
| | - Eduard Gratacós
- Fetal and Perinatal Medicine Research GroupInstitut d'Investigacions Biomèdiques August Pi i SunyerUniversity of BarcelonaBarcelonaSpain; Department of Maternal-Fetal MedicineInstitut Clínic de Ginecologia, Obstetrícia i Neonatologia Hospital ClinicBarcelonaSpain; Centro de Investigación Biomédica en Red en Enfermedades RarasBarcelonaSpain
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de Assunção RA, Liao AW, Brizot MDL, Francisco RPV, Zugaib M. Changes in fetal myocardial performance index following intravascular transfusion: preliminary report. J Matern Fetal Neonatal Med 2015; 29:2697-702. [PMID: 26421506 DOI: 10.3109/14767058.2015.1101757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the changes in fetal left ventricle myocardial performance index (MPI) following intrauterine intravascular transfusion (IUT). METHODS Prospective study, including 25 IUT performed in 13 singleton pregnancies with maternal Rh D alloimmune disease. Left ventricle MPI was evaluated prior to transfusion and repeated 24 h after each procedure. Delta MPI was calculated as the difference between post- and pre-transfusion MPI z-scores. Multilevel regression analysis was used to examine the association between delta MPI and gestational age at procedure, fetal middle cerebral artery peak velocity MoM, pre- and post-MPI and hemoglobin z-score values, the volume of blood transfused and feto-placental volume percentage expansion. Adjustments were made for repeated measurements within the same fetus, and across different time points. The significance level was set as 0.05. RESULTS MPI z-score values increased significantly following transfusion (delta MPI = 1.10 ± 2.47, p=0.036). Delta MPI showed a significant correlation with gestational age at transfusion (r= -0.47, p=0.018), pre-transfusion MPI z-score (r= -0.50, p=0.012) and feto-placental volume percentage expansion (r= -0.41, p=0.044). CONCLUSION Left ventricle MPI increases significantly after intrauterine blood transfusion and greater changes are associated with procedures at an earlier gestational age, lower pre-transfusion MPI z-scores and smaller feto-placental volume expansion.
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Affiliation(s)
- Renata Almeida de Assunção
- a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil
| | - Adolfo Wenjaw Liao
- a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil
| | - Maria de Lourdes Brizot
- a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil
| | | | - Marcelo Zugaib
- a Department of Obstetrics and Gynecology , Hospital das Clínicas, São Paulo University Medical School, Brazil , São Paulo , Brazil
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Pérez-Cruz M, Cruz-Lemini M, Fernández MT, Parra JA, Bartrons J, Gómez-Roig MD, Crispi F, Gratacós E. Fetal cardiac function in late-onset intrauterine growth restriction vs small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler. Ultrasound Obstet Gynecol 2015; 46:465-471. [PMID: 26112274 DOI: 10.1002/uog.14930] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/29/2015] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and mean uterine artery (UtA) pulsatility index (PI) can predict a subgroup of fetuses with poor perinatal outcome; however, the association of these criteria with fetal cardiac structure and function is unknown. Our aim was to determine the presence and severity of signs indicating cardiac dysfunction in small fetuses, classified as intrauterine growth-restricted (IUGR) or small-for-gestational age (SGA), according to EFW, CPR and UtA-PI. METHODS A cohort of 209 late-onset small fetuses that were delivered > 34 weeks of gestation was divided in two categories: SGA (n = 59) if EFW was between the 3(rd) and 9(th) centiles with normal CPR and UtA-PI; and IUGR (n = 150) if EFW was < 3(rd) centile, or < 10(th) centile with a CPR < 5(th) centile and/or UtA-PI > 95(th) centile. The small population was compared with 150 appropriately grown fetuses (controls). Fetal cardiac morphometry and function were assessed by echocardiography using two-dimensional M-mode, conventional and tissue Doppler. RESULTS Compared with controls, both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index ± SD: controls, 1.8 ± 0.3; SGA, 1.5 ± 0.2; and IUGR, 1.6 ± 0.3; P < 0.01) and showed signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (mean ± SD: controls, 8.2 ± 1.1; SGA, 7.4 ± 1.2; and IUGR, 6.9 ± 1.1; P < 0.001) and increased left myocardial performance index (mean ± SD: controls, 0.45 ± 0.14; SGA, 0.51 ± 0.08; and IUGR, 0.57 ± 0.1; P < 0.001). CONCLUSIONS Despite a perinatal outcome comparable to that of normal fetuses, the population of so-defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not 'constitutionally small' and that further research is needed.
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Affiliation(s)
- M Pérez-Cruz
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M Cruz-Lemini
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M T Fernández
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - J A Parra
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - J Bartrons
- Department of Paediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - M D Gómez-Roig
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Spanish Maternal & Child Health Network Retic SAMID, Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- IDIBAPS and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacós
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- IDIBAPS and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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46
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Fan X, Zhou Q, Zeng S, Zhou J, Peng Q, Zhang M, Ding Y. Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy. J Ultrasound Med 2014; 33:1171-1177. [PMID: 24958403 DOI: 10.7863/ultra.33.7.1171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate changes in fetal myocardial deformation in intrahepatic cholestasis of pregnancy. METHODS Patients with intrahepatic cholestasis of pregnancy were divided into 2 groups according to the total maternal serum bile acid concentration: mild cholestasis (10-40 μmol/L) and severe cholestasis (>40 μmol/L). Fetal echocardiography and velocity vector imaging were performed on women with cholestasis and control patients. The left ventricular global longitudinal strain and strain rate were measured. Clinical characteristics, maternal serum bile acid levels, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in umbilical vein blood were compared between groups. The relationships among fetal myocardial deformation, maternal total bile acids, and cord NT-proBNP were analyzed. RESULTS Twenty women with mild cholestasis, 20 with severe cholestasis, and 40 control patients were enrolled. There were no significant differences in maternal and gestational ages between the case and control groups. Maternal bile acids and NT-proBNP were significantly higher in fetuses of mothers with cholestasis than control fetuses. The left ventricular longitudinal strain (-10.56% ± 1.83% versus -18.36% ± 1.11%; P < .01), systolic strain rate (-1.63 ± 0.18 versus -2.04 ± 0.18 secondsz(-1); P < .01), and diastolic strain rate (1.37 ± 0.18 versus 1.83 ± 0.14 seconds(-1); P < .01) were significantly decreased in fetuses with severe cholestasis compared with control fetuses. There were positive correlations between fetal myocardial deformation and maternal total bile acids (r = 0.705, 0.643, and 0.690, respectively; P < .01) and between myocardial deformation and NT-proBNP (r = 0.672, 0.643, and 0.647; P < .01). CONCLUSIONS Fetal myocardial deformation is impaired in severe intrahepatic cholestasis of pregnancy. Further investigation is needed to determine whether fetal echocardiography and velocity vector imaging can help predict which fetuses of mothers with cholestasis are likely to have poor outcomes.
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Affiliation(s)
- Xuemei Fan
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Qichang Zhou
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China.
| | - Shi Zeng
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiawei Zhou
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Qinghai Peng
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhang
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiling Ding
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
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Lee MY, Won HS, Jeon EJ, Yoon HC, Choi JY, Hong SJ, Kim MJ. Feasibility of using auto Mod-MPI system, a novel technique for automated measurement of fetal modified myocardial performance index. Ultrasound Obstet Gynecol 2014; 43:640-645. [PMID: 24214891 DOI: 10.1002/uog.13247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/11/2013] [Accepted: 10/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To evaluate the reproducibility of measurement of the fetal left modified myocardial performance index (Mod-MPI) determined using a novel automated system. METHODS This was a prospective study of 116 ultrasound examinations from 110 normal singleton pregnancies at 12 + 1 to 37 + 1 weeks' gestation. Two experienced operators each measured the left Mod-MPI twice manually and twice automatically using the Auto Mod-MPI system. Intra- and interoperator reproducibility were assessed using intraclass correlation coefficients (ICCs) and the manual and automated measurements obtained by the more experienced operator were compared using Bland-Altman plots and ICCs. RESULTS Both operators successfully measured the left Mod-MPI in all cases using the Auto Mod-MPI system. For both operators, intraoperator reproducibility was higher when performing automated measurements (ICC = 0.967 and 0.962 for Operators 1 and 2, respectively) than when performing manual measurements (ICC = 0.857 and 0.856 for Operators 1 and 2, respectively). Interoperator agreement was also better for automated than for manual measurements (ICC = 0.930 vs 0.723, respectively). There was good agreement between the automated and manual values measured by the more experienced operator. CONCLUSIONS The Auto Mod-MPI system is a reliable technique for measuring fetal left Mod-MPI and demonstrates excellent reproducibility.
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Affiliation(s)
- M-Y Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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