Perinatal Changes in Fetal Ventricular Geometry, Myocardial Performance, and Cardiac Function in Normal Term Pregnancies

Patey, O.; Thilaganathan, B.; Carvalho, J. S.

doi:10.1016/j.echo.2017.01.011

Cited by 31 publications

(37 citation statements)

References 65 publications

(36 reference statements)

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“…Perinatal changes in LV/RV sphericity and LV/RV‐IVCT′ intervals in FGR have similar trends to those reported previously in normal fetuses and neonates. Additionally, our perinatal results revealed the presence of impaired LV relaxation (E/A and E′/A′ ratios < 1) in FGR neonates, with a significant increase in LV‐E/E′ ratio that is indicative of the persistence of LV diastolic dysfunction in the first hours after birth.…”

Section: Discussionsupporting

confidence: 87%

Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term

Patey

Carvalho

Thilaganathan

2019

Ultrasound in Obstet & Gyne

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Compared to normal pregnancy, FGR fetuses and neonates at term exhibit altered cardiac indices indicative of myocardial impairment that reflect adaptation to placental hypoxemia and alterations in hemodynamic load around the time of birth. Elucidating potential mechanisms that contribute to the alterations in perinatal cardiac adaptation in FGR could improve the management and evolve better therapeutic strategies to reduce the risk of adverse pregnancy outcome. This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 87%

Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term

Patey

Carvalho

Thilaganathan

2019

Ultrasound in Obstet & Gyne

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“…These geometric changes were associated with lower LV and RV longitudinal systolic deformation and higher apical radial deformation. These findings are similar to those that we observed previously in normal pregnancy 15 , suggesting that the decrease in global myocardial deformation and RV-MPI and increase in LV-CO are a consequence of the increase in LV loading and decrease in RV loading that occur at birth. However, LV-MPI was unchanged owing to persistently prolonged IVCT and IVRT .…”

Section: Perinatal Cardiac Changessupporting

confidence: 92%

Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Patey

Carvalho

Thilaganathan

2019

Ultrasound in Obstet & Gyne

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Objective To evaluate the effect of diabetes in pregnancy on fetal and neonatal cardiac geometry and function around the time of delivery. Methods This was a prospective study of 75 pregnant women delivering at term, comprising 54 normal pregnancies and 21 with a diagnosis of pregestational or gestational diabetes mellitus. Fetal and neonatal conventional and spectral tissue Doppler and two‐dimensional speckle‐tracking echocardiography were performed a few days before and within hours after delivery. Fetal and neonatal cardiac geometry, global myocardial deformation and performance, diastolic and systolic function and left ventricular (LV) torsion were compared between normal pregnancies and those with diabetes, and perinatal changes within the diabetes group were assessed. Results Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in fetal ventricular geometry, myocardial deformation and cardiac function (right ventricular (RV) sphericity index, 0.56 vs 0.65; LV torsion, 2.1 °/cm vs 5.6 °/cm; LV isovolumetric relaxation time, 101 ms vs 115 ms; and RV isovolumetric contraction time, 107 ms vs 119 ms; P < 0.001 for all). Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in neonatal cardiac parameters (mean RV sphericity index, 0.43 vs 0.55; mean LV torsion, 1.30 °/cm vs 2.78 °/cm; median LV myocardial performance index (MPI′), 0.39 vs 0.51; median RV‐MPI′, 0.34 vs 0.40; P < 0.01 for all). Paired comparison between fetal and neonatal cardiac indices in diabetic pregnancies demonstrated that delivery resulted in a significant improvement in some, but not all, cardiac indices (mean RV sphericity index, 0.65 vs 0.55; mean LV torsion, 5.60 °/cm vs 2.78 °/cm; median RV‐MPI′, 0.51 vs 0.40; P < 0.01 for all). Conclusions Compared with normal term fetuses and neonates, those of diabetic women exhibit cardiac indices indicative of myocardial impairment, reflecting a response to a relatively hyperglycemic intrauterine environment with alteration in fetal loading conditions (LV preload deprivation and increased RV afterload) and adaptation to subsequent acute changes in hemodynamic load at delivery. Elucidating mechanisms that contribute to the alterations in perinatal cardiac function in diabetic pregnancy could help in refining management and developing better therapeutic strategies to reduce the risk of adverse pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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“…The proposed pattern of decreasing RV FAC with GA seems plausible from a physiological perspective as it may reflect the reduced need of RV to deform to maintain stroke volume. First, the ventricles initiate a myocardial compaction process at 12 weeks of gestation that continues until the early neonatal stage [54]. Second, significant parallel changes occur at the level of the pulmonary circulation as pregnancy progresses.…”

Section: Discussionmentioning

confidence: 99%

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

et al. 2019

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Objectives: Fetal right ventricular (RV) function assessment is challenging due to the RV geometry and limitations of in utero assessment. Postnatally, 2D echocardiographic RV fractional area change (FAC) is used to assess RV global systolic function by calculating the percentage of change in RV area from systole to diastole. Reports on FAC are scarce in prenatal life, and nomograms throughout pregnancy are not available. Our aims were (1) to study prenatal RV FAC feasibility and reproducibility and (2) to construct nomograms for RV FAC and end-diastolic (ED) and end-systolic (ES) RV areas from 18 to 41 weeks of gestation. Methods: Prospective cohort study including 602 low-risk singleton pregnancies undergoing a fetal echocardiography from 18 to 41 weeks of gestation. RV ED and ES areas were measured following standard recommendations for ventricular dimensions and establishing strict landmarks to identify the different phases of the cardiac cycle. RV FAC was calculated as: ([ED area -ES area]/ED area) × 100. RV FAC intra-and inter-observer reproducibility was evaluated in 45 fetuses by calculating the intraclass correlation coefficient (ICC). Parametric regressions were tested to model each parameter against gestational age (GA) and estimated fetal weight (EFW). Results: RV areas and FAC were successfully obtained in ∼99% of fetuses with acceptable reproducibility throughout gestation (RV ED area inter-observer ICC [95% CI] 0.96 [0.93-0.98], RV ES area 0.97 [0.94-0.98], and FAC 0.69 [0.44-0.83]). Nomograms were constructed for RV ED and ES areas and FAC. RV areas showed a quadratic and logarithmic increase with GA and EFW, respectively. In contrast, RV FAC showed a slight quadratic decrease throughout gestation (mean RV FAC ranged from 36% at 18 weeks of gestation [10-90th centiles: 25-47%, respectively] to 29% at 41 weeks [10-90th centiles: 18-40%, Guirado et al. respectively]). The best models for RV areas and FAC were a second-degree polynomial. Conclusions: RV FAC is a feasible and reproducible parameter to assess RV global systolic function in fetal life. We provide reference ranges adjusted by GA and EFW that can be used as normal references for the assessment of RV function in prenatal conditions.

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Perinatal Changes in Fetal Ventricular Geometry, Myocardial Performance, and Cardiac Function in Normal Term Pregnancies

Cited by 31 publications

References 65 publications

Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term

Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term

Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

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