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Okutucu G, Oluklu D, Gulen Yildiz E, Bastemur AG, Tanacan A, Kara O, Şahin D. Do Maternal Heart Diseases Affect Fetal Cardiac Functions? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:851-861. [PMID: 38213069 DOI: 10.1002/jum.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To investigate whether fetal cardiac function is affected by underlying heart disease in pregnant women. METHODS A total of 100 pregnant women who were ≥34 gestational weeks were included in the study, 40 in the maternal heart disease (MHD) group diagnosed with heart disease and 60 in the control group. All cardiac diseases in pregnant women were diagnosed preconceptionally and categorized according to the New York Heart Association (NYHA) classification system. Fetal cardiac functions of study groups were evaluated by M-mode, color tissue Doppler imaging (c-TDI), and pulsed wave Doppler. RESULTS Tricuspid annular plane systolic excursion and myocardial performance index (MPI) values were significantly higher and isovolumetric relaxation time was prolonged in the MHD group. The MPI value was found higher in MHD group with NYHA Class II compared to those with NYHA Class I. No significant change in any of the fetal tricuspid annular peak velocity values measured by c-TDI in the MHD group. There were no differences in fetal cardiac functions and perinatal outcomes between pregnant women with acquired and congenital heart diseases. Patients in NYHA Class II had lower birth weight, 1st and 5th minute APGAR scores, and higher neonatal intensive care unit admission rates. CONCLUSIONS Underlying heart diseases in pregnant women can cause alterations in the systolic and diastolic function of the fetal heart. High fetal MPI values detected in cardiac patients may indicate that cardiac pathologies during pregnancy affect fetal cardiac globular myocardial function. Cardiac pathologies that progress with restricted physical activity may cause changes in fetal cardiac function and may be associated with adverse perinatal outcomes.
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Affiliation(s)
- Gulcan Okutucu
- 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
| | - Esra Gulen Yildiz
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ayse Gulcin Bastemur
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Department of Obstetrics and Gynecology, Division of Perinatology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Scharf JL, Dracopoulos C, Gembicki M, Welp A, Weichert J. How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index. Diagnostics (Basel) 2023; 13:diagnostics13101705. [PMID: 37238193 DOI: 10.3390/diagnostics13101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Objectives: In utero functional cardiac assessments using echocardiography have become increasingly important. The myocardial performance index (MPI, Tei index) is currently used to evaluate fetal cardiac anatomy, hemodynamics and function. An ultrasound examination is highly examiner-dependent, and training is of enormous significance in terms of proper application and subsequent interpretation. Future experts will progressively be guided by applications of artificial intelligence, on whose algorithms prenatal diagnostics will rely on increasingly. The objective of this study was to demonstrate the feasibility of whether less experienced operators might benefit from an automated tool of MPI quantification in the clinical routine. (2) Methods: In this study, a total of 85 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by a targeted ultrasound. The modified right ventricular MPI (RV-Mod-MPI) was measured, both by a beginner and an expert. A calculation was performed semiautomatically using a Samsung Hera W10 ultrasound system (MPI+™, Samsung Healthcare, Gangwon-do, South Korea) by taking separate recordings of the right ventricle's in- and outflow using a conventional pulsed-wave Doppler. The measured RV-Mod-MPI values were assigned to gestational age. The data were compared between the beginner and the expert using a Bland-Altman plot to test the agreement between both operators, and the intraclass correlation was calculated. (3) Results: The mean maternal age was 32 years (19 to 42 years), and the mean maternal pre-pregnancy body mass index was 24.85 kg/m2 (ranging from 17.11 to 44.08 kg/m2). The mean gestational age was 24.44 weeks (ranging from 19.29 to 36.43 weeks). The averaged RV-Mod-MPI value of the beginner was 0.513 ± 0.09, and that of the expert was 0.501 ± 0.08. Between the beginner and the expert, the measured RV-Mod-MPI values indicated a similar distribution. The statistical analysis showed a Bland-Altman bias of 0.01136 (95% limits of agreement from -0.1674 to 0.1902). The intraclass correlation coefficient was 0.624 (95% confidence interval from 0.423 to 0.755). (4) Conclusions: For experts as well as for beginners, the RV-Mod-MPI is an excellent diagnostic tool for the assessment of fetal cardiac function. It is a time-saving procedure, offers an intuitive user interface and is easy to learn. There is no additional effort required to measure the RV-Mod-MPI. In times of reduced resources, such assisted systems of fast value acquisition represent clear added value. The establishment of the automated measurement of the RV-Mod-MPI in clinical routine should be the next level in cardiac function assessment.
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Affiliation(s)
- Jann Lennard Scharf
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Christoph Dracopoulos
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Michael Gembicki
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Amrei Welp
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jan Weichert
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Avnet H, Thomas S, Beirne G, Alphonse J, Welsh A. Poor Correlation between Fetal Tissue Doppler Imaging and Pulsed Wave Myocardial Performance Indices. Fetal Diagn Ther 2023; 50:225-235. [PMID: 36948159 DOI: 10.1159/000529945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Both tissue Doppler imaging (TDI) and pulsed wave Doppler (PWD) Myocardial Performance Indices (MPIs) have been proposed as tools for functional fetal cardiology. We wished to determine if there was any correlation between TDI-MPI and PWD-MPI. METHODS A cohort of uncomplicated women with morphologically normal singleton fetuses between 22 and 39 weeks of gestation was recruited. A single sonologist acquired Doppler waveforms for evaluation of both left and right TDI-MPI and PWD-MPI. The PWD-MPI values were calculated using a previously published algorithm and the TDI-MPI time intervals were measured manually by a single operator. RESULTS Achievability and repeatability were high for both modalities. TDI produced significantly lower right MPI values yet significantly higher left MPI values, potentially reflecting their evaluation of physiologically different events, blood flow versus myocardial contraction. CONCLUSION This study demonstrates that MPIs measured from PWD and TDI have a weak correlation and cannot be used interchangeably, even with the exclusion of suboptimal TDI-MPI scans from the analysis. Given the lack of correlation between the two methods, the high variation in TDI waveform, and the lack of unified approach to TDI analysis, we feel further research is needed before adoption of this technique.
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Affiliation(s)
- Hagai Avnet
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women Sydney, Randwick, New South Wales, Australia
| | - Samantha Thomas
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Geraldene Beirne
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Alphonse
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women Sydney, Randwick, New South Wales, Australia
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Ali NSAA, Ibrahim FSEM, Shalaby NAT, Hassan HGEMA. Role of prenatal fetal echocardiography in the assessment of intrauterine growth restriction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intrauterine growth restriction (IUGR) is a common diagnosis in obstetrics and carries an increased risk of perinatal mortality and morbidity. Identification of IUGR is crucial because proper evaluation and management can result in a favourable outcome. Cardiovascular dysfunction and remodelling is a central feature of IUGR. The aim of the study was to use the left modified myocardial performance index (MPI), assess cardiac function in foetuses with intrauterine growth restriction (IUGR) compared to healthy foetuses, and to connect the relationship between changes in MPI and perinatal outcome. A prospective study was conducted with 60 singleton foetuses between 24 and 40 weeks of gestation without foetal chromosomal abnormalities or major malformations, divided into two groups: 30 women with intrauterine growth restriction (30 women) and another 30 women with normal pregnancies (foetal growth pattern appropriate for gestational age and normal heart findings with normal sinus rhythm) who were matched for gestational age and served as the controls. Trans-abdominal ultrasound examination was done with 3.5–7-MHz curvilinear Probe (GE Medical US equipment). The umbilical arteries, middle cerebral artery, and ductus venosus all had blood flow velocity waveforms recorded. The pulsatility index (PI), cerebroplacental ratio (CPR), and Doppler velocimetry (DV) of the umbilical artery were all measured. All foetuses had their myocardial performance index assessed. Normal and abnormal umbilical artery(UA) Doppler, as well as normal and abnormal MCA Doppler, were used to examine the intrauterine growth restriction group. Foetal growth restrictions (FGR) foetuses' Mod-MPI values were compared to gestation-matched controls. The outcomes of the perinatal period were documented.
Results
Intrauterine growth restriction foetuses with defective umbilical arteries Doppler had a substantially higher mean left myocardial performance index (mean 0.58 SD 0.093) than healthy foetuses (mean 0.45SD 0.070) (P 0.001). When compared to the control group, IUGR foetuses with abnormal left myocardial performance index had a significantly worse perinatal outcome and higher morbidity. When compared to intrauterine growth restriction foetuses with normal MPI, intrauterine growth restriction foetuses with defective left MPI had a significantly worse perinatal outcome (whether the UA Doppler was normal or abnormal). Based on the perinatal result, the foetal myocardial performance index was linked to the severity of foetal impairment in intrauterine growth restriction foetuses.
Conclusion
MPI has the potential to be a useful technique for evaluating IUGR pregnancies and predicting neonatal outcome. Within the IUGR foetuses, MPI foetal echocardiographic characteristics can define a high-risk group.
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A proposed fetal risk scoring system for gestational diabetes to assist in optimising timing of delivery. SOUTH AFRICAN JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2022. [DOI: 10.7196/sajog.2022.v28i2.2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. The pathophysiology of gestational diabetes, which is related to abnormal gluocose tolerance and hyperinsulinaemia, renders standard fetal monitoring models ineffective, insufficient and inappropriate, as these models revolve around detecting and prognosticating on placenta-mediated disease rather than increased metabolic rates due to hyperinsulinaemia, functional hypoxia and ischaemic trophoblastic thresholds. To improve perinatal morbidity and mortality in gestational diabetes, there is therefore a need to introduce new prognostic parameters and scoring systems.
Objectives. A proposed risk scoring system has been developed, based on our previous studies, to risk-categorise patients with gestational diabetes in terms of fetal outcome in view of the fact that the pathophysiology of gestational diabetes is not recognised by standard monitoring models, which revolve around placental insufficiency rather than metabolic anomalies.Methods. Patients with diabetes from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression analysis was used to assess the effect of individual risk factors with proposed cut-offs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score was assessed by computing the area under the receiver operating characteristic (ROC) curve.
Results. Four potential parameters were identified to risk-categorise fetuses in a pregnancy complicated by gestational diabetes, i.e. the myocardial performance index (MPI), the E/A ratio (early diastolic filling/late diastolic filling, a marker of diastolic dysfunction), increasing fetal weight (macrosomia), and an increased amniotic fluid index. The total score, obtained by summation of the composite scores for these parameters, ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by an ROC area under the curve of 0.94. A cut-point of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for predicting adverse outcome.
Conclusion. To our knowledge, this is the first gestational diabetes scoring system proposed to predict an adverse outcome.
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Oluklu D, Kara O, Turgut E, Goncu Ayhan S, Yildirim M, Sahin D. Evaluation of fetal cardiac morphology and functions in pregnant women with familial Mediterranean fever. Echocardiography 2022; 39:606-611. [PMID: 35279878 DOI: 10.1111/echo.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We aimed to evaluate and compare fetal cardiac morphology and functions of pregnant women with familial Mediterranean fever (FMF) and healthy pregnant women. METHODS The study included 34 pregnant women with FMF and 68 healthy pregnant women matched with maternal age, gravidity, parity, gestational age, and pre-pregnancy body mass index (BMI) in 34th-37th gestational weeks. Fetal echocardiographic evaluation was performed with two-dimensional (2D) imaging, M-mode imaging, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI). RESULTS Fetal cardiac morphological measures, including cardiothoracic ratio, cardiac axis angle, right and left ventricular area, sphericity index, and ventricular septal thickness was similar in both groups. Compared with the control group, myocardial performance index (MPI), which indicates global myocardial performance, was significantly higher, and ejection time (ET) was significantly shortened in the FMF group. In addition, which shows the diastolic functional parameters such as, tricuspid E wave, E/A, E/E' ratio, and mitral E wave, E/A, E/E' ratio, were significantly higher; tricuspid A and mitral A waves were significantly lower. We found that mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) were significantly lower in those with FMF duration over eight years than those with FMF duration less than 8 years. CONCLUSION There is no fetal cardiac morphological change in pregnant women with FMF. However, there may be changes in diastolic function. As the maternal FMF duration increases, systolic functions may also change.
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Affiliation(s)
- Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Oliveira M, Dias JP, Guedes-Martins L. Fetal Cardiac Function: Myocardial Performance Index. Curr Cardiol Rev 2022; 18:e271221199505. [PMID: 34961451 PMCID: PMC9893141 DOI: 10.2174/1573403x18666211227145856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
The Myocardial Performance Index (MPI) or Tei index, presented by Tei in 1995, is the ratio of the sum of the duration of the isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) to the duration of the ejection time (ET). The Modified Myocardial Performance Index (Mod-MPI), proposed in 2005, is considered a reliable and useful tool in the study of fetal heart function in several conditions, such as growth restriction, twin-twin transfusion syndrome, maternal diabetes, preeclampsia, intrahepatic cholestasis of pregnancy, and adverse perinatal outcomes. Nevertheless, clinical translation is currently limited by poorly standardised methodology as variations in the technique, machine settings, caliper placement, and specific training required can result in significantly different MPI values. This review aims to provide a survey of the relevant literature on MPI, present a strict methodology and technical considerations, and propose future research.
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Affiliation(s)
- Mariana Oliveira
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Joana Portela Dias
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação, Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação, Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal
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Özalp M, Demir O, Dinç G, Şal H, Aran T, Osmanağaoğlu MA, Dilber E. Fetal cardiac Doppler changes in gestational diabetic pregnancies and its relationship with perinatal outcomes. J Obstet Gynaecol Res 2021; 47:3480-3487. [PMID: 34254402 DOI: 10.1111/jog.14941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/03/2021] [Accepted: 06/25/2021] [Indexed: 12/22/2022]
Abstract
AIM To examine the structural and functional changes of the fetal heart in gestational diabetes mellitus (GDM) and to evaluate the power of fetal cardiac Doppler parameters in predicting adverse perinatal outcomes in this group of pregnancy. METHODS Within the study's scope, 36 cases in the A1 GDM group, 33 cases in the A2 GDM group, and 124 cases in the control group were evaluated. The relationship between structural and functional fetal cardiac parameters and perinatal outcomes was evaluated via fetal echocardiography. RESULTS Fetal left ventricular myocardial performance index (MPI) values were found to be statistically significantly higher when compared between the A1 GDM and A2 GDM groups and the control group (p = 0.000 and p = 0.000, respectively), while the E/A ratio was found to be significantly lower (p = 0.000 and p = 0.000, respectively). It was determined that the maternal blood HbA1c level showed a significant negative correlation with the fetal cardiac E/A ratio and a significant positive correlation with isovolumetric relaxation time and MPI (p = 0.000, p = 0.000, and p = 0.000, respectively). Adverse perinatal outcome rate was higher in the diabetic group (46.4%-22.6%). When the cases with GDM were examined in terms of perinatal outcomes, it was observed that there was a significant difference in HbA1c levels, E/A ratio, and MPI values between the cases in the group with adverse perinatal outcomes and the group with normal results (p = 0.001, p = 0.000, and p = 0.000, respectively). CONCLUSIONS The strong relationship between abnormal cardiac function and adverse perinatal outcomes suggest that cardiac Doppler may be a valuable tool for fetal monitoring and management for the GDM patient group.
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Affiliation(s)
- Miraç Özalp
- Department of Perinatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Omer Demir
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gülseren Dinç
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hidayet Şal
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Turhan Aran
- Department of Perinatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | | | - Embiya Dilber
- Department of Pediatric Cardiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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Sun L, Wang J, Su X, Chen X, Zhou Y, Zhang X, Lu H, Niu J, Yu L, Sun C, Zhang W, Han J, Zhang L, Wang Z, Chen P, Chen T, Hong H, Zhou L, Ye B, Guo W, Zhao W, Zhang N, Li Z, Zhao S, Wu Q, Tian J, Jiang Y. Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study. BMJ Open 2021; 11:e049640. [PMID: 34233998 PMCID: PMC8264880 DOI: 10.1136/bmjopen-2021-049640] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The primary aim of this study was to establish the normal reference ranges of the fetal left ventricular (LV) Modified Myocardial Performance Index (Mod-MPI). A secondary aim was to evaluate the agreement between manual and automatic measurements for fetal Mod-MPI. DESIGN A prospective, multicentre, cross-sectional study. PARTICIPANTS Normal singleton pregnancies. METHODS The LV functions of normal singleton pregnancies were assessed in nine centres covering eight provinces in China using unified ultrasound protocols and settings and standardised measurements by pulsed Doppler at 20-24, 28-32 and 34-38 weeks of gestation. The isovolumetric relaxation time (IRT), isovolumetric contraction time, ejection time (ET) and Mod-MPI were measured both automatically and manually. RESULTS This cross-sectional study included 2081 fetuses, and there was a linear correlation between gestational age (GA) and Mod-MPI (0.416+0.001×GA (weeks), p<0.001, r2=0.013), IRT (36.201+0.162× GA (weeks), p<0.001, r2=0.021) and ET (171.418-0.078*GA (weeks), p<0.001, r2=0.002). This finding was verified using longitudinal data in a subgroup of 610 women. The agreement between the manual and automated measurements for Mod-MPI was good. CONCLUSIONS We constructed normal reference values of fetal LV Mod-MPI. Automatic measurement can be considered for ease of measurement in view of the good agreement between the automatic and manual values.
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Affiliation(s)
- Lijuan Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Jingjing Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Xiaoting Su
- Department of Ultrasound, Qingdao Women and Children's Hospital, Shandong, China
| | - Xinlin Chen
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Hubei, China
| | - Yuqing Zhou
- Department of Ultrasound, Shanghai Changning Maternity & Infant Health Hospital, Shanghai, China
| | - Xiaoming Zhang
- Department of Ultrasound, Inner Mongolia people's hospital, Inner Mongolia, China
| | - Hong Lu
- Department of Ultrasound, Women's Hospital School of Medicine Zhejiang University, Zhejiang, China
| | - Jianmei Niu
- Department of Ultrasound, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Yu
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Congxin Sun
- Department of Ultrasound, Shijiazhuang Obstetrics and Gynecology Hospital, Hebei, China
| | - Wenjun Zhang
- Department of Medical Ultrasound, Taihe Hospital, Hubei University of Medicine, Hubei, China
| | - Jijing Han
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Lina Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Zhenna Wang
- Department of Ultrasound, Qingdao Women and Children's Hospital, Shandong, China
| | - Peiwen Chen
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Hubei, China
| | - Tiantian Chen
- Department of Ultrasound, Shanghai Changning Maternity & Infant Health Hospital, Shanghai, China
| | - Hua Hong
- Department of Ultrasound, Inner Mongolia people's hospital, Inner Mongolia, China
| | - Lulu Zhou
- Department of Ultrasound, Women's Hospital School of Medicine Zhejiang University, Zhejiang, China
| | - Baoying Ye
- Department of Ultrasound, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Guo
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Wei Zhao
- Department of Ultrasound, Shijiazhuang Obstetrics and Gynecology Hospital, Hebei, China
| | - Na Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Sheng Zhao
- Department of Ultrasound, Maternal and Child Health Hospital of Hubei Province, Hubei, China
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology hospital, Capital Medical University, Beijing, China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medicine University, Heilongjiang, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peixoto AB, Bravo-Valenzuela NJ, Rocha LA, Araujo Júnior E. Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update. Radiol Bras 2021; 54:99-106. [PMID: 33854264 PMCID: PMC8029930 DOI: 10.1590/0100-3984.2020.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Clinic, Hospital Universitário Mário Palmério - Universidade de Uberaba (Uniube), Uberaba, MG, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Division of Pediatrics (Pediatric Cardiology), Department of Internal Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luciane Alves Rocha
- Graduate Program in Health Sciences, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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11
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Kim SM, Ye SY. Evaluation of the Fetal Left Ventricular Myocardial Performance Index (MPI) by Using an Automated Measurement of Doppler Signals in Normal Pregnancies. Diagnostics (Basel) 2021; 11:diagnostics11020358. [PMID: 33672746 PMCID: PMC7924560 DOI: 10.3390/diagnostics11020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022] Open
Abstract
The myocardial performance index is widely used as an indicator of the heart’s performance. However, due to the subjective nature of ultrasonic testing, there are differences in the measurements among inspectors, requiring a quantitative and objective assessment. In this study, an automated program was developed to quantitatively evaluate the myocardial performance index (MPI) and the cardiac time intervals in the left ventricle for each trimester. One hundred and thirty-three pregnant women who visited the hospital for prenatal examinations were studied, and skilled inspectors obtained left ventricular blood flow waveforms from 47 fetuses in the 12 weeks, 54 fetuses in the 22 weeks, and 32 fetuses in the 31 weeks of pregnancy using a pulse Doppler mode of ultrasound equipment. The acquired images automatically measured the isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT,) ejection time (ET), and filling time (FT), and calculated the Tei index (TI) and the K-index (KI); each interval was manually measured during the actual inspection for comparison. In this study, the ultrasonic Doppler waveform was objectively analyzed and measured by the automated program, and it will help with the evaluation of fetal heart function.
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Affiliation(s)
- Su-Min Kim
- Department of Obstetrics, Busan Well-High Woman’s Hospital, 95 Myeongji Ocean City 4-ro, Gangseo-gu, Busan 46764, Korea;
- Department of Radiological Science, Graduate School, Catholic University of Pusan, 57 Oryun-daero, Geumjeong-gu, Busan 46252, Korea
| | - Soo-Young Ye
- Department of Radiological Science, Graduate School, Catholic University of Pusan, 57 Oryun-daero, Geumjeong-gu, Busan 46252, Korea
- Correspondence: ; Tel.: +82-51-510-0589
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12
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Bhorat I, Foolchand S, Reddy T. Cardiac Doppler in poorly controlled gestational diabetics and its link to markers of intra-uterine hypoxia and adverse outcome. J OBSTET GYNAECOL 2020; 41:66-72. [PMID: 32148119 DOI: 10.1080/01443615.2019.1710480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the study was to investigate foetal cardiac function using the modified myocardial performance index (Mod-MPI) in poorly controlled gestational diabetics and its link with intrauterine markers for hypoxia and to an adverse outcome. In a prospective, cross sectional study, 44 consecutive women with severe or poorly controlled gestational diabetic pregnancies in their third trimester on insulin therapy were recruited and matched with 44 women with normal pregnancies which served as the control group. Using Doppler echocardiography the foetal Mod-MPI was calculated. The foetal Mod-MPI was significantly higher in the diabetic group compared to the controls indicating significant myocardial dysfunction. The Mod-MPI served as an excellent marker of adverse outcomes. Foetal myocardial function was significantly impaired in poorly controlled gestational diabetics and there was a significant link of Mod-MPI to intrauterine markers of hypoxia, as well as to an adverse outcome. Mod-MPI has the potential to improve foetal surveillance in gestational diabetes.IMPACT STATEMENTWhat is already known on this subject? Abnormal foetal cardiac function, as reflected in the modified myocardial performance index, has been reported to be significantly increased in foetuses of poorly controlled diabetics managed on insulin.What do the results of this study add? There is a significant link between abnormal foetal cardiac function to intrauterine markers of hypoxia, as well as to an adverse outcome; and that development of myocardial dysfunction could be one of the main mechanisms, inducing foetal compromise in poorly controlled gestational diabetes.What are the implications of these findings for clinical practice and/or further research? This study explores an interesting concept of foetal pathophysiology in gestational diabetes, namely the concept of "pseudo-hypoxia" in a foetus of a gestational diabetic mother, and this intrauterine "hypoxic stress" in turn leading to myocardial dysfunction. The Mod-MPI, a clinical marker for cardiac dysfunction, can therefore be used in the clinical setting to track a deteriorating metabolic state.
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Affiliation(s)
- Ismail Bhorat
- Department of Obstetrics and Gynaecology, Sub-department of Fetal Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Serantha Foolchand
- Department of Obstetrics and Gynaecology, Sub-department of Fetal Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council of South Africa, Durban, South Africa
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13
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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] [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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14
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Assessment of the Fetal Myocardial Performance Index in Well-Controlled Gestational Diabetics and to Determine Whether It Is Predictive of Adverse Perinatal Outcome. Pediatr Cardiol 2019; 40:1460-1467. [PMID: 31324952 DOI: 10.1007/s00246-019-02158-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
This study was aimed at determining if the myocardial performance index (MPI) is altered in well-controlled gestational diabetics and if so whether it is predictive of adverse perinatal outcome. In a prospective cross-sectional study, 54 consecutive women with well-controlled gestational diabetes controlled on insulin or metformin in the third trimester were recruited and matched with 54 women with normal pregnancies (control group). Using Doppler echocardiography, the MPI was calculated. Sonographic biophysical and placental resistance Doppler markers in both groups were also determined. An abnormal outcome was defined as any of the following: stillbirth; neonatal death; neonatal intensive care admissions; tachypnea with pulmonary edema; neonatal cord pH < 7.15; 5-min Apgar score < 7, polycythemia; and nucleated red blood cells > 10/100 white blood cell counts, hypoglycemia. The MPI was significantly higher in the diabetic group compared to controls (p < 0.0001). Rate of adverse outcome was 22% in the diabetic group. The diabetic group with adverse outcomes had significantly elevated MPI values compared to the diabetic group with normal outcomes. There were 26 diabetics controlled on metformin and 28 controlled on insulin. The adverse outcome rate was slightly higher in the IDDM group compared to the non-insulin-dependent group but was not statistically significant. The main adverse outcomes were low Apgars (18%), hypoglycemia (22%), polycythemia (13%) and low pH in 7%. All control births had normal outcomes. MPI served as an independent predictor of adverse outcome. The MPI z-score had a good diagnostic accuracy as evidenced by the area under the ROC curve of 0.83. An MPI z-score exceeding 4.55 conferred a 90% sensitivity and 74% specificity, with 77% of outcomes correctly classified with a likelihood ratio of 3.5. The MPI is impaired in fetuses in well-controlled gestational diabetes, with fetuses with an adverse outcome having significantly higher MPI values compared to the fetuses with normal outcome in the diabetic group. MPI has the potential to improve fetal surveillance in gestational diabetes.
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15
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Henry A, Alphonse J, Tynan D, Welsh AW. Fetal myocardial performance index in assessment and management of small-for-gestational-age fetus: a cohort and nested case-control study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:225-235. [PMID: 28345186 DOI: 10.1002/uog.17476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/27/2017] [Accepted: 03/17/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the clinical utility of the fetal myocardial performance index (MPI) in assessment and management of the small-for-gestational-age (SGA) fetus/growth-restricted fetus (FGR). METHODS This was a prospective cohort study in metropolitan Australia of patients referred in the period June 2012 to March 2015 to fetal medicine services at 24-38 weeks' gestation for suspected singleton SGA/FGR (estimated fetal weight (EFW) < 10th centile with or without abnormal umbilical artery (UA) Doppler) pregnancy. Patients had MPI assessed in addition to routine measures, and were followed through to birth. We compared MPI values against those of a local reference population and gestational age-matched controls, and assessed the correlation with perinatal outcome and other Doppler measures. RESULTS Fifty-two cases were included, 38 diagnosed < 32 weeks and 14 diagnosed ≥ 32 weeks. None demonstrated significantly elevated left, right or delta MPI compared with the reference population or with gestational age-matched controls at the time of first MPI evaluation. There were no consistent longitudinal patterns in MPI that would suggest its clinical utility. The mean ± SD gestational age at delivery was 34.6 ± 3.8 weeks and birth weight was 1.7 ± 0.6 kg, and the median neonatal hospital admission time was 27 days, confirming a pathological cohort. There were no significant correlations between left, right or delta-MPI and perinatal outcome, although there were significant correlations between UA, middle cerebral artery (MCA) and ductus venosus (DV) Doppler and perinatal outcome (birth weight, gestational age at birth and length of neonatal hospital stay). Exploratory subgroup comparisons (EFW < 3rd vs 3rd -10th centile; early- vs late-onset; abnormal vs normal UA Doppler) found only minor differences in MPI, reaching statistical, but not clinical, significance, only in the EFW < 3rd vs 3rd -10th centile comparison. CONCLUSIONS MPI did not demonstrate clinical utility in either triage or longitudinal follow-up of an SGA/FGR cohort presenting to fetal medicine services. Given that prior research suggesting its utility originates from single-center cohorts, while multicenter, large cohorts have suggested little utility or no additional utility if routine UA/MCA/DV Doppler is performed, publication bias may have affected previous reports. It seems unlikely that MPI has clinical utility in assessment and management of SGA/FGR fetuses. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Henry
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, Australia
| | - J Alphonse
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - D Tynan
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - A W Welsh
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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16
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Henry A, Gopikrishna S, Mahajan A, Alphonse J, Meriki N, Welsh AW. Use of the Foetal Myocardial Performance Index in monochorionic, diamniotic twin pregnancy: a prospective cohort and nested case-control study. J Matern Fetal Neonatal Med 2018; 32:2017-2029. [DOI: 10.1080/14767058.2018.1424817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amanda Henry
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
- Department of Women’s and Children’s Health, St. George Hospital, Sydney, Australia
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Saranya Gopikrishna
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
| | - Aditi Mahajan
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Jennifer Alphonse
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
| | - Neama Meriki
- Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Maternal Fetal Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Alec W. Welsh
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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17
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Krause K, Möllers M, Hammer K, Falkenberg MK, Möllmann U, Görlich D, Klockenbusch W, Schmitz R. Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE). J Perinat Med 2017; 45:821-827. [PMID: 28063262 DOI: 10.1515/jpm-2016-0280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/30/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate longitudinal mechanical dyssynchrony in normally grown fetuses by speckle tracking echocardiography (STE) and to compare longitudinal mechanical dyssynchrony in fetal growth restriction (FGR) with normal controls. MATERIALS AND METHODS A prospective study was performed on 30 FGR and 62 normally grown fetuses, including 30 controls matched by gestational age, using STE and a transversal four-chamber view. Data analysis was carried out with a high frame rate of about 175 frames/s. Dyssynchrony was analyzed offline with QLab 9 (Philips Medical Systems, Andover, MA, USA) as time differences between peaks in strain of both ventricles and the septum. Inter- and intraventricular and intraseptal dyssynchrony were obtained and inter- and intraobserver reliability was analyzed. RESULTS Longitudinal mechanical dyssynchrony was feasible in all cases, with high inter- and intraobserver reliability. Levels of inter- and intraventricular dyssynchrony were higher in the FGR than in the control group. CONCLUSION Speckle tracking echocardiography (STE) is a reliable technique for cardiac function assessment in the fetal heart. Interventricular dyssynchrony could be a potential parameter for early detection of subclinical myocardial dysfunction before other parameters demand intervention. The future clinical role of longitudinal mechanical dyssynchrony needs to be verified in larger studies and with a technique customized for prenatal echocardiography.
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18
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MacDonald TM, Robinson AJ, Walker SP, Hui L. Prospective longitudinal assessment of the fetal left modified Myocardial Performance Index. J Matern Fetal Neonatal Med 2017; 32:760-767. [PMID: 29020812 DOI: 10.1080/14767058.2017.1391777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The fetal left modified Myocardial Performance Index (Mod-myocardial performance index (MPI)) is a measure of systolic versus diastolic time intervals obtained from a single cardiac cycle with ultrasound. It is a measure of global ventricular function and has been investigated for potential utility in fetal conditions associated with cardiac dysfunction. OBJECTIVES The objective of this study is to compare values from a precisely replicated fetal left Mod-MPI technique to published reference ranges. METHODS Three hundred and sixty-five nulliparae prospectively underwent fetal left Mod-MPI measurement at 27+0-29+0 and 35+0-37+0 weeks' gestation. Measurements from pregnancies complicated by gestational diabetes mellitus, preeclampsia, or a small-for-gestational-age (<10th centile) infant were excluded. Mod-MPI values were compared with three published references created using similar measurement techniques. RESULTS Compared with one selected reference, at 29+0 and 35+0-37+0 weeks' gestation, 90-100% of our values fell within the 5th-95th percentile range as expected. Thus, this reference range was validated for our population in late pregnancy. However, the expected level of concordance was not seen at 27+0-28+6 weeks'. The other two references to which we compared our Mod-MPI values demonstrated poor concordance, especially at 27+0-29+0 weeks'. Pearson interobserver correlation was also improved at 35+0-37+0 weeks' at 0.434, compared with 0.083 at 27+0-29+0 weeks' gestation. CONCLUSIONS Concordance and interobserver variability between our cohort and similar populations were both improved at 35+0-37+0 weeks' compared with 27+0-29+0 weeks' gestation. Overall, variable Mod-MPI reproducibility across gestations limits clinical application, especially earlier in pregnancy. Manual Mod-MPI measurement should be considered most reliable in late pregnancy until automated MPI measurement is possible.
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Affiliation(s)
- Teresa M MacDonald
- a Mercy Perinatal, Mercy Hospital for Women , Melbourne , Australia.,b Department of Obstetrics and Gynecology , University of Melbourne , Melbourne , Australia
| | - Alice J Robinson
- a Mercy Perinatal, Mercy Hospital for Women , Melbourne , Australia
| | - Susan P Walker
- a Mercy Perinatal, Mercy Hospital for Women , Melbourne , Australia.,b Department of Obstetrics and Gynecology , University of Melbourne , Melbourne , Australia
| | - Lisa Hui
- a Mercy Perinatal, Mercy Hospital for Women , Melbourne , Australia.,b Department of Obstetrics and Gynecology , University of Melbourne , Melbourne , Australia
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19
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Maheshwari P, Alphonse J, Henry A, Wang J, Redmond SJ, Welsh AW. Beat-to-beat variability of fetal myocardial performance index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:215-220. [PMID: 27392316 DOI: 10.1002/uog.16012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/28/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine whether there is beat-to-beat (BTB) variability in the fetal left myocardial performance index (MPI), as evaluated by an automated system, and whether there is a correlation between MPI and fetal heart rate (FHR). METHODS This was a prospective cross-sectional study of uncomplicated, morphologically normal, singleton pregnancies at 20-38 weeks' gestation. Multiple cineloops for left MPI measurement were acquired during a single examination of each fetus. Raw cineloop data were analyzed by our automated MPI system (intraclass correlation coefficient of 1.0 for any given waveform) to produce a set of MPIs. The corresponding instantaneous FHR was measured for each individual cardiac cycle for which MPI was calculated. RESULTS Data from 29 fetuses were analyzed; mean MPI was 0.52, mean FHR was 150 beats per min and the median number of cardiac cycles examined per fetus was 70 (interquartile range, 31-115). Marked BTB variability was noted; median coefficient of variation was 10% (range, 5.5-13.9%). FHR was weakly correlated with absolute MPI (r = 0.22; P < 0.05). BTB variation in MPI as a percentage of the mean MPI was not significantly correlated with FHR (r = 0.031; P = 0.146). When standard error of the mean of all MPI values was divided by the mean for each case, it showed that at least four cardiac cycles should be averaged to reduce MPI variability to approximately ± 5%. CONCLUSION There is significant BTB variability in fetal left MPI, which has an overall weak correlation with FHR. This could be a factor affecting the consistency of MPI values reported by different research groups. Variability would be reduced by averaging 4-5 cardiac cycles per fetus. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Maheshwari
- Faculty of Medicine, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - J Alphonse
- Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, NSW, Australia
| | - A Henry
- Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, NSW, Australia
- School of Women's & Children's Health, University of New South Wales, Randwick, Sydney, NSW, Australia
- Department of Obstetrics & Gynaecology, St George Hospital, Kogarah, NSW, Australia
| | - J Wang
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - S J Redmond
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - A W Welsh
- Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, NSW, Australia
- School of Women's & Children's Health, University of New South Wales, Randwick, Sydney, NSW, Australia
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20
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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. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1585-1594. [PMID: 28503785 DOI: 10.7863/ultra.16.07079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/11/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the reproducibility of the fetal right myocardial performance index determined by simultaneous recording of inflow and outflow using a dual gate pulsed-wave Doppler (DD). METHODS This was a prospective study of 39 normal singleton fetuses. Two experienced operators each measured the right myocardial performance index in three ways, twice: (1) separate recording of the inflow and outflow using single-gate pulsed-wave Doppler (PD), (2) simultaneous recordings of the inflow and outflow using tissue Doppler (TD), and (3) simultaneous recordings of the inflow and outflow using DD. Intra- and interoperator reproducibility were assessed with intraclass correlation coefficients. The measurements from all three methods taken by the more experienced operator were compared using Bland-Altman plots and mean differences. RESULTS For both operators, intra-operator reproducibility was the highest when using DD, followed by PD, and TD. Interoperator agreement was the highest for PD measurements, followed by DD, and TD. The smallest mean difference was between the PD and DD measurements by the more experienced operator. There was a positive correlation between PD and DD values (r = 0.369, P < .001). CONCLUSIONS Dual gate pulsed-wave Doppler may be an effective alternative to the PD or TD methods, and can separately evaluate systolic and diastolic myocardial function.
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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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21
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Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function. Heart Fail Rev 2017; 22:861-877. [DOI: 10.1007/s10741-017-9638-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Bhorat I, Pillay M, Reddy T. Determination of the fetal myocardial performance index in women with gestational impaired glucose tolerance and to assess whether this parameter is a possible prognostic indicator of adverse fetal outcome. J Matern Fetal Neonatal Med 2017; 31:2019-2026. [PMID: 28532199 DOI: 10.1080/14767058.2017.1334047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to investigate if the myocardial performance index (MPI) is altered in fetuses in women with gestational impaired glucose tolerance (GIGT), controlled on diet and whether this parameter is also predictive of adverse outcome in this group, as in poorly controlled gestational diabetes. METHODS In a prospective cross-sectional study, 32 women with GIGT on diet in the 3rd trimester were recruited and matched with 32 women with normal pregnancies (control group). Using Doppler echocardiography, the MPI was calculated. Placental resistance Doppler markers in both groups were also determined. An abnormal outcome was defined as any of the following: stillbirth, neonatal death, neonatal intensive care unit (NICU) admissions, tachypnea with pulmonary oedema, neonatal cord pH <7.15, five minute Apgar score <7, and cardiomyopathy. RESULTS The cases had a significantly higher median MPI compared to controls, p value <.0001. There were eight abnormal outcomes recorded in the 32 fetuses in the study group, corresponding to an adverse outcome rate of 25%. Fetuses with an adverse outcome had significantly higher MPI measurements compared to the GIGT fetuses with normal outcome. The MPI served as an excellent predictor of adverse outcome in the GIGT fetuses, with a total area under the ROC curve of 0.96. An MPI z-score greater than 4.0 conferred a sensitivity of 100% and specificity of 80%. No abnormal outcomes were noted in the control group. CONCLUSIONS The MPI is impaired in fetuses in GIGT women, with fetuses with an adverse outcome having significantly higher MPI measurements compared to the fetuses with normal outcome in the GIGT group. MPI has the potential to improve fetal surveillance in gestational diabetes.
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Affiliation(s)
- Ismail Bhorat
- a Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine , University of Kwa-Zulu Natal , Durban , South Africa
| | - Morgan Pillay
- a Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine , University of Kwa-Zulu Natal , Durban , South Africa
| | - Tarylee Reddy
- b Biostatistics Unit , South African Medical Research Council of South Africa , Durban , South Africa
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Meriki N, Welsh AW. Fetal cardiac function: Feasibility in obtaining the right modified myocardial performance index in a single Doppler waveform. Australas J Ultrasound Med 2017; 20:18-25. [DOI: 10.1002/ajum.12035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Neama Meriki
- Department of Maternal fetal Medicine King Khalid University Hospital Riyadh Saudi Arabia
- Department of Obstetrics & Gynaecology College of Medicine King Saud University Riyadh Saudi Arabia
| | - Alec W Welsh
- Department of Maternal‐Fetal Medicine Royal Hospital for WomenRandwick New South Wales Australia
- Division of Women's and Children's Health University of New South Wales Randwick New South Wales Australia
- Australian Centre for Perinatal Science University of New South Wales Randwick New South Wales Australia
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Bhorat IE, Bagratee JS, Reddy T. Assessment of fetal myocardial performance in severe early onset pre-eclampsia (EO-PET) with and without intrauterine growth restriction across deteriorating stages of placental vascular resistance and links to adverse outcomes. Eur J Obstet Gynecol Reprod Biol 2017; 210:325-333. [PMID: 28113071 DOI: 10.1016/j.ejogrb.2017.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/23/2016] [Accepted: 01/11/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether fetuses in severe early onset pre-eclampsia (EO-PET) with or without intrauterine growth restriction has cardiac dysfunction across deteriorating stages of placental vascular resistance and whether this dysfunction influences perinatal outcome. STUDY DESIGN This was a prospective cross-sectional study performed in a tertiary care university medical centre. Sixty pregnant patients with severe early-onset pre-eclampsia between 27 and 32 weeks were recruited and matched with 60 patients having normal pregnancies. An analysis of cardiac function using the myocardial performance index (MPI) and early ventricular filling (E) and late active atrial contraction (A) ratios (E/A ratios) in the study group was performed compared to controls and further analysis was performed based on worsening placental vascular resistance and presence of growth restriction. RESULTS MPI values were increased in the pre-eclamptic group, irrespective if growth restriction co-exists, compared to controls (0.61 vs 0.38, p<0.001). Its median value progressively increased with worsening placental vascular resistance. For adverse perinatal outcome cut-off MPI values have been suggested. The E/A ratios were significantly decreased in the pre-eclamptic group compared to controls (0.66 vs 0.79, p<0.0001). No adverse outcomes were noted in the control group. CONCLUSION Fetal cardiac function is significantly impaired in pregnancies complicated by severe early onset pre-eclampsia, irrespective if growth restriction co-exists and worsens with deteriorating grades of placental vascular resistance. The MPI can potentially be integrated into routine fetal surveillance techniques.
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Affiliation(s)
- I E Bhorat
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
| | - J S Bagratee
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - T Reddy
- Biostatistics Unit, Medical Research Council, Durban, South Africa
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Welsh AW, Maheshwari P, Wang J, Henry A, Chang D, Crispi F, Gardiner HM, Hernandez-Andrade E, Meriki N, Redmond S, Yagel S. Evaluation of an automated fetal myocardial performance index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:496-503. [PMID: 26423314 DOI: 10.1002/uog.15770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/17/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare automated measurements of the fetal left myocardial performance index (MPI) with manual measurements for absolute value, repeatability and waveform acceptability. METHODS This was a multicenter international online study using images from uncomplicated, morphologically normal singleton pregnancies (16-38 weeks' gestation). Single Doppler ultrasound cardiac cycle images of 25 cases were selected, triplicated and randomized (n = 75). Six senior observers, unaware of the repetition of images, manually calculated MPI for each waveform and the results were compared with automation. Intraobserver repeatability and interobserver reproducibility were assessed using intraclass correlation coefficients (ICCs) and 95% CI. The agreement between each observer's manual MPI measurements and corresponding automated measurements was evaluated using Bland-Altman plots and ICCs with 95% CI. The degree of variation between experts in the classification of fetal MPI waveform quality was assessed using individual cardiac cycle left MPI images previously classified by two authors as 'optimal', 'suboptimal' or 'unacceptable', with 30 images selected for each quality group. Ten images in each category were duplicated and the resulting 120 images were randomized and then classified online by five observers. The kappa statistic (κ) was used to demonstrate interobserver and intraobserver agreement and agreement of classifications by the five observers. RESULTS The automated measurement software returned the same value for any given image, resulting in an ICC of 1.00. Manual measurements had intraobserver repeatability ICC values ranging from 0.69 to 0.97, and the interobserver reproducibility ICC was 0.78. Comparison of automated vs manual MPI absolute measurements for each observer gave ICCs ranging from 0.77 to 0.96. Interobserver image quality classification agreement gave k = 0.69 (P < 0.001), and the intraobserver agreement was variable (κ ranging from 0.40 to 0.81). CONCLUSIONS Automated fetal MPI provides superior repeatability and reproducibility to manual methodology. Additionally, experts vary significantly when classifying suitability of fetal MPI waveforms. Automated MPI may facilitate clinical translation by removing human subjectivity. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A W Welsh
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia.
- School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - P Maheshwari
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - J Wang
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - A Henry
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - D Chang
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - F Crispi
- Maternal-Fetal Medicine, Hospital Clinica Barcelona, Barcelona, Spain
| | | | - E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Wayne State University School of Medicine Detroit, Detroit, MI, USA
| | - N Meriki
- School of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - S Redmond
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - S Yagel
- Obstetrics and Gynaecology, Hadassah University Hospital, Mt Scopus, Jerusalem, Israel
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Tang X, Hernandez-Andrade E, Ahn H, Garcia M, Saker H, Korzeniewski SJ, Tarca AL, Yeo L, Hassan SS, Romero R. Intermediate Diastolic Velocity as a Parameter of Cardiac Dysfunction in Growth-Restricted Fetuses. Fetal Diagn Ther 2015; 39:28-39. [PMID: 26279291 DOI: 10.1159/000431321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/07/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the intermediate intracardiac diastolic velocities in fetuses with growth restriction. METHODS Doppler waveforms of the two atrioventricular valves were obtained. Peak velocities of the E (early) and A (atrial) components, and the lowest intermediate velocity (IDV) between them, were measured in 400 normally grown and in 100 growth-restricted fetuses. The prevalence of abnormal IDV, E/IDV, and A/IDV ratios in fetuses presenting with perinatal death or acidemia at birth (pH ≤7.1) was estimated. RESULTS IDV was significantly lower and E/IDV ratios significantly higher in the two ventricles of growth-restricted fetuses with reduced diastolic velocities in the umbilical artery (p < 0.05). In 13 fetuses presenting with perinatal death or acidemia at birth, 11 (85%) had either an E/IDV or A/IDV ratio >95th percentile, whereas 5 (38%) showed absent or reversed atrial velocities in the ductus venosus (DV-ARAV; p < 0.04). Fetuses without DV-ARAV but with elevated E/IDV ratios in either ventricle were nearly 7-fold more likely to have perinatal demise or acidemia at birth (OR 6.9, 95% CI 1.4-34) than those with E/IDV ratios <95th percentile. CONCLUSION The E/IDV and A/IDV ratios in the two cardiac ventricles might provide information about the risk of perinatal demise or acidemia in growth-restricted fetuses.
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Affiliation(s)
- Xiangna Tang
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Md. and Detroit, Mich., USA
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Maheshwari P, Henry A, Welsh AW. The Fetal Modified Myocardial Performance Index: Is Automation the Future? BIOMED RESEARCH INTERNATIONAL 2015; 2015:215910. [PMID: 26185751 PMCID: PMC4491561 DOI: 10.1155/2015/215910] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Abstract
The fetal modified myocardial performance index (Mod-MPI) is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1) a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3) ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.
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Affiliation(s)
- Priya Maheshwari
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Amanda Henry
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Women's and Children's Health, St George Hospital, Kogarah, NSW 2217, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia
| | - Alec W. Welsh
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia
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Welsh AW, Henry A, Meriki N, Mahajan A, Wu L, Alphonse J. Is There a Measurable Difference between the Left and Right Modified Myocardial Performance Indices, and Does This Change to Reflect Unilateral Myocardial Dysfunction in Pathology? Fetal Diagn Ther 2015; 38:288-95. [DOI: 10.1159/000381709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022]
Abstract
Introduction: Fetal cardiac dysfunction may manifest itself unilaterally as right and left ventricles differing in design, function and load, measurable as differing in myocardial performance indices (MPIs). We wished to define this difference (‘delta-MPI' or DMPI), present its normal range and pilot its use in pathological pregnancy. Material and Methods: Prospective cross-sectional study of 324 normal singleton fetuses (16-38 weeks of gestation). Left and right modified MPI (LMPI and RMPI) were performed during a single examination using the ‘peak' valve click technique. Thirty-seven pathological singleton and monochorionic diamniotic twin pregnancies were compared as pilot data. Results: Modified MPIs (mean ± SD) were 0.45 ± 0.06 (LMPI) and 0.47 ± 0.09 (RMPI), being similar at 18 weeks' gestation with DMPI increasing slightly throughout pregnancy (0.02 ± 0.08). Both singleton intrauterine growth restriction (IUGR) and recipient twin-twin transfusion syndrome (TTTS) showed significantly elevated RMPI, LMPI and DMPI, most pronounced for DMPI (450 and 500% increase, respectively; p < 0.01). DMPI acquisition rates were 83.3% normal and 87.0% pathological. Discussion: We demonstrate for the first time differing intrafetal LMPI and RMPI in a large gestational cohort, with this difference increasing with gestational age. Pilot data confirm the potential for DMPI as a tool to assess unilateral myocardial function in singleton IUGR and recipient twins in TTTS, and further studies are under way to evaluate its clinical utility.
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Mahajan A, Henry A, Meriki N, Hernandez-Andrade E, Crispi F, Wu L, Welsh AW. The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research. Fetal Diagn Ther 2015; 38:1-13. [DOI: 10.1159/000363181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.
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Wang J, Henry A, Welsh AW, Redmond SJ. Automated fetal cardiac valve movement detection for modified myocardial performance index calculation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:1063-6. [PMID: 25570145 DOI: 10.1109/embc.2014.6943777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Modified Myocardial Performance Index (Mod-MPI) is becoming an important index in fetal cardiac function evaluation. However, the current method for Mod-MPI calculation can be time-consuming and demonstrates poor inter-operator repeatability. This paper presents an automated method for detecting the opening and closing events of fetal cardiac valves with the aim of automating the Mod-MPI calculation. Fifty-four Doppler ultrasound images, showing blood inflow and outflow for the left ventricle, are analyzed to attempt to automatically detect the timings of a total of 905 opening and closing events for both aortic and mitral valves. Timings are found according to the morphological characteristics of waveforms as well as intensity information of images. The proposed method can detect the four valve movement events with high sensitivity (95.60-98.64%) and precision (96.85-100.00%). Results are verified by comparison with manual annotation of same images from an expert.
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Meriki N, Henry A, Sanderson J, Majajan A, Wu L, Welsh AW. Development of Normal Gestational Ranges for the Right Myocardial Performance Index in the Australian Population with Three Alternative Caliper Placements. Fetal Diagn Ther 2014; 36:272-81. [DOI: 10.1159/000362388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/18/2014] [Indexed: 11/19/2022]
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Chawengsettakul S, Russameecharoen K, Wanitpongpan P. Fetal cardiac function measured by myocardial performance index of small-for-gestational age fetuses. J Obstet Gynaecol Res 2014; 41:222-8. [DOI: 10.1111/jog.12508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 05/26/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Suphang Chawengsettakul
- Department of Obstetrics and Gynecology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Kusol Russameecharoen
- Department of Obstetrics and Gynecology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Prapat Wanitpongpan
- Department of Obstetrics and Gynecology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
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Lobmaier SM, Cruz-Lemini M, Valenzuela-Alcaraz B, Ortiz JU, Martinez JM, Gratacos E, Crispi F. Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:632-639. [PMID: 24639072 DOI: 10.1002/uog.13365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare left myocardial performance index (MPI) values and reproducibility using different settings and ultrasound equipment in order to standardize optimal machine settings. METHODS Left MPI was prospectively evaluated by one observer performing conventional Doppler in 62 fetuses (28-36 weeks of gestational age) using different settings (changing sweep speed, gain and wall motion filter (WMF)) and two different ultrasound devices (Siemens Antares, Siemens; Voluson 730 Expert, GE Medical Systems). Intraclass coefficients of agreement (ICCs) were calculated using Bland-Altman analysis. RESULTS Using baseline settings on the Siemens, mean (SD) MPI was 0.44 (0.05) with an ICC of 0.81. Decreasing the sweep speed resulted in decreasing average MPI values (0.43) and decreasing ICC (0.61). Lowering gain also influenced average MPI values (0.46) and ICC (0.76). Raising gain resulted in similar MPI values (0.45) with better ICC (0.90) compared with baseline settings. Raising wall motion filter (WMF) provided the best ICC (0.94) compared with the other settings. Changing the ultrasound equipment resulted in an ICC of 0.64. The optimal settings to achieve the highest reproducibility in measurement of MPI were sweep speed 8, gain 60 dB and WMF 281 Hz for Siemens Antares and sweep speed 5, gain -10 dB and WMF 210 Hz for Voluson 730 Expert. CONCLUSION Changing ultrasound settings or equipment may affect the calculation and repeatability of measurement of MPI values. Strict standardization of methods decreases the variability of this parameter for fetal cardiac function assessment.
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Affiliation(s)
- S M Lobmaier
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
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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 IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 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] [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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Welsh A. The development of, and future for, fetal functional cardiac imaging techniques. Australas J Ultrasound Med 2014; 17:57-60. [PMID: 28191209 PMCID: PMC5024939 DOI: 10.1002/j.2205-0140.2014.tb00107.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alec Welsh
- Head of Department, Maternal-Fetal Medicine Royal Hospital for Women Director Australian Centre for Perinatal Science (ACPS) Professor in Maternal-Fetal Medicine School of Women's & Children's Health University of New South Wales Royal Hospital For Women Randwick New South Wales Australia
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36
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Yozgat Y, Kilic A, Ozdemir R, Karadeniz C, Kucuk M, Karaarslan U, Mese T, Unal N. Modified myocardial performance index is not affected in fetuses with an isolated echogenic focus in the left ventricle. J Matern Fetal Neonatal Med 2014; 28:333-7. [PMID: 24749803 DOI: 10.3109/14767058.2014.916679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We prospectively investigated the efficacy of modified myocardial performance index (mod-MPI) in the assessment of cardiac functions in fetuses with and without an isolated hyperechogenic focus (IHF) in the left ventricle and compared with conventional fetal echocardiography. METHODS The study group consisted of 50 fetuses with only an IHF in the left ventricle, without any other cardiac or extracardiac anomalies; 50 fetuses without IHF served as controls. All fetal echocardiographic studies were performed between 20th and 24th weeks of gestation. Left ventricular functions were evaluated with both conventional echocardiographic methods (peak velocity of the aortic valve, mitral E/A ratio, fractional shortening) and mod-MPI. RESULTS There was no statistically significant difference between the groups in terms of maternal age, BMI or gestational age at the time of examination (p > 0.05 for all). No statistically significant differences were found between the findings of conventional echocardiographic measurements and left ventricular mod-MPI between the study and control groups (p > 0.05 for all). CONCLUSION Fetal left ventricular mod-MPI is not affected by the presence of an IHF in the fetal left ventricle between 20th and 24th gestational weeks and thus it does not need to be assessed in this situation.
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Affiliation(s)
- Yilmaz Yozgat
- Department of Pediatric Cardiology, Dr Behcet Uz Children's Hospital , Izmir , Turkey and
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Henry A, Shand A, Welsh A. The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Australas J Ultrasound Med 2013; 16:135-141. [PMID: 28191187 PMCID: PMC5029999 DOI: 10.1002/j.2205-0140.2013.tb00101.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Corticosteroids are widely used in obstetrics due to their striking effect on perinatal morbidity and mortality of premature neonates. Despite this, relatively few studies have explored short term fetal effects of corticosteroids as measured by ultrasound. Objectives: 1) To present a literature review of short term fetal cardiovascular effects of corticosteroids 2) To describe the protocol of a current observational study (SUPER-A*STEROID) of cardiovascular effects of dexamethasone and betamethasone in the first week after their administration. This trial is nested within the A*STEROID blinded multicentre randomised controlled trial of the two steroid preparations. Findings: Existing data suggest corticosteroids have little effect on the major measured fetal blood vessels when the baseline ultrasound is normal. In the compromised fetus, where the umbilical artery end-diastolic flow is abnormal prior to maternal corticosteroids, flow is temporarily restored in approximately 50% of cases. Whether such changes are beneficial is uncertain. Very little data exist that directly compare the short-term effects of betamethasone and dexamethasone. The SUPER- A*STEROID study described will help provide this information.
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Affiliation(s)
- Amanda Henry
- School of Women's and Children's HealthUNSW MedicineSydneyNew South WalesAustralia; Department of Maternal-FetalMedicine Royal Hospital for WomenRandwickNew South WalesAustralia; Women's and Children's Health St George HospitalKogarahNew South WalesAustralia
| | - Antonia Shand
- School of Women's and Children's HealthUNSW MedicineSydneyNew South WalesAustralia; Department of Maternal-FetalMedicine Royal Hospital for WomenRandwickNew South WalesAustralia; Kolling Institute of Medical ResearchRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Alec Welsh
- School of Women's and Children's HealthUNSW MedicineSydneyNew South WalesAustralia; Department of Maternal-FetalMedicine Royal Hospital for WomenRandwickNew South WalesAustralia
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Meriki N, Welsh AW. Development of Australian reference ranges for the left fetal modified myocardial performance index and the influence of caliper location on time interval measurement. Fetal Diagn Ther 2012; 32:87-95. [PMID: 22759698 DOI: 10.1159/000334133] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To construct gestational age-adjusted reference ranges of the left fetal modified myocardial performance index (Mod-MPI) in the Australian population and assess the influence of valve click caliper position on constituent time intervals and the Mod-MPI. METHODS This is a prospective longitudinal study of 117 normal singleton fetuses undergoing 318 ultrasound scans at 4-6 weekly intervals between 18 and 38 weeks of gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were measured at 3 different caliper positions in each fetus: beginning of the original valve clicks ('original'), beginning of the reflected valve clicks ('reflected'), and peak of valve clicks ('peak'). The Mod-MPI was calculated as (ICT + IRT)/ET. RESULTS The Mod-MPI increased throughout gestation with means ± SD of 0.42 ± 0.05 'reflected' and 'peak' versus 0.49 ± 0.03 'original' at 19 weeks, and means of 0.46 ± 0.05 'reflected and peak' versus 0.51 ± 0.08 'original' at 36 weeks. Throughout gestation, ICT remained fairly constant and IRT increased, while ET decreased with 'original' click and remained constant for 'reflected' and 'peak' clicks. A modest increase in Mod-MPI was seen with increasing fetal heart rate. Analysis of repeatability for the 3 methods showed the following ICCs: 'original', 0.797 (95% CI 0.762-0.829); 'reflected', 0.809 (95% CI 0.775-0.839), and 'peak', 0.799 (95% CI 0.764-0.831). CONCLUSIONS Detailed exploration of the morphology of mitral and aortic valve closure and opening clicks shows how selection of different phases of these clicks may significantly influence the Mod-MPI. We recommend that the peak of the valve clicks be standardized between research groups.
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Affiliation(s)
- N Meriki
- Department of Obstetrics and Gynaecology, King Saud University, Riyadh, Saudi Arabia
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Hernandez-Andrade E, Benavides-Serralde JA, Cruz-Martinez R, Welsh A, Mancilla-Ramirez J. Evaluation of conventional Doppler fetal cardiac function parameters: E/A ratios, outflow tracts, and myocardial performance index. Fetal Diagn Ther 2012; 32:22-9. [PMID: 22677618 DOI: 10.1159/000330792] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/09/2011] [Indexed: 12/27/2022]
Abstract
Structural evaluation of the fetal heart is well established. Functional evaluation using pulsed-wave Doppler may also be performed. E/A ratios express the relationship between the maximal velocities of the E and A waveforms of ventricular filling. In normal fetuses, E/A ratios are usually <1 but show a constant increment during gestation, mainly related to the increment of the E wave. In intrauterine growth restriction (IUGR) fetuses, E/A ratios are lower compared to values in normally grown fetuses at the same gestational age. Cardiac outflows provide information on the time-velocity integral that, combined with the vessel area, allows calculation of the left and right cardiac outputs. In normal fetuses there is a predominance of the right ventricle (55-60%) in contributing to the combined cardiac output. In IUGR fetuses this predominance shifts to the left ventricle in order to increase the flow to the upper part of the fetal body and brain. The myocardial performance index (MPI) also provides information on systolic and diastolic cardiac function. The MPI is an early and consistent marker of cardiac dysfunction which becomes altered in early stages of chronic hypoxia or in cases with cardiac overload such as in twin-to-twin transfusion syndrome.
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