Obstet Gynecol Sci.  2021 May;64(3):257-265. 10.5468/ogs.20274.

Fetal cardiac function by mitral and tricuspid annular plane systolic excursion using spatio-temporal image correlation M‐mode and left cardiac output in fetuses of pregestational diabetic mothers

• Bravo-Valenzuela NJM
• Peixoto AB
• Mattar R
• Araujo Júnior E

• KMID: 2515977
• DOI: http://doi.org/10.5468/ogs.20274

Abstract

Objective
To assess the mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) and cardiac output (CO) in fetuses of pregnant women with pregestational diabetes mellitus (DM) using spatio-temporal image correlation M-mode (STIC-M) and virtual organ computer-aided analysis (VOCAL).
Methods
This study was prospective and cross-sectional. It included 45 fetuses each from mothers with pregestational DM and healthy mothers, with gestation ages ranging from 20 to 36.6 weeks. The fetal cardiac volumes were obtained and analyzed by STIC and VOCAL methods. MAPSE and TAPSE were measured by STIC-M in the apical or basal fourchamber view. The values of the right (RV) and left ventricular (LV) CO were calculated by STIC and VOCAL.
Results
The median values of TAPSE were 6.1 and 6.2 mm in the diabetic and control groups (P<0.001), respectively. The median values of MAPSE were 4.6 mm in the fetuses of mothers with diabetes and 4.8 mm in fetuses of healthy mothers. The fetal LV CO (60.4 L/min vs. 71.1 L/min; P=0.033, respectively) and RV CO (65.2 vs. 70.1 L/min; P=0.026, respectively) were lower in the pregestational DM group than in the control group. A significant effect of pregestational DM was observed in all functional parameters after adjusting, with fetal heart rate as covariant. There was moderate significant positive correlation between MAPSE and LV CO (r=0.53; P=0.0001) and between TAPSE and RV CO (r=0.46; P=0.0001).
Conclusion
Significant difference in functional parameters (TAPSE, MAPSE and LV CO) obtained by STIC and VOCAL were observed in the fetuses of the pregestational DM group compared to those of the control group.

Keyword

Fetal heart; Diabetes mellitus; Systolic heart failure; Four-dimensional echocardiography; Cardiac output

Figure

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  Fig. 1 Measurement of the fetal left ventricle (LV) volume using spatio-temporal image correlation and virtual organ computer-aided analysis (VOCAL) methods in a fetus from pregestational diabetes mellitus at 22 weeks and 5 days of gestation (LV diastolic volume=0.48 cm3 and heart rate [HR]=166 bpm). The LV cardiac output (LV CO) and LV ejection fraction (LVEF) were calculated from the measurements of the ventricular volumes according to the following formulas: LV CO=(LVDv−LVSv)×HR and LVEF (LVDv−LVSv)/LVDv. The calipers were positioned on the internal border of the mitral valve and on the ventricular endocardial border to perform the manual delimitation of the internal left ventricular volume. After 6 sequential planes, the VOCAL software provided the chamber volume and the reconstructed 3D image. LVDv, left diastolic volume; LVSv, left systolic volume.

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  Fig. 2 In the apical four-chamber view of the fetal heart, the spatio-temporal image correlation in M-mode image is positioned at the junction between the free ventricular wall and the atrioventricular valve for the calculation of mitral annular plane systolic excursion (MAPSE) (A) and tricuspid annular plane systolic excursion (TAPSE) (B) annular plane systolic excursions. MAPSE=5.4 mm; TAPSE=5.4 mm.

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  Fig. 3 Scatter plot of the correlation between tricuspid annular plane systolic excursion (TAPSE) (A), mitral annular plane systolic excursion (MAPSE) (B), left ventricle cardiac output (LV CO) (C), right ventricle cardiac output (RV CO) (D), and fetal heart rate (FHR).

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  Fig. 4 Scatter plot of the correlation between mitral annular plane systolic excursion (MAPSE) and left ventricle cardiac output (LV CO) (A) and correlation between tricuspid annular plane systolic excursion (TAPSE) and right ventricle cardiac output (RV CO) (B).

Reference

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