Assessment of Left Ventricular Pre-Ejection Period in the Fetus Using Simultaneous Magnetocardiography and Echocardiography

Mensah-Brown, Nana Aba; Wakai, Ronald T.; Cheulkar, Bageshree; Srinivasan, Shardha; Strasburger, Janette F.

doi:10.1159/000318345

Cited by 22 publications

(15 citation statements)

References 31 publications

(26 reference statements)

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“…339 The fMCG captures the P wave, PR interval, QRS interval, ST-T waves, QT interval, and RR interval in most fetuses of >24 weeks' gestation and QRS and RR intervals in fetuses of >17 weeks' gestation. [340][341][342][343] With the use of fMCG, normative data for cardiac intervals, including gender-based intervals and those in multiple pregnancies, have been establis hed.…”

Section: Fetal Magnetocardiographymentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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983

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Fetal Magnetocardiographymentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

983

543

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“…Although there was no significant difference between the eRR and mRR values, ePR and mPR were measured on different heartbeats, and it is possible that these intervals fluctuated beat by beat. Mensah-Brown et al [23] succeeded in simultaneous recording of fMCG and fUCG to calculate the fetal ventricular preejection time. However, this method is not easy to apply for determination of the atrial preejection time.…”

Section: Discussionmentioning

confidence: 99%

Comparison of PR Intervals Determined by Fetal Magnetocardiography and Pulsed Doppler Echocardiography

et al. 2012

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Objective: In clinical practice, measurement of mechanical PR interval (mPR) with pulsed Doppler echocardiography is a standard method used to estimate the atrioventricular conduction time in the fetus. However, fetal echocardiography does not directly reflect the electrical properties of the heart. Technological advances in fetal magnetocardiography (fMCG) have allowed recording of the electrical PR interval (ePR) with high time resolution. The aim of this study was to clarify the differences between ePR and mPR. Methods: The study subjects were 295 normal human fetuses (gestational age, range 20.4–41.4 weeks) who underwent fMCG, and 135 of them underwent fetal echocardiography 15–90 min before or after fMCG. The ePR was measured using the fMCG, and the mPR was determined by two pulsed Doppler methods, simultaneous recording of the left ventricular inward and outward flow (LV in/out) (n = 135) and superior vena cava and ascending aorta (SVC/aAo) (n = 84). Results: The ePR showed a significant, but weak, positive correlation with gestational age (r = 0.162, p = 0.0053). The mPR was significantly longer than the ePR (p < 0.0001), with mean differences of 14.6% (95% limits of agreement –10.7, 39.9) for the LV in/out method and 14.7% (95% limits of agreement –8.6, 38.0) for the SVC/aAo method. Conclusion: Our results point to the risk of overestimation of the atrioventricular conduction time when the mPR is used, and the need for careful interpretation of PR prolongation determined by mPR.

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“…4–7 Like fetal electrocardiography, fMCG directly records rhythm but it also exhibits a much higher signal-to-noise ratio, allowing fetuses as early as 20 weeks’ gestation to be evaluated with a high success rate. While a number of studies of fetal AVB have been published recently 8,9 there is a paucity of studies of fetal BAB.…”

Section: Introductionmentioning

confidence: 99%

Magnetophysiologic and echocardiographic comparison of blocked atrial bigeminy and 2:1 atrioventricular block in the fetus

et al. 2013

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BACKGROUND Blocked atrial bigeminy (BAB) and second-degree atrioventricular block with 2:1 conduction block (2:1 AVB) both present as ventricular bradycardia and can be difficult to distinguish by echocardiography. Since the prognosis and clinical management of these rhythms are different, an accurate diagnosis is essential. OBJECTIVE To identify magnetic and mechanical heart rate and rhythm parameters that could reliably distinguish BAB from 2:1 AVB. METHODS A retrospective fetal magnetocardiography (fMCG) and pulsed Doppler ultrasound study of 10 subjects with BAB and 7 subjects with 2:1 AVB was performed in order to identify parameters that could reliably distinguish BAB from 2:1 AVB. RESULTS Distinguishing BAB from 2:1 AVB by using fMCG was relatively straightforward because in BAB the ectopic P wave (P′) occurred early, resulting in a bigeminal (short-long) atrial rhythm. The normalized coupling interval of the ectopic beat (PP′ of the blocked beat to PP of the conducted beat) was 0.29 ± 0.03. In contrast, the echocardiographic assessment of inflow-outflow gave a normalized mechanical coupling interval (AA′/AA) near 0.5, which made it difficult to distinguish BAB from 2:1 AVB. Heart rate distinguished most subjects with BAB from those with 2:1 AVB (82 ± 5.7 beats/min vs 69 ± 4.2 beats/min), but was not a completely reliable indicator. In most subjects, BAB alternated with sinus rhythm or other rhythms, resulting in complex heart rate and rhythm patterns. CONCLUSIONS Fetal BAB and 2:1 AV block can be difficult to distinguish using echocardiography because in many fetuses with BAB the mechanical rhythm does not accurately reflect the magnetic rhythm. fMCG provides a more reliable means of making a differential diagnosis.

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Assessment of Left Ventricular Pre-Ejection Period in the Fetus Using Simultaneous Magnetocardiography and Echocardiography

Cited by 22 publications

References 31 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Comparison of PR Intervals Determined by Fetal Magnetocardiography and Pulsed Doppler Echocardiography

Magnetophysiologic and echocardiographic comparison of blocked atrial bigeminy and 2:1 atrioventricular block in the fetus

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