Atrial dominance in the human embryonic heart: a study of cardiac function at 6-10 weeks of gestation

OBJECTIVE

To investigate the difference in forces developed by atrial and ventricular myocardium during contraction in human embryos using a novel method.

METHODS

This was a cross-sectional study of 115 pregnancies examined at 6-10 weeks of gestation. Ventricular inflow and outflow velocities were obtained by Doppler echocardiography and the relative force development was evaluated by calculating the ratio between atrial and ventricular ejection force (EF).

RESULTS

Data from 97 embryos with monophasic ventricular filling were analyzed. Both inflow and outflow cardiac velocities increased with advancing gestational age (P < 0.001). The mean peak inflow velocity (31.7 ± 10.2 cm/s) was significantly higher (P < 0.0001) than the outflow velocity (19.6 ± 6.1 cm/s). The EFinflow /EFoutflow ratio was more than 1.0 in all but four (96%) cases.

CONCLUSION

Our study indicates the possibility of atrial dominance in the embryonic period of heart development, which may have clinical implications, as deviations from this normal pattern may indicate human embryonic cardiac dysfunction.

Reference values for variables of fetal cardiocirculatory dynamics at 11-14 weeks of gestation

OBJECTIVE

Despite the increasing popularity of first-trimester fetal echocardiography, the evaluation of fetal heart function during this period remains challenging. The parameters of normal cardiac function at 11-14 weeks' gestation are not well defined and appropriate reference values have not yet been established. The purpose of this study was to evaluate the fetal cardiocirculatory dynamics during routine first-trimester screening and establish cross-sectional reference ranges for 11-14 weeks' gestation.

METHODS

Fetal echocardiography was performed on 202 women with singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Global cardiac function was evaluated using the heart : chest area ratio and Tei index of the left (LV) and right (RV) ventricles. The proportion of isovolumic contraction (ICT%) and ejection (ET%) times of the cardiac cycle, and the outflow velocities described the systolic function. Diastolic function was evaluated by the proportion of relaxation (IRT%) and filling (FT%) times, the ratio of the blood velocity through the atrioventricular valves during early filling (E) and atrial contraction (A) phases of the cardiac cycle, and ductus venosus pulsatility index for veins (DV-PIV). All participants had additional fetal echocardiography in the second trimester and neonatal clinical examination after birth to confirm normality.

RESULTS

The mean heart : chest area ratio (0.203 +/- 0.04) and the Tei indices of both ventricles did not vary significantly during weeks 11-14, but the mean Tei index of the LV (0.375 +/- 0.092) was significantly higher than that of the RV (0.332 +/- 0.079) (P = 0.001). The fetal heart rate (FHR) decreased with increasing crown-rump length (CRL) (P < 0.00001). The LV-ICT% did not vary significantly (P = 0.27), LV-IRT% (P = 0.03) and LV-ET% decreased (P = 0.01), whereas the LV-FT% increased (P = 0.02) with CRL. The RV-ET% (P = 0.84) and RV-FT% (P = 0.60) remained relatively stable. The LV-ET% was lower than the RV-ET% (P = 0.0001). The LV (P = 0.004) and RV (P < 0.00001) outflow velocities and E : A ratios of both ventricles (P < 0.0001) increased with advancing gestation. The E-velocity of the LV (P = 0.003) and RV (P = 0.002) increased significantly but the increase in A-velocity was not significant. The outflow velocity (P = 0.008) and E-velocity (P = 0.005) of the RV were higher than that of the LV but the A-velocities were similar (P = 0.066). The mean DV-PIV was 0.97 +/- 0.23 and did not change significantly (P = 0.95) during weeks 11-14. The FHR and DV-PIV did not correlate with the Tei index of either ventricle.

CONCLUSION

We have established reference ranges for the noninvasive evaluation of fetal cardiocirculatory dynamics at 11-14 weeks' gestation.

Doppler study of the embryonic heart in normal pregnant women

OBJECTIVE

To describe normal fetal cardiac and hemodynamic development in normal early first trimester pregnancies.

MATERIALS AND METHODS

Eighty-eight women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound, pulsed and color Doppler. Heart diameter, heart rate, and inflow and outflow waveforms with valve signals were documented. The proportion of the cardiac cycle of isovolumetric relaxation time (IRT%) and isovolumetric contraction time (ICT%) as well as Tei index were calculated.

RESULTS

Ninety-one percent of studies were successful. Heart diameter and the fetal heart rate showed a positive correlation with increasing gestational age: R = 0.80 (p < 0.000001), R = 0.76 (p < 0.000001), respectively. Mean heart diameter at 6 weeks was 1.28 +/- 0.26 mm and mean fetal heart rate was 117 +/- 6 bpm compared to 3.88 +/- 0.54 mm and 171 +/- 6 bpm at 10 weeks. The inflow waveform was monophasic (atrial contraction) in all cases from 6 to 9 weeks. Eight pregnancies (9%) miscarried between 6 and 12 weeks of gestation and the heart exams were characterized by increased IRT% compared with the survivors. In survivors, IRT% decreased between 7 and 8 weeks, from 32.9 +/- 10.7% to 20.8 +/- 5.7% (p < 0.0001). ICT% decreased from 18.6 +/- 4.4% of the cardiac cycle at 8 weeks to 12.6 +/- 4.4% at 9 weeks (p < 0.0008) (after heart development period).

CONCLUSIONS

Doppler examination of the fetal cardiac function is possible after 5 weeks of gestation. After 8 weeks of gestation, the fetal heart is morphologically mature but has not yet achieved effective myocardial compliance. The embryonic human heart is dependent on the atrial contraction for ventricular filling throughout the period of cardiac development. Non-survivors manifest myocardial dysfunction.

Microvessel density assessment in benign and malignant endometrial changes

Tumor angiogenesis is believed to be a prognostic indicator associated with tumor growth and metastasis. Microvessel density (MVD) assessment with common endothelial markers such as CD34 has been found to influence prognosis among endometrial carcinoma patients. The CD105/endoglin antibody has been reported to preferentially bind to proliferated endothelial cells in tissues participating in angiogenesis. The aim of this study was to evaluate the quantification of angiogenesis by assessing MVD in endometrial lesions when comparing the performance of anti-CD34 and anti-CD105 in women with benign and malignant endometrial changes. The study included 58 women (37 postmenopausal) with normal, hyperplastic and malignant endometrium in which preoperative transvaginal sonography was performed. Histological results of the removed endometrium were correlated with MVD assessed in "hot areas" where high densities of microvessels were detected within tumoral tissue. Endometrial cancer was confirmed in 37 women (3 premenopausal). Benign hyperplasia (14 cases), secretory or proliferative endometrium (5 cases) or endometrial atrophy (2 cases) was found in the remaining women. Malignant changes were mostly noted as FIGO stage I and II (28 cases) and had a low (1 or 2) histological grade (29 cases). Median MVD's assessed with CD105 and CD34 were 10.4 and 32.3, respectively. Median MVD assessed with CD34 was almost twice higher in women with endometrial cancer than in women with benign endometrium (CD34 MVD = 41.8 vs. 27.6, p=0.004). In cases of CD105 MVD significant differences between women with benign and malignant endometrial changes were also found (CD105 MVD = 11.8, vs. 6.4; p=0.00007). The menopausal status, but not the clinical stage or histological grading was significantly correlated with both CD34 MVD (p=0.02) and CD105 MVD (p=0.0003). A significant correlation was also found between CD34 and CD105 measured MVD (p=0.000001). In conclusion, transition from endometrial hyperplasia to endometrial cancer appears to be accompanied by microvessel density changes. MVD assessed with both CD34 and CD105 antibodies could be used as a potential prognostic factor in women with endometrial cancer. Our study showed that endoglin, by staining the proliferating microvessels could be more specific and sensitive marker for tumor neoangiogenesis than the more commonly used marker, CD34.

Epidemiology of peri/intraventricular haemorrhage in newborns at term

Peri/intraventricular hemorrhage (PIVH) has significant consequences, particularly leading to cases of adverse neurodevelopment. The aim of this study was to asses the epidemiology of peri/intraventricular haemorrhage in newborns born at term. Study was designed and performed according to epidemiological model of case-controlled studies. The study population was based on 2675 full-term neonates (the mean gestational age was 39.1 +/- 1.2 weeks) admitted to Department of Neonatology of Medical University of Silesia in Katowice (Poland) between the years 2003-2005. Periventricular/intraventricular hemorrhage was diagnosed in 392 neonates (14.65%). In this group of neonates 281 (71.68%) were diagnosed as IVH I degrees , 108 (27.55%) as PIVH II degrees , 2 (0.5%) as PIVH III degrees and in 1 neonate (0.25%) as IVH IV degrees . Further research was carried out on 392 neonates who were diagnosed with PIVH (together I degrees -IV degrees ) and 2283 healthy neonate. The study's inclusion criterion was term delivery (after 37(th) week of gestation). Mean gestational age of the group was 39.11 +/-1.26 weeks and ranged from 37 to 43 weeks. The mean gestational age of neonates with PIVH was 38.91 +/- 1.26 week and -38.14 +/- 1.23 week for those neonates without this pathology. Also, the various potential risk factors of PIVH were analyzed such as: gender, newborn's condition in the 5 minutes after birth (assessed by Apgar score), type of delivery (vaginal, cesarean section, vacuum extractor), umbilical collision, intrauterine infection, hypertension, mother's inflammation of urinary tract and infection of upper airways. We postulate that the etiology of PIVH in term neonates is multifactoral. The findings suggest that male gender, lower birth weight and the mode of delivery are associated with the development of PIVH in term neonates.

Doppler study of the peripheral flows in early gestation

The aim of this study was to determine the first trimester human peripheral arterial and venous blood flow between 5 - 10 weeks of gestation. Two hundred twenty four women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound. Ductus venosus, umbilical artery waveforms and pulsatility indexes (PI) were assessed as well as the waveform of the umbilical vein and the mean velocity (V(mean)) of the umbilical artery flow. The heart rate was also obtained and analyzed. The fetal heart rate showed a positive correlation with increasing gestational age R=0.76 (p<0.000001). Recordings from the umbilical artery, umbilical vein and ductus venosus were obtained starting from 7 weeks of gestation. The signal from the ductus venosus presented always as antegrade flow during atrial contractions. The pulsatility index (PI) of DV as well as PI of the umbilical artery remained unchanged during the study (statistically non-significant). The umbilical artery, using Doppler tracing was investigated and an absent diastolic flow was documented in every case. Umbilical artery V(mean) increased from 3.8 + 0.32 cm/s to 9.0 + 0.21 cm/s from 7 to 10 weeks of gestation (p< 0.005). Recordings from the umbilical vein showed the pulsation during atrial contractions. Ductus venosus blood velocity and waveform patterns did not change significantly during the study period. Pulsation in the umbilical vein is a typical Doppler finding at the embryonic time. Placental volume blood flow increased significantly with no change in the placental vascular impedance.

Postprandial response of ghrelin and PYY and indices of low-grade chronic inflammation in lean young women with polycystic ovary syndrome

The aim of the study were to answer the question 1.) Whether circulating pro-inflammatory markers of endothelial dysfunction and due to chronic low-grade inflammation of obesity, are altered in untreated lean, young relatively healthy polycystic ovary syndrome (PCOS) patients in comparison with healthy controls; 2.) Whether postprandial plasma concentration pattern of ghrelin and PYY can be predictable as risk factors for atherosclerosis and depend of obesity. Forty young women with PCOS were divided in two groups: 19 lean and 21 obese. The control group included 20 lean, healthy volunteers. Plasma total and active ghrelin, total PYY and PYY(3-36), serum adiponectin and insulin were measured using RIA technique, serum sCD40L, visfatin, sP-, sE-selectins, resistin by EIA. Composition of test meal was: 527 kcal total and consisted of 24.1% fat, 54.4% carbohydrate and 21.5% protein. Total and active ghrelin and total PYY were significantly lower in obese PCOS women, whereas active ghrelin was also significantly lower in lean PCOS women compared to controls. Postprandial plasma total ghrelin levels decrease were blunted in lean and obese compared to controls (12.8 % and 18.2% vs 28.2 %). Postprandial plasma active ghrelin decreased in lean and obese PCOS groups (49.9 % and 44.1 %) and controls (63.8 %). PCOS subjects exhibited smaller rises in postprandial levels of total PYY. Postprandial plasma PYY(3-36) levels increased in obese PCOS women (30.9 %) and controls (41%), whereas lean PCOS women exhibited blunted increase (11.5%). sCD40L levels increased, whereas adiponectin decreased in PCOS groups independently, whereas rise in visfatin, sE- and sP-selectin and the fall in adiponectin was associated with obesity. sP- and sE -selectins correlated positively with obesity. In summary, our study provides the first evidence that lean untreated young PCOS women contribute to the so called "pancreatic islet adaptation to insulin resistance" because of ghrelin and PYY profiles. We confirmed existing of low-grade chronic inflammation in early stage of visceral obesity in lean PCOS patients. The lost endogenous "islet adaptation to insulin resistance" may lead to endothelial dysfunction and promote acceleration of atherosclerosis.

Basal and postprandial gut peptides affecting food intake in lean and obese pregnant women

Maternal obesity has been reported as a risk factor for various maternal and fetal complications. The aim of the present study was to examine the patterns of basal and postprandial plasma concentrations of certain gut hormones affecting food intake such as acylated ghrelin, peptide YY(3-36) (PYY(3-36)), cholecystokinin (CCK), insulin and glucose in pregnant women with varying body mass gain during physiological pregnancy. The study included 34 women with singleton pregnancies in the 2(nd) trimester of gestation. The examined pregnant women were divided into 4 groups; I. control pregnancy (CP) with weight gain below 0.5 kg/week; II. overweight low weight gain <1 kg/week (OLWG), III. overweight high weight gain >1 kg/week (OHWG); morbidly obese pregnant with weight gain >1.5 kg/week (MOP). The basal acylated-ghrelin levels in MOP subjects were significantly higher than those in CP and no usual suppression of acylated ghrelin after the meal observed in CP as well as in OLWG and OHWG was found in MOP women. Basal PYY(3-36) plasma levels were similar in CP, OLWG and OHWG but in MOP was significantly reduced and no significant increase in hormone level, typically observed in CP, was detected after a meal in overweight or obese women studied. The fasting CCK and C-reactive protein (CRP) levels in MOP subjects were significantly higher than those in CP and other overweight women. In conclusion, we found that pregnant women with overweight and obesity exhibit significant changes in fasting and postprandial gut hormones affecting food intake such as acylated ghrelin, PYY(3-36) and CCK as well as in CRP and these changes might contribute, at least in part, the development of obesity in pregnancy.

[Nuchal cord and nuchal translucency measurements between 10th and 14th weeks of gestation]

Our objective was to determine the incidence of nuchal cord and it's possible influence on the nuchal translucency (NT) measurements between 10th and 14th week of gestation. One hundred fourteen singleton pregnancies were studied with transvaginal sonography. Nuchal translucency was measured according to the criteria published by Snijders et al. from the Fetal Medicine Foundation. Nuchal cord was detected with color Doppler flow mapping in 8 of 114 fetuses (7.01%). Mean cord thickness in these fetuses was 1.1 mm (range 0.5-1.4 mm). Mean nuchal translucency with and without umbilical cord were 1.67 mm (SD = 0.67; range: 0.5-3.6) and 1.59 mm (SD = 0.54; range: 0.5-3.0), respectively. The differences were statistically significant (p = 0.0146, Student's t-test for paired observations). We conclude that although relatively infrequent, nuchal cord might have influence on nuchal translucency measurements at the end of the Ist trimester.

[Sonographic evaluation of cervical length and cervical canal width in 24th week of twin pregnancy in prediction of preterm delivery]

OBJECTIVE

Sonographic evaluation of the cervical length and cervical canal width in 24th week of twin pregnancy in prediction of preterm delivery.

MATERIALS AND METHODS

43 primiparous patients with twin pregnancy. Group I (n = 16, 37.2%) with spontaneous delivery before 36 of gestation; group II (n = 27, 62.8%) delivering in term. Sonographic measurements of the cervical length and cervical canal width were done in 24th week of gestation.

RESULTS

Mean values of cervical length in group I were: 25.6 mm (+/- 3.7 mm); and in group II--32.5 mm (+/- 6.0 mm). Corresponding values of canal width were: 14.6 mm (+/- 11.8 mm) and 6.2 mm (+/- 3.0 mm).

CONCLUSIONS

We suggest, that cervical length is more valuable parameter in predicting risk of preterm delivery in twin pregnancy.

[Sonographic evaluation of the uterus on 3rd day after normal, vaginal delivery in women with benign fever]

OBJECTIVE

Sonographic evaluation of the uterus on 3rd day after normal, vaginal delivery in women with benign fever.

MATERIALS AND METHODS

112 primiparous patients after vaginal delivery on term, following uncomplicated pregnancy. Group I (n = 78, 69.6%) with body temperature below 37.5 degrees C, group II (n = 34, 30.4%) with temperature higher than 37.5 degrees C. In all patients following sonographic features were evaluated: uterus volume, uterine cavity volume and uterine cavity content.

RESULTS

No significant differences were observed.

CONCLUSIONS

We suggest, that uterus volume, uterine cavity volume and uterine cavity content is not often correlated with benign fever following vaginal delivery.

[The analysis of 135 water births]

DESIGN

The authors showed the results of the study of the influence of warm tub bath during delivery on 135 women.

MATERIALS AND METHODS

In a prospective study 135 women bathed in a warm tub bath during first and second stage of labor after a strictly normal pregnancy, ending with spontaneous delivery at term. A control group consisted of 135 women fulfilling the same criteria, but who did not take the bath during labor. The newborns weight, their condition, perineum injury, time of first and second stage of delivery and number of periteotomies was analyzed.

CONCLUSIONS

The observed features were undistinguishing.