Alberto Borges Peixoto1,2,3, Nathalie Jeanne Magioli Bravo-Valenzuela3, Wellington P Martins1,4, Rosiane Mattar1, Antonio Fernandes Moron1, Edward Araujo Júnior1. 1. Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil. 2. Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil. 3. Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil. 4. Department of Reproductive Medicine, SEMEAR fertilidade, Ribeirão Preto, Brazil.
Abstract
Objective: To establish reference ranges for the fetal left ventricle (LV) modified myocardial performance index (Mod-MPI), respective time periods, and right and left atrioventricular peak velocities between 20 and 36 + 6 weeks of gestation. Methods: This cross-sectional study evaluated 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. The LV Mod-MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Polynomial regression was used to obtain the best-fit using Mod-MPI and atrioventricular peak velocity measurements and gestational age (GA) with adjustments using the coefficient of determination (R2). The intra- and interobserver reliability was evaluated using the concordance correlation coefficient (CCC). Results: LV Mod-MPI (R2 = 0.026, p = .002) and isovolumetric relaxation time (IRT) (R2 = 0.036, p < .001) significantly increased with advancing GA. Isovolumetric contraction time (ICT) and ejection time (ET) did not significantly change with GA. RV and LV E wave, A wave, and E/A ratio significantly increased with GA (p < .001). The mean of each parameter ranged as follows: LV Mod-MPI (0.44-0.47 s), IRT (0.041-0.045 s), ICT (0.032-0.034 s), ET (0.167-0.167 s), RV E (30.2-46.91 cm/s), RV A (47.1-60.7 cm/s), RV E/A (0.65-0.78 cm/s), LV E (27.0-41.4 cm/s), LV A (43.2-53.8 cm/s), and LV E/A (0.63-0.78 cm/s). Only LV A wave measurements demonstrated an intraobserver CCC >0.80. The remaining intra- and interobserver reproducibility parameters demonstrated lower CCC.Conclusions: Reference values were replicated for the fetal LV Mod-MPI and LV and RV transvalvular peak velocities between 20 and 36 + 6 weeks of gestation.
Objective: To establish reference ranges for the fetal left ventricle (LV) modified myocardial performance index (Mod-MPI), respective time periods, and right and left atrioventricular peak velocities between 20 and 36 + 6 weeks of gestation. Methods: This cross-sectional study evaluated 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. The LV Mod-MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Polynomial regression was used to obtain the best-fit using Mod-MPI and atrioventricular peak velocity measurements and gestational age (GA) with adjustments using the coefficient of determination (R2). The intra- and interobserver reliability was evaluated using the concordance correlation coefficient (CCC). Results: LV Mod-MPI (R2 = 0.026, p = .002) and isovolumetric relaxation time (IRT) (R2 = 0.036, p < .001) significantly increased with advancing GA. Isovolumetric contraction time (ICT) and ejection time (ET) did not significantly change with GA. RV and LV E wave, A wave, and E/A ratio significantly increased with GA (p < .001). The mean of each parameter ranged as follows: LV Mod-MPI (0.44-0.47 s), IRT (0.041-0.045 s), ICT (0.032-0.034 s), ET (0.167-0.167 s), RV E (30.2-46.91 cm/s), RV A (47.1-60.7 cm/s), RV E/A (0.65-0.78 cm/s), LV E (27.0-41.4 cm/s), LV A (43.2-53.8 cm/s), and LV E/A (0.63-0.78 cm/s). Only LV A wave measurements demonstrated an intraobserver CCC >0.80. The remaining intra- and interobserver reproducibility parameters demonstrated lower CCC.Conclusions: Reference values were replicated for the fetal LV Mod-MPI and LV and RV transvalvular peak velocities between 20 and 36 + 6 weeks of gestation.