Assessment of fetal heart rate variability and velocity variability by Doppler velocimetry of the descending aorta at 10–20 weeks of gestation

Ursem, Nicolette; Clark, Edward B.; Keller, Bradley B.; Hop, Wim C. J.; Wladimiroff, J. W.

doi:10.1046/j.1469-0705.1999.14060397.x

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…When assessing the relationship between aortic Doppler indices and fetal heartbeat (FHB), Aortic PS, PI, and TAMV displayed a significant negative correlation with FHB (p < 0.01, p < 0.01, p < 0.05), consistent with previous research [24,25]. Similarly, as ISI is inversely proportional to PSV, it exhibited an inverse relationship with NT and CRL (p < 0.05) but a direct positive correlation with FHB (p < 0.05) (Figure 4).…”

Section: Discussionsupporting

confidence: 90%

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging

Wu,

Chen,

et al. 2024

Bioengineering

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Objectives: This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. Methods: A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. Results: Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) − 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) − 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) − 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = −0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (−0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (−0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (−0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (−0.128, p = 0.045) and CRL (−0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). Conclusions: Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.

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Section: Discussionsupporting

confidence: 90%

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging

Wu,

Chen,

et al. 2024

Bioengineering

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“…Studies of the dorsal aorta of the normally developing chick embryo suggest a hemodynamic feedback mechanism to be responsible for the flow velocity variability in this vessel 23 . Similar flow velocity variability patterns have been established in the umbilical artery 4 and descending aorta 24 in normal human fetal development. Whether an altered hemodynamic feedback mechanism is responsible for the increase in peak and time-averaged flow velocity variabilites in the umbilical artery in the presence of congenital heart disease is not clear.…”

Section: Variability Analysis In Fetal Heart Defects Ursem Et Alsupporting

confidence: 72%

Fetal heart rate and umbilical artery velocity variability in fetuses with congenital cardiac defects: a preliminary study

Ursem

Clark

Pagotto

et al. 2001

Ultrasound in Obstet & Gyne

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Objective To examine whether variabilities in fetal heart rate and umbilical artery flow velocity are possible markers for hemodynamic dysfunction in fetuses with a congenital heart defect. Results Fetuses with a congenital heart defect displayed decreased umbilical artery peak systolic and time-averaged velocities. However, variability in peak systolic and timeaveraged velocities and fetal heart rate variability were increased compared with normal controls. Absolute fetal heart rates were similar between the two groups. MethodsConclusions Marked cardiovascular changes occur in the fetus with a congenital heart defect compared with the normal healthy fetus. We propose that variability in fetal heart rate and umbilical artery blood flow velocity could be additional markers for impaired homeostasis in the presence of fetal congenital heart disease.

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“…We observed an increase of SDNN (total variability, in these short recordings mainly parasympathetic activity) and RMSSD (vagal control) from 20 weeks GA, while fHRV parameters remained continuously low prior to 20 weeks GA. Morphological studies show that terminal innervation is present in the human fetal heart from 18 weeks GA and that vagal sensory afferent nerves invade the brainstem from 20 weeks GA. 39,40 We therefore hypothesize that the function of the cANS, presumably mostly parasympathetic modulation, establishes at approximately 20 weeks GA. This is supported by studies using PW Doppler in the descending aorta, where fHRV also remained unchanged until 20 weeks GA. 41 In contrast, studies administering autonomic neurotransmitters describe a fetal cardiac reaction from 15 to 17 weeks GA onwards, yet this does not prove the endogenous function of the cANS as the fetal heart rate of preinnervated embryos also reacts to administration of autonomic neurotransmitters. 42,43 With the assessment of fHRV, we study the genuine in vivo function of the cANS, which seems to establish from 20 weeks GA.…”

Section: Development Of Fhrv Parameters During Pregnancymentioning

confidence: 96%

Assessment of human fetal cardiac autonomic nervous system development using color tissue Doppler imaging

et al. 2021

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Assessment of fetal heart rate variability and velocity variability by Doppler velocimetry of the descending aorta at 10–20 weeks of gestation

Cited by 9 publications

References 17 publications

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging

Fetal heart rate and umbilical artery velocity variability in fetuses with congenital cardiac defects: a preliminary study

Assessment of human fetal cardiac autonomic nervous system development using color tissue Doppler imaging

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