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Fetal Myocardial Performance Index

Rashmi Pilania, Pooja Sikka, Manoj K Rohit, Vanita Suri, Praveen Kumar
INTRODUCTION: Maternal diabetes mellitus is associated with an increased risk of fetal and neonatal morbidity and mortality. Usual screening tests have not proved to be good prognostic indicators of fetal distress. Fetal cardiodynamics is potentially a useful screening tool. AIM: To determine if cardiodynamics of the fetus differ in pregnancy with diabetes requiring insulin than those without and to determine whether cardiodynamics predict fetal and neonatal outcomes...
July 2016: Journal of Clinical and Diagnostic Research: JCDR
J Degenhardt, C Enzensberger, A Tenzer, A Kawecki, T Kohl, E Widriani, R Axt-Fliedner
: Purpose: To evaluate pre- and postprocedural myocardial function in fetuses with moderate to severe congenital diaphragmatic hernia (CDH) who underwent FETO to improve survival and to reduce morbidity and to compare these data with fetuses and CDH not undergoing FETO and normal controls. Materials and Methods: 8 fetuses with isolated left-sided CDH were included and underwent FETO at our center between 2012 and 2013. Prior to and after the operation, myocardial function was assessed by measuring the mitral annular plane systolic excursion (MAPSE), the tricuspid annular plane systolic excursion (TAPSE), Tei index, isovolumetric contraction time (ICT), ejection time (ET), isovolumetric relaxation time (IRT) for the left ventricle in PW Doppler ultrasound as well as ICT, ET, IRT and Tei index in pulsed wave tissue Doppler imaging (PW-TDI) for the left and right ventricle...
September 14, 2016: Ultraschall in der Medizin
Jiao Chen, Liang Xie, Li Dai, Li Yu, Lijun Liu, Yongbi Zhou, Guiying Wu, Fengfei Qin, Hanmin Liu
The objective of this study was to detect the effect of a large ventricular septal defect (VSD) on right ventricular function before and after birth. All consecutive children with large VSD who were born in our hospital between January 2013-February 2016 and followed up throughout early infancy, and who lacked malformations or chromosomal abnormalities, were identified by a retrospective review of the medical records and included in this retrospective longitudinal case-control study (n = 30). Thirty normal control cases with an equivalent gestational age and gender served as controls...
August 25, 2016: Pediatric Cardiology
Amar Bhide, Olli Vuolteenaho, Mervi Haapsamo, Tiina Erkinaro, Juha Rasanen, Ganesh Acharya
Myocardial performance index (MPI) is increased in growth-restricted fetuses with placental insufficiency, but it is unknown if this is due to fetal hypoxemia or increased placental vascular resistance (Rplac). We used chronically instrumented sheep fetuses (n = 24). In 12 fetuses, placental embolization was performed 24 h before experiments. On the day of the experiment, left (LV) and right (RV) ventricular MPIs were obtained by pulsed Doppler at baseline and in the hypoxemia and recovery phases. At baseline, Rplac was greater and fetal pO2 lower in the placental embolization group, but RV and LV MPIs were comparable to those of the control group...
November 2016: Ultrasound in Medicine & Biology
Warwick B Dunn, J William Allwood, Tim Van Mieghem, R Katie Morris, Fiona L Mackie, Caroline E Fox, Mark D Kilby
INTRODUCTION: Twin-twin transfusion syndrome (TTTS) complicates 15% of monochorionic twin pregnancies, often being associated with recipient cardiac dysfunction. Untreated, it has a fetal mortality rate of at least 90%; although treatment by fetoscopic laser coagulation significantly improves prognosis. Measurement of recipient amniotic fluid metabolites, such as cardiac Troponin T and atrial natriuretic polypeptide, correlate with cardiac function in this fetus. The aim of this study is to describe the amniotic fluid metabolomic profile in TTTS, relate this to fetal recipient cardiac function and assess the metabolomic changes induced by fetoscopic laser coagulation...
August 2016: Placenta
Kasemsri Srisupundit, Fuanglada Tongprasert, Suchaya Luewan, Kuntharee Traisrisilp, Phudit Jatavan, Theera Tongsong
OBJECTIVE: To compare fetal Tei index before, immediately after and 30 min after cordocentesis for prenatal diagnosis. PATIENTS AND METHODS: Pregnant women undergoing prenatal diagnostic cordocentesis in the early mid-trimester underwent measurement of the fetal Tei index of both right and left ventricles just before cordocentesis, immediately after and at 30 min after the procedure. RESULTS: A total of 143 singleton women underwent cordocentesis at a median gestational age of 19 weeks (range 16-23)...
September 2016: Prenatal Diagnosis
P Maheshwari, J Alphonse, A Henry, J Wang, S J Redmond, A Welsh
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 MPI and fetal heart rate (FHR) correlate. METHODS: Prospective cross-sectional study of women at 20-38 weeks gestation with uncomplicated, morphologically normal singleton pregnancies. Multiple cineloops for left MPI measurement were acquired during a single examination in each fetus. Raw cineloop data was analysed by our automated MPI system (ICC of 1...
July 8, 2016: Ultrasound in Obstetrics & Gynecology
Anupama Nair, Sitaraman Radhakrishnan
OBJECTIVE: The aim of this study was to determine normal values for fetal left ventricular (LV)-myocardial performance index (MPI) in Indian population and to assess its relation to advancing gestation and fetal heart rate (FHR). MATERIALS AND METHODS: Two hundred pregnant women without any pregnancy-related complications and whose fetuses were shown to have structurally normal hearts were enrolled in this study. Doppler waveform involving simultaneous display of mitral inflow and LV outflow was obtained in all...
May 2016: Annals of Pediatric Cardiology
Cem Yasar Sanhal, Ozgur Kara, Aykan Yucel
OBJECTIVE: To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). METHODS: Forty-one ICP cases were compared with 41 gestational age matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods (ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)), which were employed in the calculation of mod-MPI (mod-MPI = (ICT+IRT)/ET)...
May 17, 2016: Journal of Maternal-fetal & Neonatal Medicine
Fatma Nihan Turhan Çağlar, Cem Ozde, Evrim Bostancı, İlker Murat Çağlar, Serkan Çiftçi, İsmail Unğan, Bülent Demir, Osman Karakaya
BACKGROUND: Preeclampsia (PE) is a multisystemic disorder characterized by hypertension and proteinuria that is specific to pregnancy and associated with maternal and fetal morbidity-mortality. AIM: To assess right heart structure and function in PE by echocardiography using conventional and tissue Doppler techniques. METHODS: In total, 67 women with untreated PE and 46 matched healthy pregnant women were included. PE was defined according to the ACOG (2002) criteria...
April 2016: Pregnancy Hypertension
Matthew M Finneran, Ryan Pickens, Megan Templin, Courtney D Stephenson
OBJECTIVE: To validate the efficacy of laser therapy for TTTS in the treatment of recipient twin cardiomyopathy and investigate if severity of preoperative cardiomyopathy can predict fetal survival postoperatively. STUDY DESIGN: Retrospective study of MCDA pregnancies complicated by TTTS treated by selective fetoscopic laser photocoagulation (SFLP) performed between March 2010 and October 2014 at a single center. The recipient right ventricular (RV) and left ventricular (LV) MPI were measured both pre and postoperatively...
May 6, 2016: Journal of Maternal-fetal & Neonatal Medicine
Arne Willruth, Johannes Steinhard, Christian Enzensberger, Roland Axt-Fliedner, Ulrich Gembruch, Astrid Doelle, Willem Gorissen, Rolf Fimmers, Franz Bahlmann
PURPOSE: To construct biventricular reference ranges for isovolumic time intervals (isovolumic contraction time, ICT; isovolumic relaxation time, IRT) and ejection time (ET) for colour tissue Doppler imaging (cTDI) between 15 and 37 weeks' in healthy fetuses. METHODS: This was a prospective multicentre cross-sectional study involving 160 singleton pregnancies between 15 and 37 weeks of gestation, using cTDI. ICT, ET, IRT and myocardial performance index (MPI) were analysed offline using a small region of interest (ROI) within the basal part of the right and left ventricular wall immediately distal to the annulus...
March 25, 2016: Archives of Gynecology and Obstetrics
Viola Seravalli, Jena L Miller, Dana Block-Abraham, Ahmet A Baschat
The ductus venosus has a central role in the distribution of highly oxygenated umbilical venous blood to the heart. Its waveform is related to the pressure-volume changes in the cardiac atria and it is therefore important in the monitoring of any fetal condition that may affect forward cardiac function. The cardiovascular parameters that can influence forward cardiac function include afterload, myocardial performance and preload. Decreased forward flow during atrial systole (a-wave) is the most sensitive and ubiquitous finding when any of these parameters is affected...
June 2016: Acta Obstetricia et Gynecologica Scandinavica
Mi-Young Lee, Hye-Sung Won, Ji Eun Park, Jae-Yoon Shim, Pil-Ryang Lee, Ahm Kim, Jung Bok Lee
OBJECTIVES: To establish normal reference ranges for the fetal left modified myocardial performance index (Mod-MPI) measured by the Auto Mod-MPI system and evaluate Mod-MPI changes in recipients of twin-to-twin transfusion syndrome (TTTS) before and after fetoscopic laser coagulation. METHODS: This was a prospective longitudinal study of normal singleton fetuses from 12.0 to 40.0 weeks of gestation. TTTS cases treated by laser coagulation were reviewed for Mod-MPI measurements of recipients...
May 2016: Prenatal Diagnosis
Shiraz Arif Maskatia, Ricardo H Pignatelli, Nancy A Ayres, Carolyn A Altman, Haleh Sangi-Haghpeykar, Wesley Lee
BACKGROUND: Normative data for fetal myocardial deformation values have not been comprehensively described in a longitudinal cohort. The effect of gestational age on these values and on interobserver variability require further investigation. METHODS: Sixty gravid women were prospectively enrolled before 20 weeks' gestation. The following measures were obtained by two blinded observers at five time points across gestation and also at 4 to 8 weeks' postnatal age: global circumferential strain and strain rate, global longitudinal left ventricular strain and strain rate, global longitudinal right ventricular strain and strain rate, and left and right ventricular myocardial performance indices...
April 2016: Journal of the American Society of Echocardiography
Jingjing Wang, Amanda Henry, Alec W Welsh, Stephen J Redmond
The Modified Myocardial Performance Index (Mod-MPI) has sparked great interest as a parameter for fetal cardiac function assessment. However, measurement of this index requires expertise and its clinical application might be limited, owing to its poor repeatability. Research groups have been investigating left Mod-MPI (that is, Mod-MPI from left ventricle valve events), and an automated algorithm has been developed for left Mod-MPI calculation in our previous study. Right MPI is also important as it becomes abnormal earlier than left MPI in some pathologies; however, for use across the gestational age spectrum, it requires two-image acquisition...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
A W Welsh, P Maheshwari, J Wang, A Henry, D Chang, F Crispi, H M Gardiner, E Hernandez-Andrade, N Meriki, S Redmond, S Yagel
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...
October 2016: Ultrasound in Obstetrics & Gynecology
L H Pedersen, R Mogra, J Hyett
OBJECTIVE: To determine the acute effects of corticosteroids on the cardiovascular system in growth-restricted fetuses. METHODS: This was a prospective cohort study conducted at a tertiary hospital between January 2011 and October 2013. Fetal cardiovascular function in fetuses with intrauterine growth restriction (IUGR) was assessed immediately before and 24 h after the first dose of betamethasone, administered in routine management of IUGR. Fetal arterial and venous Dopplers were assessed...
August 2016: Ultrasound in Obstetrics & Gynecology
Priya Maheshwari, Amanda Henry, Alec W Welsh
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...
2015: BioMed Research International
Yen K Bui, Lisa W Howley, Steven E Ambrose, Henry L Galan, Timothy M Crombleholme, Julia Drose, John Bokowski, Bettina F Cuneo
OBJECTIVES: "Heart sparing" refers to prominent antegrade fetal coronary artery (CA) blood flow readily visualized by color Doppler and is a harbinger of poor outcome in growth restricted fetus, but little is known of the features and presentation of heart sparing in normally grown fetuses. Our objective was to describe heart sparing effects in normally grown fetuses, and compare the presentation and outcome of heart sparing between fetuses with growth restriction and those who were normally grown...
2016: Journal of Maternal-fetal & Neonatal Medicine
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