Hafif semptomları olan gebelikte COVID-19 bulaşmış annelerin fetüslerinde doku doppler türevli miyokard performans indeksinin değerlendirilmesi

Year 2024, Volume: 49 Issue: 2, 407 - 414, 30.06.2024

Cenk Soysal , Rahmi Özdemir

https://doi.org/10.17826/cumj.1392668

Abstract

Amaç: Şiddetli akut respiratuar sendromu koronavirüs 2 (SARS-CoV-2) ile enfekte olmuş ve asemptomatik veya hafif semptomları olan hamile kadınların fetüsleri ile enfekte olmamış hamile kadınların fetüslerinin, ekokardiyografi ve doku Doppler (TD) görüntüleme ile değerlendirilen fetal kardiyak fonksiyonlarını karşılaştırmaktır.
Gereç ve Yöntem: Gestasyonel yaşları 20 haftadan fazla olan ve COVID-19 enfekte, hafif ya da asemptomatik gebe kadınların fetüslerinin triküspit ve mitral kapakların lateral anülüslerinde erken diyastolik miyokardiyal hızlar (Em) ve geç miyokardiyal hızlar (Am) ve Em/Am oranları ölçülmüştür (n=45). Aynı gestasyonel yaşa sahip sağlıklı hamile kadınların fetüsleriyle Fetal eko sonuçları (n=43) karşılaştırılmıştır. Ayrıca doku doppler türevli miyokard performans indeksi (MPI) de ölçülmüştür.
Bulgular: Fetüslerin gestasyonel yaşları sırasıyla 26.1 ± 3.3 hafta ve 26.6 ± 3.5 hafta olarak tespit edilmiştir). Araştırma grubunda mitral kapak Em/Am oranı 0.56±0.08 iken, kontrol grubunda 0.61±0.06 olarak bulunmuştur. Araştırma grubunda triküspit kapak Em/Am oranı 0.58±0.11 iken, kontrol grubunda 0.63±0.10 olarak ölçülmüştür. Doku doppler türevli mitral kapak MPI'si araştırma grubunda 0.48±0.07, kontrol grubunda ise 0.40±0.07 olarak belirlenmiştir.
Sonuç: Maternal COVID-19 enfeksiyonu fetal MPI ve diyastolik fonksiyonları etkilemektedir. Eşlik eden maternal komorbidite olmaksızın SARS-CoV-2 ile enfekte olmuş, düşük riskli, hafif semptomatik hamile kadınların antenatal takibinde fetal kardiyak ekokardiyografi yapılmalıdır.

Keywords

COVID-19, E/A oranı, fetal ekokardiyografi, miyokard performans indeksi

Evaluation of the tissue doppler-derived myocardial performance index in fetuses of mothers infected with COVID-19 during pregnancy with mild symptoms

Abstract

Purpose: To compare cardiac functions evaluated with echocardiography and tissue Doppler (TD) imaging between fetuses of pregnant women who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were asymptomatic or had mild symptoms and fetuses of pregnant women who were not infected.
Material and Methods: Early diastolic myocardial velocities (Em) and late myocardial velocities (Am) and Em/Am ratios were measured in the lateral annuli of tricuspid and mitral valves of fetuses of pregnant women with COVID-19 at more than 20 weeks of gestational age who had COVID-19 (n=45) and gestational age-matched healthy pregnant women’s fetuses (n=43). The TD-derived myocardial performance index (MPI) was also measured.
Results: The gestational ages of the fetuses were found as 26.1 ± 3.3 and 26.6 ± 3.5 weeks, respectively. The mitral valve Em/Am ratio was 0.56±0.08 and 0.61±0.06 in the study group and the control group, respectively. The tricuspid valve Em/Am ratio was 0.58±0.11 and 0.63±0.10 in the study group and the control group, respectively. The TD-derived mitral valve MPI was 0.48±0.07 and 0.40±0.07 in the study group and the control group, respectively.
Conclusion: Maternal COVID-19 affects fetal MPI and diastolic function. Fetal cardiac echocardiography should be performed during antenatal follow-up of low-risk, mildly symptomatic pregnant women infected with SARS-CoV-2 without concomitant maternal comorbidity.

Keywords

COVID-19, E/A ratio, fetal echocardiography, myocardial performance index

References

• Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiol Rev. 2021;101:303-18.
• León-Juárez M, Martínez-Castillo M, González-García LD, Helguera-Repetto AC, Zaga-Clavellina V, García-Cordero J et al. Cellular and molecular mechanisms of viral infection in the human placenta. Pathog Dis. 2017;75:ftx093.
• Hichijo A, Morine M. A case of fetal parvovirus b19 myocarditis that caused terminal heart failure. Case Rep Obstet Gynecol. 2014;2014:463571.
• Ye Z, Wang L, Yang T, Chen L, Wang T, Chen L et al. Maternal viral infection and risk of fetal congenital heart disease: A meta-analysis of observational studies. J Am Heart Assoc. 2019;8:e011264.
• Rasmussen SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. American journal of obstetrics and gynecology. 2012;207:3-8.
• Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Pperinatol. 2020;37:861-5.
• Hayakawa S, Komine-Aizawa S, Mor GG. Covid-19 pandemic and pregnancy. J Obstet Gynaecol Res. 2020;46:1958-66.
• Patanè L, Morotti D, Giunta MR, Sigismondi C, Piccoli MG, Frigerio L et al. Vertical transmission of coronavirus disease 2019: severe acute respiratory syndrome coronavirus 2 RNA on the fetal side of the placenta in pregnancies with coronavirus disease 2019-positive mothers and neonates at birth. Am J Obstet Gynecol MFM. 2020;2:100145.
• Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20.
• Rasmussen SA, Kelley CF, Horton JP, Jamieson DJ. Coronavirus disease 2019 (COVID-19) vaccines and pregnancy: what obstetricians need to know. Obstet Gynecol. 2021;137:408-14.
• Almond DJJopE. Is the 1918 influenza pandemic over? Long-term effects of in utero influenza exposure in the post-1940 US population. J Polit Econ. 2006;114:672-712.
• Lamouroux A, Attie-Bitach T, Martinovic J, Leruez-Ville M, Ville Y. Evidence for and against vertical transmission for severe acute respiratory syndrome coronavirus 2. Am J Obstet Gynecol. 2020;223:91.e1-4.
• Yang Z, Liu Y. Vertical transmission of severe acute respiratory syndrome coronavirus 2: a systematic review. Am J Perinatol. 2020;37:1055-60.
• Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;99:823-9.
• Komine-Aizawa S, Takada K, Hayakawa S. Placental barrier against COVID-19. Placenta. 2020;99:45-9.
• Baergen RN, Heller DS. Placental pathology in Covid-19 positive mothers: preliminary findings. Pediatr Dev Pathol. 2020;23:177-80.
• Mulvey JJ, Magro CM, Ma LX, Nuovo GJ, Baergen RN. Analysis of complement deposition and viral RNA in placentas of COVID-19 patients. Ann Diagn Pathol. 2020;46:151530.
• Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatrics. 2021;175:817-26.
• Dervisoglu P, Kosecik M, Kumbasar S. Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study. J Obstet Gynaecol. 2018;38:408-12.
• Alici Davutoglu E, Ozel A, Oztunc F, Madazli R. Modified myocardial performance index and its prognostic significance for adverse perinatal outcome in early and late onset fetal growth restriction. J Matern Fetal Neonatal Med. 2020;33:277-82.
• Chan LY, Fok WY, Wong JT, Yu CM, Leung TN, Lau TK. Reference charts of gestation-specific tissue Doppler imaging indices of systolic and diastolic functions in the normal fetal heart. Am Heart J. 2005;150:750-5.
• Porche LM, Sinkovskaya E, Seaman RD, Galadima H, Romary L, Philips J et al. Fetal myocardial performance index in the third trimester of pregnancy: feasibility and reproducibility of conventional spectral doppler versus spectral tissue doppler technique. Am J Perinatol. 2021;38:296-303.
• Bui YK, Kipps AK, Brook MM, Moon-Grady AJ. Tissue Doppler is more sensitive and reproducible than spectral pulsed-wave Doppler for fetal right ventricle myocardial performance index determination in normal and diabetic pregnancies. J Am Soc Echocardiogr. 2013;26:507-14.
• Irani RA, Buhimschi CS, Cross SN, Zhao G, Copel JA, Bhandari V et al. Fetal myocardial function as assessed by n-terminal fragment brain natriuretic protein in premature fetuses exposed to intra-amniotic inflammation. Am J Perinatol. 2020;37:745-53.
• Letti Müller AL, Barrios Pde M, Kliemann LM, Valério EG, Gasnier R, Magalhães JA. Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome. Ultrasound Obstet Gynecol. 2010;36:26-31.