Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes

Garcia-Flores, Jose; Jáñez, Mercedes; González, Maria C. Bermúdez; Martínez, N. Arias; Espada, Mercedes; González, A.

doi:10.1016/j.ejogrb.2010.08.002

Cited by 54 publications

(56 citation statements)

References 16 publications

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“…Abnormal fetal left Mod-MPI in gestational diabetes compared with normal fetuses has also been reported [13,100]. However, other studies report no difference in fetal MPI between diabetic and control pregnancies [12,15,102]. …”

Section: Clinical Application Of Mpimentioning

confidence: 79%

“…Despite the recognition of fetal hypertrophic cardiomyopathy in fetuses with diabetic mothers, the effect of diabetes on global cardiac function is still in question [12,15]. Fetuses of pre-gestational and poorly controlled diabetic mothers demonstrate increased right and left ventricular MPI compared to non-diabetic controls as early as the first trimester [16,99,100] and also in late gestation [11,101,102].…”

Section: Clinical Application Of Mpimentioning

confidence: 99%

“…An increased IRT is generally accompanied by a reduced ET, with the ICT the most stable MPI parameter [4]. The MPI has been used to demonstrate fetal cardiac dysfunction in a number of pathologies including maternal diabetes [11,12,13,14,15,16], TTTS [7,17,18,19,20,21,22], congenital heart malformations [23,24,25,26,27,28], pre-eclampsia [29], IUGR [11,30,31,32,33,34], and other fetal conditions [35,36,37,38]. Several studies have proposed methods to improve the repeatability of fetal MPI by defining fixed machine settings [39] and using the clicks of the aortic and mitral valves as landmarks to delineate the constituent time intervals [9,40,41].…”

Section: Introductionmentioning

confidence: 99%

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The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

et al. 2015

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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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Section: Clinical Application Of Mpimentioning

confidence: 79%

Section: Clinical Application Of Mpimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

et al. 2015

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“…It measures global ventricular function that is independent of ventricular geometry. Most publications following the introduction of modified MPI (Mod-MPI) focused on the left MPI in both normal and pathological pregnancies [5,6,7,8,9,10]. The initial focus on left MPI may be due to the ability to acquire it in a single plane [3], thus allowing measurement of concordant isovolumetric time intervals and potentially improving measurement accuracy; however, the translational potential of the left Mod-MPI (LMPI) has been hampered by widely differing reports of the normal range [9,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Development of Normal Gestational Ranges for the Right Myocardial Performance Index in the Australian Population with Three Alternative Caliper Placements

Meriki

Henry²,

Sanderson³

et al. 2014

Fetal Diagn Ther

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Objectives: To construct gestational age-adjusted reference ranges for the right fetal modified myocardial performance index (RMPI) in an Australian population and to assess the influence of valve click caliper position on constituent time intervals and the RMPI. Methods: A prospective cross-sectional study of RMPI from 235 normal fetuses at 17-38 weeks of gestation was performed. Two Doppler waveforms were obtained: tricuspid and pulmonary valves for ‘a' and ‘b' readings, respectively. The ultrasound machine settings were: Doppler sweep velocity 15 cm/s, angle of insonation <15°, minimal gain, and wall motion filter 300 Hz. The ‘a' and ‘b' intervals were measured at three different caliper positions in each fetus: at the beginning of the original valve clicks (‘original'), at the beginning of the reflected tricuspid and pulmonary closure clicks (‘reflected') and at the peak of valve clicks (‘peak'). RMPI was calculated as (a - b)/b. The three readings were obtained and averaged per examination, with intraobserver repeatability assessed by intraclass correlation coefficient (ICC) and 95% CI. Results: For ‘original', ‘reflected' and ‘peak' RMPI, mean ± SD, ICC (95% CI) were: 0.53 ± 0.10, 0.86 (0.83-0.89); 0.48 ± 0.10, 0.84 (0.81-0.87) and 0.48 ± 0.10, 0.89 (0.87-0.91), respectively. The RMPI increased by approximately 15% as gestation increased and decreased slightly with increasing heart rate. Conclusion: This is the first publication of reference ranges for RMPI based on caliper position. All methods showed good ICC, including the ‘peak' method which we have previously proposed for routine use based on its repeatability and ease of identification when measuring the myocardial performance index.

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“…Results: Successful automation was performed on 63 cases (97%) showing repeatability ICCs of: 0.83 manual intraobserver; 0.77 manual interobserver; 1.00 automated. The degree of absolute agreement between manual and automated values was: inexperienced observer ICC 0.43 (95% CI 0.21-growth restriction [4][5][6], twin-twin transfusion syndrome (TTTS) [7][8][9], maternal diabetes [10][11][12], preeclampsia [13], and cholestasis [14].…”

Section: Objectivesmentioning

confidence: 99%

Automation of the Fetal Right Myocardial Performance Index to Optimise Repeatability

Leung¹,

Avnet²,

Henry³

et al. 2017

Fetal Diagn Ther

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Objectives: To compare the repeatability and degree of absolute agreement of an automated fetal right myocardial performance index (MPI) algorithm with manual measurements along with the impact of MPI observer experience on these two aspects. Methods: Prospective cross-sectional study of 65 uncomplicated singleton pregnancies from 22 to 39 weeks' gestation. Image analysis of double-waveform right MPI measurements was conducted first with a MATLAB automated MPI software and then independently by an experienced and an inexperienced observer. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI) were used to evaluate manual and automated intra- and interobserver repeatability. In addition, Bland-Altman plots were used to determine the degree of absolute agreement. Results: Successful automation was performed on 63 cases (97%) showing repeatability ICCs of: 0.83 manual intraobserver; 0.77 manual interobserver; 1.00 automated. The degree of absolute agreement between manual and automated values was: inexperienced observer ICC 0.43 (95% CI 0.21-0.62); experienced observer ICC 0.76 (95% CI 0.63-0.85). Conclusion: Automation of right MPI demonstrates a superior reproducibility over manual measurements and reduces the experience required for successful analysis. This may lend a greater clinical applicability to MPI, and future studies to develop an automated universal reference range would be useful.

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Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes

Cited by 54 publications

References 16 publications

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

Development of Normal Gestational Ranges for the Right Myocardial Performance Index in the Australian Population with Three Alternative Caliper Placements

Automation of the Fetal Right Myocardial Performance Index to Optimise Repeatability

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