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Vol. 28, No. 3, 2010
Issue release date: October 2010
Section title: Original Paper
Free Access
Fetal Diagn Ther 2010;28:167–174
(DOI:10.1159/000318345)

Assessment of Left Ventricular Pre-Ejection Period in the Fetus Using Simultaneous Magnetocardiography and Echocardiography

Mensah-Brown N.A.a · Wakai R.T.a · Cheulkar B.b · Srinivasan S.c · Strasburger J.F.b
aDepartment of Medical Physics, University of Wisconsin, Madison, Wisc., bDepartment of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisc., and cDepartment of Pediatrics, American Family Children’s Hospital, UW, Madison, Wisc., USA
email Corresponding Author

Abstract

Introduction: Fetal magnetocardiography (fMCG) is a promising new technique for assessing fetal rhythm; however, no prior studies have utilized fMCG to evaluate human fetal electromechanical physiology. Pre-ejection period (PEP) is an important measure of the electromechanical activation of the heart, and is altered by disease states and arrhythmias. Materials and Methods: A novel technique was used to assess fetal PEP and its relationship to other fetal systolic time intervals, RR interval, and gestational age (GA). 25 normal human fetuses between 19 and 38 weeks’ gestation were studied using simultaneous pulsed Doppler ultrasound and fMCG. Correlations among PEP, ejection time, QRS width and RR interval were assessed using linear regression. Results: Across all subjects, PEP was found to correlate with GA (R = 0.57, p < 0.0001), QRS width (R = 0.35, p = 0.026), and RR interval (R = 0.37, p = 0.018). In individual sessions, PEP negatively correlated beat-to-beat with the preceding RR interval. Conclusion: PEP exhibits developmental trends that provide a better understanding of the normal development of the human fetal heart.

© 2010 S. Karger AG, Basel


  

Key Words

  • Pre-ejection period
  • Fetal magnetocardiography
  • Fetal echocardiography
  • Electromechanical coupling
  • Systolic time intervals

References

  1. Lewis RP, Rittogers SE, Froester WF, Boudoulas H: A critical review of the systolic time intervals. Circulation 1977;56:146–158.
  2. Weissler AM, Harris WS, Schoenfeld CD: Systolic time intervals in heart failure in man. Circulation 1968;37:149–159.
  3. Gillebert TC, Van de Veire N, De Buyzere ML, De Sutter J: Time intervals and global cardiac function. Use and limitations. Eur Heart J 2004;25:2185–2186.
  4. Nii M, Hamilton RM, Fenwick L, Kingdom JC, Roman KS, Jaeggi ET: Assessment of fetal atrioventricular time intervals by tissue Doppler and pulse Doppler echocardiography: normal values and correlation with fetal electrocardiography. Heart 2006;92:1831–1837.
  5. Evers JL: Cardiac pre-ejection period during prenatal life. Gynecol Obstet Invest 1980;11:193–213.
  6. Murata Y, Martin CB Jr: Systolic time intervals of the fetal cardiac cycle. Obstet Gynecol 1974;44:224–232.
  7. Sampson MB: Antepartum measurement of the preejection period in high-risk pregnancy. Obstet Gynecol 1980;56:289–295.
  8. Goodlin RC, Girard J, Hollmen A: Systolic time intervals in the fetus and neonate. Obstet Gynecol 1972;39:295–303.
  9. Organ LW, Bernstein A, Hawrylyshyn PA: The pre-ejection period as an antepartum indicator of fetal well-being. Am J Obstet Gynecol 1980;137:810–819.
  10. Murata Y, Martin CB Jr, Ikenoue T, Lu PS: Antepartum evaluation of the pre-ejection period of the fetal cardiac cycle. Am J Obstet Gynecol 1978;132:278–284.
  11. Neilson JP: Fetal electrocardiogram for fetal monitoring during labour. Cochrane Cochrane Database Syst Rev 2006 Jul 19;3:CD000116.
  12. Zhao H, Chen M, Van Veen BD, Strasburger JF, Wakai RT: Simultaneous fetal magnetocardiography and ultrasound/Doppler imaging. IEEE Trans Biomed Eng 2007;54:1167–1171.
  13. Fleming JE, Raymond SP, Smith GC, Whitfield CR: The measurement of fetal systolic time intervals: lessons from ultrasound. Eur J Obstet Gynecol Reprod Biol 1986;23:289–294.
  14. Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–310.
  15. Wakai RT, Strasburger JF, Li Z, Deal BJ, Gotteiner NL: Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia. Circulation 2003;107:307–312.
  16. Zhao H, Cuneo BF, Strasburger JF, Huhta JC, Gotteiner NL, Wakai RT: Electrophysiological characteristics of fetal atrioventricular block. J Am Coll Cardiol 2008;51:77–84.
  17. Garrard CL Jr, Weissler AM, Dodge HT: The relationship of alterations in systolic time intervals to ejection fraction in patients with cardiac disease. Circulation 1970;42:455–462.
  18. Levy AM, Leaman DM, Hanson JS: Effects of digoxin on systolic time intervals of neonates and infants. Circulation 1972;46:816–823.
  19. Wolfson RN, Zador IE, Pillay SK, Timor-Tritsch IE, Hertz RH: Antenatal investigation of human fetal systolic time intervals. Am J Obstet Gynecol 1977;129:203–207.
  20. Wallace AG, Mitchell JH, Skinner NS, Sarnoff SJ: Duration of the phases of left ventricular systole. Circ Res 1963;12:611–619.
  21. Weissler AM, Peeler RG, Roehll WH Jr: Relationships between left ventricular ejection time, stroke volume, and heart rate in normal individuals and patients with cardiovascular disease. Am Heart J 1961;62:367–378.

  

Author Contacts

Janette F. Strasburger, MD
Children’s Hospital of Wisconsin – Fox Valley
2nd Floor Pavilion, 130 Second St., Neenah, WI 54956 (USA)
Tel. +1 920 969 5301, Fax +1 920 969 7909
E-Mail jstrasburger@chw.org

  

Article Information

Received: May 4, 2010
Accepted after revision: June 29, 2010
Published online: October 26, 2010
Number of Print Pages : 8
Number of Figures : 6, Number of Tables : 1, Number of References : 21

  

Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 28, No. 3, Year 2010 (Cover Date: October 2010)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Introduction: Fetal magnetocardiography (fMCG) is a promising new technique for assessing fetal rhythm; however, no prior studies have utilized fMCG to evaluate human fetal electromechanical physiology. Pre-ejection period (PEP) is an important measure of the electromechanical activation of the heart, and is altered by disease states and arrhythmias. Materials and Methods: A novel technique was used to assess fetal PEP and its relationship to other fetal systolic time intervals, RR interval, and gestational age (GA). 25 normal human fetuses between 19 and 38 weeks’ gestation were studied using simultaneous pulsed Doppler ultrasound and fMCG. Correlations among PEP, ejection time, QRS width and RR interval were assessed using linear regression. Results: Across all subjects, PEP was found to correlate with GA (R = 0.57, p < 0.0001), QRS width (R = 0.35, p = 0.026), and RR interval (R = 0.37, p = 0.018). In individual sessions, PEP negatively correlated beat-to-beat with the preceding RR interval. Conclusion: PEP exhibits developmental trends that provide a better understanding of the normal development of the human fetal heart.

© 2010 S. Karger AG, Basel


  

Author Contacts

Janette F. Strasburger, MD
Children’s Hospital of Wisconsin – Fox Valley
2nd Floor Pavilion, 130 Second St., Neenah, WI 54956 (USA)
Tel. +1 920 969 5301, Fax +1 920 969 7909
E-Mail jstrasburger@chw.org

  

Article Information

Received: May 4, 2010
Accepted after revision: June 29, 2010
Published online: October 26, 2010
Number of Print Pages : 8
Number of Figures : 6, Number of Tables : 1, Number of References : 21

  

Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 28, No. 3, Year 2010 (Cover Date: October 2010)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/4/2010
Accepted: 6/29/2010
Published online: 10/26/2010
Issue release date: October 2010

Number of Print Pages: 8
Number of Figures: 6
Number of Tables: 1

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Lewis RP, Rittogers SE, Froester WF, Boudoulas H: A critical review of the systolic time intervals. Circulation 1977;56:146–158.
  2. Weissler AM, Harris WS, Schoenfeld CD: Systolic time intervals in heart failure in man. Circulation 1968;37:149–159.
  3. Gillebert TC, Van de Veire N, De Buyzere ML, De Sutter J: Time intervals and global cardiac function. Use and limitations. Eur Heart J 2004;25:2185–2186.
  4. Nii M, Hamilton RM, Fenwick L, Kingdom JC, Roman KS, Jaeggi ET: Assessment of fetal atrioventricular time intervals by tissue Doppler and pulse Doppler echocardiography: normal values and correlation with fetal electrocardiography. Heart 2006;92:1831–1837.
  5. Evers JL: Cardiac pre-ejection period during prenatal life. Gynecol Obstet Invest 1980;11:193–213.
  6. Murata Y, Martin CB Jr: Systolic time intervals of the fetal cardiac cycle. Obstet Gynecol 1974;44:224–232.
  7. Sampson MB: Antepartum measurement of the preejection period in high-risk pregnancy. Obstet Gynecol 1980;56:289–295.
  8. Goodlin RC, Girard J, Hollmen A: Systolic time intervals in the fetus and neonate. Obstet Gynecol 1972;39:295–303.
  9. Organ LW, Bernstein A, Hawrylyshyn PA: The pre-ejection period as an antepartum indicator of fetal well-being. Am J Obstet Gynecol 1980;137:810–819.
  10. Murata Y, Martin CB Jr, Ikenoue T, Lu PS: Antepartum evaluation of the pre-ejection period of the fetal cardiac cycle. Am J Obstet Gynecol 1978;132:278–284.
  11. Neilson JP: Fetal electrocardiogram for fetal monitoring during labour. Cochrane Cochrane Database Syst Rev 2006 Jul 19;3:CD000116.
  12. Zhao H, Chen M, Van Veen BD, Strasburger JF, Wakai RT: Simultaneous fetal magnetocardiography and ultrasound/Doppler imaging. IEEE Trans Biomed Eng 2007;54:1167–1171.
  13. Fleming JE, Raymond SP, Smith GC, Whitfield CR: The measurement of fetal systolic time intervals: lessons from ultrasound. Eur J Obstet Gynecol Reprod Biol 1986;23:289–294.
  14. Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–310.
  15. Wakai RT, Strasburger JF, Li Z, Deal BJ, Gotteiner NL: Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia. Circulation 2003;107:307–312.
  16. Zhao H, Cuneo BF, Strasburger JF, Huhta JC, Gotteiner NL, Wakai RT: Electrophysiological characteristics of fetal atrioventricular block. J Am Coll Cardiol 2008;51:77–84.
  17. Garrard CL Jr, Weissler AM, Dodge HT: The relationship of alterations in systolic time intervals to ejection fraction in patients with cardiac disease. Circulation 1970;42:455–462.
  18. Levy AM, Leaman DM, Hanson JS: Effects of digoxin on systolic time intervals of neonates and infants. Circulation 1972;46:816–823.
  19. Wolfson RN, Zador IE, Pillay SK, Timor-Tritsch IE, Hertz RH: Antenatal investigation of human fetal systolic time intervals. Am J Obstet Gynecol 1977;129:203–207.
  20. Wallace AG, Mitchell JH, Skinner NS, Sarnoff SJ: Duration of the phases of left ventricular systole. Circ Res 1963;12:611–619.
  21. Weissler AM, Peeler RG, Roehll WH Jr: Relationships between left ventricular ejection time, stroke volume, and heart rate in normal individuals and patients with cardiovascular disease. Am Heart J 1961;62:367–378.