Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome

Müller, Ana Lúcia Letti; Barrios, P. De M.; Kliemann, Lúcia Maria; Valério, Edimárlei Gonsales; Gasnier, Rose; Magalhães, José Antônio de Azevedo

doi:10.1002/uog.7584

Cited by 59 publications

(34 citation statements)

References 72 publications

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“…The effect of several other fetal pathologies on MPI have also been evaluated [35,36,37,38,104,105,106,107,108,109,110,111,112,113]. Romero et al [113] demonstrated abnormal cardiac function in fetuses with pre-term rupture of membranes and positive microbial cultures in the amniotic fluid.…”

Section: Clinical Application Of Mpimentioning

confidence: 99%

“…Romero et al [113] demonstrated abnormal cardiac function in fetuses with pre-term rupture of membranes and positive microbial cultures in the amniotic fluid. Additionally, increased MPI values have been shown in fetuses with signs of fetal inflammatory response syndrome [36]. …”

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: 99%

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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“…Preterm rupture of membranes, particularly in cases with intra-amniotic infection, is associated with changes in fetal cardiac function consistent with increased left ventricular compliance and systolic dysfunction measured as an increased E/A ratio [131,132], shorter ejection time [133], and ventricular strain [132]. …”

Section: Research and Clinical Applications Of Fetal Cardiac Functionmentioning

confidence: 99%

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

2012

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Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.

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“…Friedman et al [4] first used the same cardiac cycle by defining a different position of the Doppler sample volume, and then Hernandez-Andrade et al [5] in 2005 proposed a modified MPI (Mod-MPI) based on the use of mitral (MV) and aortic valve (AoV) clicks as landmarks for the measurement of time intervals. There has been subsequent growth in research into fetal MPI for application in normal and complicated pregnancies [6,7,8,9,10,11]. Although individual units have demonstrated reproducibility in fetuses [5,12], published normal ranges have been widely variable, causing concern as to the validity of this new technique.…”

Section: Introductionmentioning

confidence: 99%

Development of Australian Reference Ranges for the Left Fetal Modified Myocardial Performance Index and the Influence of Caliper Location on Time Interval Measurement

Meriki

Welsh

2012

Fetal Diagn Ther

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Objectives: To construct gestational age-adjusted reference ranges of the left fetal modified myocardial performance index (Mod-MPI) in the Australian population and assess the influence of valve click caliper position on constituent time intervals and the Mod-MPI. Methods: This is a prospective longitudinal study of 117 normal singleton fetuses undergoing 318 ultrasound scans at 4–6 weekly intervals between 18 and 38 weeks of gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were measured at 3 different caliper positions in each fetus: beginning of the original valve clicks (‘original’), beginning of the reflected valve clicks (‘reflected’), and peak of valve clicks (‘peak’). The Mod-MPI was calculated as (ICT + IRT)/ET. Results: The Mod-MPI increased throughout gestation with means ± SD of 0.42 ± 0.05 ‘reflected’ and ‘peak’ versus 0.49 ± 0.03 ‘original’ at 19 weeks, and means of 0.46 ± 0.05 ‘reflected and peak’ versus 0.51 ± 0.08 ‘original’ at 36 weeks. Throughout gestation, ICT remained fairly constant and IRT increased, while ET decreased with ‘original’ click and remained constant for ‘reflected’ and ‘peak’ clicks. A modest increase in Mod-MPI was seen with increasing fetal heart rate. Analysis of repeatability for the 3 methods showed the following ICCs: ‘original’, 0.797 (95% CI 0.762–0.829); ‘reflected’, 0.809 (95% CI 0.775–0.839), and ‘peak’, 0.799 (95% CI 0.764–0.831). Conclusions: Detailed exploration of the morphology of mitral and aortic valve closure and opening clicks shows how selection of different phases of these clicks may significantly influence the Mod-MPI. We recommend that the peak of the valve clicks be standardized between research groups.

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Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome

Abstract: Objectives To examine, in patients with premature rupture of the amniotic membranes (PROM) at < 34 weeks of gestation, the relationship between fetal myocardial performance measured by the Tei index and fetal inflammatory response syndrome (FIRS). Methods

Cited by 59 publications

References 72 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

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

Development of Australian Reference Ranges for the Left Fetal Modified Myocardial Performance Index and the Influence of Caliper Location on Time Interval Measurement

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