Reference ranges for the fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (mitral annular plane systolic excursion, tricuspid annular plane systolic excursion, and septum annular plane systolic excursion) between 20 and 36 + 6 weeks of gestation

Alberto Borges Peixoto 1 , 2 , 3 , Nathalie Jeanne Bravo-valenzuela 1 , Wellington P. Martins 4 , Gabriele Tonni 5 , Rosiane Mattar 1 , Antonio Fernandes Moron 1 , David Baptista Pares 1  and Edward Araujo Júnior 1
  • 1 Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
  • 2 Gynecology and Obstetrics Service, 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 SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
  • 5 Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Guastalla, Italy
Alberto Borges Peixoto
  • Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
  • Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, MG, Brazil
  • Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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, Nathalie Jeanne Bravo-valenzuela
  • Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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, Wellington P. Martins, Gabriele Tonni
  • Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Guastalla, Italy
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, Rosiane Mattar
  • Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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, Antonio Fernandes Moron
  • Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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, David Baptista Pares
  • Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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and Edward Araujo Júnior
  • Corresponding author
  • Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Abstract

Objectives

This study aimed to establish reference ranges for fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (MAPSE, TAPSE, and SAPSE) in normal pregnant women between 20 and 36 + 6 weeks of gestation.

Methods

This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. MAPSE, TAPSE, and SAPSE were measured by M-mode in real time in an apical or basal four-chamber view through placing the cursor at the atrioventricular junction, marked by the valve rings at the tricuspid, mitral, and basal septum, respectively. A regression analysis was done to determine the appropriate polynomial equation model for both measurements and standard deviation (SD) values in relation to gestational age (GA). The intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC) and limits of agreement (LoA).

Results

There was a significant positive correlation between MAPSE (r=0.705, p<0.0001), TAPSE (r=0.804, p<0.0001), and SAPSE (r=0.690, p<0.0001) and GA. The mean of each parameter ranged as follows: 2.87–5.56 mm, MAPSE; 3.98–8.07 mm, TAPSE; and 2.34–4.21 mm, SAPSE. Poor/moderate intra- and inter-observer reliability (CCC between 0.70 and 0.90) and poor/moderate agreement of all the tested parameters were evaluated (LoA between 10 and 50%).

Conclusions

Reference values were established for the fetal MAPSE, TAPSE, and SAPSE between 20 and 36 + 6 weeks of gestation in low-risk pregnant women. These parameters showed poor/moderate reproducibility.

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