Fetal cardiac function assessed by Doppler myocardial performance index (Tei Index)

Friedman, Daniel; Buyon, Jill P.; Kim, M.; Glickstein, Julie S.

doi:10.1002/uog.11

Cited by 191 publications

(193 citation statements)

References 17 publications

(38 reference statements)

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“…In addition, our results for the MPI, although slightly higher, fall within the SDs of those from another study in the literature from early pregnancy, which found MPIs of 0.378 ± 0.110 and 0.352 ± 0.115 in the left and right ventricles, respectively. 11 Friedman et al 7 suggested that global left ventricular function could be evaluated from a single Doppler waveform incorporating inflow and outflow simultaneously. We found that this was also possible in the right ventricle because of the proximity of the inflow and outflow tracts at this early gestation.…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Fetal Cardiac Function

Russell

McAuliffe

2008

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to establish normal values for fetal heart function in the first trimester. Methods. This was a prospective observational study with institutional ethics approval and written maternal consent. Thirty-two healthy pregnant women were recruited, and transabdominal fetal echocardiography was performed between 12 and 14 completed weeks' gestation. Myocardial function was assessed with the myocardial performance index to assess combined systolic and diastolic function, isovolumetric contraction time to assess systolic function, and isovolumetric relaxation time to assess diastolic function. Mitral and tricuspid inflows were also assessed by determining the ratio between passive and active ventricular filling. The ventricular outflows were also assessed by peak systolic velocities (PSVs) and time velocity integrals (TVIs). Results. The mean gestational age at the time of echocardiography was 13 weeks, and the mean crown-rump length was 79 mm. All fetuses had a normal nuchal translucency measurement (mean, 1.5 mm). The myocardial performance index was the same in the left and right sides of the heart, 0.5. The mean isovolumetric relaxation time and isovolumetric contraction time on the left side of the heart were 41 and 36 milliseconds, respectively. The mean passive/active ventricular filling ratio was 0.6 at both the mitral and tricuspid valves. The mean aortic PSV was 26 cm/s, and mean pulmonary artery PSV was 32 cm/s. The mean aortic outflow TVI was 3.6 cm, and the mean pulmonary outflow TVI was 4.1 cm. Conclusions. This study establishes normal values for cardiac function at 12 to 14 weeks' gestation. These values may assist in assessment of fetal health in early pregnancy. Key words: cardiac function; echocardiography; fetus; first trimester; myocardial performance index. dvances in ultrasound technology have led to improved visualization of the fetus in the first trimester. This has led to increased interest in examining the fetus for abnormalities, with early fetal echocardiography now offered in many units. A recent article on early fetal echocardiography in firsttrimester fetuses found that a satisfactory cardiac examination was possible in 95% of cases, with sensitivity of 70% and specificity of 98% for detection of cardiac defects. 1 Assessment of cardiac function with Doppler examination of the atrioventricular (AV) valves has been performed in early pregnancy. Those studies found that the proportion of the cardiac cycle occupied by both the isovolumetric relaxation time (IVRT) and isovolumetric contraction time (ICT) reduces during the first trimester. [2][3][4] The myocardial performance index (MPI) is a useful noninvasive Doppler-derived method of evaluating combined systolic and diastolic function, first described in

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Section: Discussionmentioning

confidence: 99%

First-Trimester Fetal Cardiac Function

Russell

McAuliffe

2008

Journal of Ultrasound in Medicine

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“…This index is an estimate of global left ventricular function in normal sinus rhythm, as previously described. 31 Previously reported normal values were used for comparison. Specifically, in 56 normal pregnancies, 2 SD above the upper limit of normal for the PR interval (pulsed Doppler echocardiographic assessment of the fetus, validated at birth by simultaneous ECG of the neonate) was 140 ms; 3 SD above the upper limit of normal (Ͼ99% CI) was 150 ms. 30 The method, which is independent of heart rate and gestational age, was subsequently validated by site investigators.…”

Section: Enrollment and Follow-up Visitsmentioning

confidence: 99%

“…31 The presence or absence of tricuspid valve regurgitation was noted and graded as mild if the regurgitant jet filled Ͻ25% of the right atrial area or moderate to severe if it exceeded this value. 23 ECG measurements obtained at birth and 1 year were descriptively compared with normal values for ECGs, 34 including heart rate, PR interval, QRS duration, and QT and QTc intervals.…”

Section: Enrollment and Follow-up Visitsmentioning

confidence: 99%

Utility of Cardiac Monitoring in Fetuses at Risk for Congenital Heart Block

et al. 2008

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Background-Anti-SSA/Ro-associated third-degree congenital heart block is irreversible, prompting a search for early markers and effective therapy. Methods and Results-One hundred twenty-seven pregnant women with anti-SSA/Ro antibodies were enrolled; 95 completed an evaluable course in 98 pregnancies. The protocol included fetal echocardiograms performed weekly from 16 to 26 weeks' gestation and biweekly from 26 to 34 weeks. PR intervals Ͼ150 ms were considered prolonged, consistent with first-degree block. Ninety-two fetuses had normal PR intervals. Neonatal lupus developed in 10 cases; 4 were neonatal lupus rash only. Three fetuses had third-degree block; none had a preceding abnormal PR interval, although in 2 fetuses Ͼ1 week elapsed between echocardiographic evaluations. Tricuspid regurgitation preceded third-degree block in 1 fetus, and an atrial echodensity preceded block in a second. Two fetuses had PR intervals Ͼ150 ms. Both were detected at or before 22 weeks, and each reversed within 1 week with 4 mg dexamethasone. The ECG of 1 additional newborn revealed a prolonged PR interval persistent at 3 years despite normal intervals throughout gestation. No first-degree block developed after a normal ECG at birth. Heart block occurred in 3 of 16 pregnancies (19%) in mothers with a previous child with congenital heart block and in 3 of 74 pregnancies (4%) in mothers without a previous child with congenital heart block or rash (Pϭ0.067). Conclusions-Prolongation of the PR interval was uncommon and did not precede more advanced block. There was a trend toward more congenital heart block in fetuses of women with previously affected offspring than those without previously affected offspring. Advanced block and cardiomyopathy can occur within 1 week of a normal echocardiogram without initial first-degree block. Echodensities and moderate/severe tricuspid regurgitation merit attention as early signs of injury. (Circulation. 2008;117:485-493.)

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“…The methodology for the measurement of MPI has been developed over time by researchers studying various foetal pathologies. For example, Freidman et al [7] proposed that LVMPI should be calculated from a single recording of the Doppler wave, representing both the outflow and inflow to the LV. This would allow simultaneous calculation of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) [7].…”

Section: Introductionmentioning

confidence: 99%

“…For example, Freidman et al [7] proposed that LVMPI should be calculated from a single recording of the Doppler wave, representing both the outflow and inflow to the LV. This would allow simultaneous calculation of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) [7]. To improve accuracy of the MPI measurement, Raboisson et al [8], and later Hernandez-Andrade et al [9], developed the MPI modification (Mod-MPI), in which the opening and closing movements of the aortic valve (AV) and mitral valve (MV), or clicks, were used as the reference points for the measurement of ICT and IRT.…”

Section: Introductionmentioning

confidence: 99%

Myocardial performance index (Tei index) in term and preterm neonates during the neonatal period

et al. 2016

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A b s t r a c t Background:The myocardial performance index (MPI) is a noninvasive method to measure global systolic and diastolic myocardial function. In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation. Aim:To assess MPI (or Tei indices) of both ventricles in term and preterm newborns, and to observe MPI trends throughout the neonatal period. Methods:Heart ultrasound imaging was performed on the first day of life (DOL), after patent ductus arteriosus (PDA) closure, and on the 28 th DOL, in 29 term and 29 preterm newborns. RVMPI and LVMPI were measured within the preterm group at 40 weeks of post-conception age (PCA).Results: A statistically significant reduction in RVMPI was observed in both term and preterm newborns. In term newborns, the RVMPI value on the first DOL was 0.42 ± 14, dropping to 0.29 ± 0.09 after PDA closure, and finally reaching 0.22 ± 0.09 on the 28 th DOL. The respective RVMPI values for the preterm newborns were 0.44 ± 0.15, 0.30 ± 0.12, and 0.21 ± 0.08. Little variability in the mean values of LVMPI was observed in both groups throughout the neonatal period. The LVMPI for term neonates in successive measurements was 0.37 ± 0.10, 0.39 ± 0.07, and 0.37 ± 0.11, respectively, and for the preterm neonates it was 0.37 ± 0.10, 0.35 ± 0.09, and 0.36 ± 0.10, respectively. The MPI values from preterm newborns taken at 40 weeks PCA (RVMPI = 0.28 ± 0.09; LVMPI = 0.37 ± 0.05) were comparable to those measured in term newborns after PDA closure. Conclusions:Observed postnatal changes in RVMPI correspond to changes in ventricular function, reflecting the haemodynamic changes of the transitional circulation. The relatively small postnatal changes in LVMPI in term and preterm newborns may reflect an immature myocardium. The RVMPI and LVMPI values at 40 weeks PCA in preterm newborns correlate best with MPI values in term newborns just after PDA closure.

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Fetal cardiac function assessed by Doppler myocardial performance index (Tei Index)

Abstract: Objectives The Tei Index (TI) is a useful, non-invasive

Cited by 191 publications

References 17 publications

First-Trimester Fetal Cardiac Function

First-Trimester Fetal Cardiac Function

Utility of Cardiac Monitoring in Fetuses at Risk for Congenital Heart Block

Myocardial performance index (Tei index) in term and preterm neonates during the neonatal period

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