P06.05: Correlation between the Delta‐myocardial performance index and aortic isthmus systolic index as markers of unilateral cardiac strain

Abstract

Objectives: Prediction of pregnancy complication occurrence using fetal cardiac output assessments made by ultrasonography at 20 to 24 weeks of gestation. Methods: We enrolled 65 mothers who visited us for fetal-targeted ultrasonography during gestational weeks 20 to 24. All gave birth at our hospital. Multiple pregnancies, cases with fetal anomaly or abnormal EFW (SGA or LGA) at the point of examination were excluded. Diameters (d) of the LV and RV outflow tract were measured just above the valves during systole. And systolic time-velocity integrals (TVI) were calculated. The left CO (LCO) and the right CO (RCO) were derived using the following equation: CO = TVI × π × d 2 /4 × HR. Pregnancy complications included gestational hypertensive disorders, FGR and PTB caused from PTL or PPROM. Results: The mean GA at assessment was 22 weeks and the GA at delivery was 37 weeks. There were 23 cases with one more pregnancy complication (FGR: 9, gestational hypertensive disorders: 8, PTB caused from PTB or PPROM: 12). LCO was lower in complication group than in normal group (117 vs. 88, p = 0.03). The RCO/LCO ratio is higher in complication group (1.42 vs. 2.43, p = 0.00). Regression analysis demonstrated that RCO/LCO was a significant predictor of pregnancy complication; Odds ratio was 7.8. The area under the ROC curve for prediction of pregnancy complications from LCO was 0.71 (p = 0.01). The diagnostic cut-off value of LCO was 80 ml/min. The area under the ROC curve from RCO/LCO was 0.68 (p = 0.02) and cut-off value was 1.41. Conclusions: This study demonstrated for the first time that pregnancy complications such as FGR, preeclampsia and PTB resulting from PTL or PPROM can be predicted based on fetal CO assessments made by ultrasonography at a GA of 20-24 weeks. The onset of pregnancy complication must be observed if fetal LCO is below 80 ml/min or RCO/LCO is over 1.41 at GA 20-24 weeks. There is the possibility that fetal hemodynamic changes have already begun before the occurrence of PTL or PPROM. P06.04Longitudinal myocardial function of the right ventricle and nuchal translucency

The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation

“…This is likely to reflect the influence of peripheral resistance and preload as well as ventricular function on the AoI, whereas Delta-MPI quantifies differential systolic and diastolic myocardial function only [22]. Other research groups have raised concerns regarding the ability of the ISI to accurately and specifically isolate relative ventricular contribution [23].…”