E Gratacós

University of Barcelona, Barcino, Catalonia, Spain

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Publications (557)1702.48 Total impact

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    ABSTRACT: We have assessed brain metabolite levels by magnetic resonance spectroscopy (MRS) in one year old infants born small at term, as compared with adequate for gestational age (AGA) born infants, and their association with neurodevelopment at two years of age. A total of 40 infants born small (birth weight <10(th) centile for GA) and 30 AGA infants underwent brain MRS at one year, on a 3 Tesla scanner. Small-born infants were subclassified as late-IUGR (intrauterine growth restriction) or as small for gestational age (SGA), based on the presence or absence of prenatal Doppler and birth weight predictors of an adverse perinatal outcome, respectively. Single-voxel PRESS (1)H-MRS data were acquired from the frontal lobe at short echo time. Neurodevelopment was evaluated at two years of age using the Bayley Scales 3rd Edition (BSID-III), assessing cognitive, language, motor, socio-emotional behavior and adaptative behavior. As compared with AGA controls, infants born small showed significantly higher levels of glutamate (Glu) and N-acetylaspartate (NAAt)/Creatine (Cr) at one year, and lower BSID-III scores at 2 years. The subgroup of late-IUGR infants further showed lower estimated glutathione (GSH) levels at one year. Significant correlations were observed for estimated GSH levels with adaptative scores, and for myo-inositol with language scores. Significant associations were also noticed for NAA/Cr with cognitive scores, and for Glu/Cr with motor scores. Infants born small show brain metabolite differences at one year of age, which are correlated with later neurodevelopment. These results support further research on MRS to develop imaging biomarkers of abnormal neurodevelopment. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 04/2015; DOI:10.1016/j.ajog.2015.04.011 · 3.97 Impact Factor
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    ABSTRACT: We report the successful use of fetoscopy to treat a case of prolapsed ureterocele in a female fetus. A diagnosis of a double renal system with an intravesical ureterocele was performed at 21 weeks' gestation. Follow-up exams showed that the ureterocele was obstructing the bladder outlet causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Those findings suggested a poor prognosis and therefore the patient was referred to our Fetal Therapy Unit to consider prenatal treatment. The ultrasound evaluation at admission confirmed severe bilateral hydronephrosis with pelvic and caliceal dilatation, but, surprisingly, the amniotic fluid was normal and no image of ureterocele could be identified into the bladder. Instead, a cystic image between the external genitalia could be observed, leading us to the diagnosis of a prolapsed ureterocele causing intermittently severe obstruction of the urethra. Due to the unpredictable course of the malformation, parents were counselled about the uncertain fetal prognosis and therefore fetal surgery to decompress the urinary system was proposed, with the agreement of the paediatric urologist. After extensive discussion and counselling, a fetoscopic operation was designed and indicated. The procedure consisted in opening the cystic mass by means of firing with contact diode laser until the opening of the ureterocele was achieved. After the surgery, resolution of the megacystis, with reduction of the hydronephrosis, and persistent normalization of the amniotic fluid volume were observed. The pregnancy continued uneventfully and a normal female infant was born at term at her local hospital. The child is developing normally with normal renal function at 4 years old. Our report demonstrates that fetoscopic decompression of a distal urethra obstruction is feasible in the rare event of congenital prolapsed ureterocele. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 04/2015; DOI:10.1002/uog.14876 · 3.14 Impact Factor
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    ABSTRACT: To assess maternal vascular structure and function in fetal growth restriction (FGR) pregnancies with and without preeclampsia (PE) at the time of diagnosis. We evaluated 124 pregnant women with FGR subdivided in 60 FGR with and 64 FGR without PE, together with 110 controls. The group of FGR without PE was further subdivided according to the gestational age at diagnosis into early (<32 weeks) or late-onset (≥32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS), and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. FGR cases with PE showed increased maternal carotid IMT (controls: mean 0.409 mm (IQR 0.386-0.439); FGR with PE: 0.425 mm (0.381-0.486); P = 0.021), BP (controls: mean BP 82 mmHg (77-89); FGR with PE: 109 mmHg (101-117); P < 0.001) and CWS, together with reduced CD and IVC collapsibility (controls: IVC collapsibility index 0.10 (0.06-0.13); FGR with PE: 0.07 (0.06-1.11); P = 0.136). FGR without PE had increased maternal IMT (0.436 mm (0.392-0.476); P = 0.001) and BP (88mmHg (81-95); P < 0.001), but similar CD and IVC collapsibility to controls. When subclassified according to gestational age, only early-onset FGR had significantly increased IMT and CWS, but both groups had increased BP. FGR without PE shares some subclinical maternal vascular features with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14815 · 3.14 Impact Factor
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    ABSTRACT: Objective: To explore the value of circulating luteinizing human chorionic gonadotropin receptor (LHCGR) forms for the prediction of preeclampsia (PE) in the first trimester of pregnancy. Methods: Case-control study, based on a cohort of 5,759 pregnancies, including 20 early PE, 20 late PE, and 300 controls. We recorded/measured maternal characteristics, mean arterial pressure (MAP), uterine artery (UtA) Doppler, placental growth factor (PlGF), soluble Fms-like tyrosine kinase-1 (sFtl-1), and LHCGR forms (hCG-LHCGR and soluble LHCGR), and their independent predictive values were analyzed by logistic regression. Results: For early PE, the model included black ethnicity, chronic hypertension, previous PE, MAP, UtA Doppler, PlGF, sFlt-1, and LHCGR forms, achieving detection rates (DR) of 83% at 10% of false-positive rates (FPR) [AUC: 0.961 (95% CI: 0.921-1)]. For late PE, the model included body mass index, previous PE, UtA Doppler, PlGF, sFlt-1, and LHCGR forms, with DR of 75% at 10% of FPR [AUC: 0.923 (95% CI: 0.871-0.976)]. In both early and late PE, LHCGR forms improved DR by 6-15%. Conclusions: LHCGR forms improved the prediction for early and late PE. These results should be confirmed in larger prospective studies. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 02/2015; DOI:10.1159/000371516 · 2.30 Impact Factor
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    ABSTRACT: To estimate the combined value of cerebral Doppler results and the Bishop score for predicting perinatal outcomes after labour induction for small for gestational age (SGA) foetuses in the presence of normal umbilical artery Doppler results. We conducted a cohort study in two tertiary centres of 164 women with normal umbilical artery Doppler recordings who underwent labour induction because of an estimated foetal weight below the 10(th) percentile. The middle cerebral artery pulsatility index and cerebroplacental ratio (CPR) were obtained in all cases within 24 hours before induction. The cervical condition was assessed at admission using the Bishop score. A predictive model for perinatal outcomes was constructed using the Decision Tree Analysis algorithm. Both a very unfavourable cervix (Bishop score < 2) (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.28-7.86) and an abnormal CPR (OR, 2.54; 95% CI, 1.18-5.61) were associated with an increased likelihood of emergent caesarean section for foetal distress, but only the latter was significantly associated with the need for neonatal admission (OR, 2.43; 95% CI, 1.28-4.59). In the decision tree analysis both criteria significantly predicted the likelihood of caesarean section for foetal distress. Combined use of the Bishop score and CPR improves the ability to predict caesarean section overall (for any indication), emergency caesarean section for foetal distress, and neonatal admission after labour induction for late-onset SGA in the presence of normal umbilical artery Doppler results. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14807 · 3.14 Impact Factor
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    ABSTRACT: Objective: To explore corpus callosum (CC) developmental differences by ultrasound in late-onset small fetuses compared with adequate for gestational age (AGA) controls. Study Design: Ninety four small (estimated fetal weight <10th centile) and 71 AGA fetuses were included. Small fetuses were further subdivided into fetal growth restriction (IUGR, n = 64) and small for gestational age (SGA, n = 30) based on poor perinatal outcome factors, that is, birth weight <3rd centile and/or abnormal cerebroplacental ratio and/or uterine artery Doppler. The entire cohort was scanned to assess CC by transvaginal neurosonography obtaining axial, coronal and midsagittal images. CC length, thickness, total area and the areas after a subdivision in 7 portions were evaluated by semiautomatic software. Furthermore, the weekly average growth of the CC in each study group was calculated and compared. Results: Small fetuses showed significantly shorter (small fetuses: 0.49 vs. AGA: 0.52; p < 0.01) and smaller CC (1.83 vs. 2.03; p < 0.01) with smaller splenium (0.47 vs. 0.55; p < 0.01) compared to controls. The CC growth rate was also reduced when compared to controls. Changes were more prominent in small fetuses with abnormal cerebroplacental Doppler suggesting fetal growth restriction. Conclusions: Neurosonographic assessment of CC showed significantly altered callosal development, suggesting in-utero brain reorganization in small fetuses. This data support the potential value of CC assessment by US to monitor brain development in fetuses at risk. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 02/2015; DOI:10.1159/000366160 · 2.30 Impact Factor
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    ABSTRACT: Objective To develop the best first trimester screening model for preeclampsia (PE) based on maternal characteristics, biophysical parameters, and angiogenic factors in a low-risk population.MethodsA prospective cohort of 9,462 pregnancies undergoing first-trimester screening. Logistic regression predictive models were developed for early and late PE (cut-off 34 weeks’ gestation at delivery). Data included the a priori risk (maternal characteristics), mean arterial pressure (MAP) and uterine artery (UtA) Doppler (11–13 weeks) in all cases. Plasma levels (8–11 weeks) of hCG, PAPP-A, placental growth factor (PlGF) and soluble Fms-like tyrosine kinase-1 (sFtl-1) was analyzed using a nested case-control study design.ResultsThe best model for early PE (n = 57, 0.6%) included a priori risk, MAP, UtA Doppler, PlGF and sFlt-1 achieving detection rates (DR) of 87.7% and 91.2% for 5% and 10% false-positive rates (FPR), respectively (AUC: 0.98 [95%CI: 0.97-0.99]). For late PE (n = 246, 2.6%), the best model included the a priori risk, MAP, UtA Doppler, PlGF and sFlt-1 achieving DR of 68.3% and 76.4% at 5% and 10% of FPR, respectively (AUC: 0.87 [95%CI: 0.84-0.90]).ConclusionPE can be predicted with high accuracy in general obstetric populations with a low-risk for PE, by combined algorithms. Angiogenic factors substantially improved the prediction. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 02/2015; 35(2). DOI:10.1002/pd.4519 · 2.51 Impact Factor
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    ABSTRACT: To determine the relationship between fetal brain metabolism and microstructure expressed by brain sulcation, and corpus callosum (CC) development assessed by fetal brain MRI and proton MR spectroscopy ((1)H-MRS). A total of 119 fetuses, 64 that were small for gestational age (estimated fetal weight <10(th) centile and normal umbilical artery Doppler) and 55 controls underwent a 3T MRI/(1)H-MRS exam at 37 weeks. Anatomical T2-w images were obtained in the three orthogonal planes and long echo time (1)H-MRS acquired from the frontal lobe. Head biometrics, cortical fissure depths (insular, sylvian, parietoccipital, cingulate and calcarine) and CC area and biometries were blindly performed by manual and semi-automated delineation using Analyze® software and corrected creating ratios for biparietal diameter (BPD) and frontooccipital diameter (FOD) respectively for group comparison. Spectroscopic data were processed using LC Model® software and analyzed as metabolic ratios of N-Acetylaspartate (NAA) to choline (Cho), Cho to creatine (Cr) and Myo-inositol (Ino) to Cho. Differences between cases and controls were assessed. To test for the association between metabolic ratios and microstructural parameters, bivariate correlation analyses were performed. Spectroscopic findings showed decreased NAA/Cho and increased Cho/Cr ratios in small fetuses. They also presented smaller head biometrics, shorter and smaller CC and greater insular and cingulate depths. Frontal lobe NAA/Cho significantly correlated with BPD (r=0.268;p=0.021), ), head circumference (r=0.259;p=0.026), CC length(r=0.265;p=0.026),CC area (r=0.317;p=0.007), and the area of 6 from the 7 CC subdivisions. It did not correlate with any of the cortical sulcation parameters evaluated. None of the other metabolic ratios presented significant correlations with cortical development or CC parameters. Frontal lobe NAA/Cho levels -which is considered a surrogate marker of neuronal activity- show a strong association with CC development. These results suggest that both metabolic and callosal alterations may be part of the same process of impaired brain development associated with intrauterine growth restriction. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 01/2015; DOI:10.1016/j.ajog.2015.01.041 · 3.97 Impact Factor
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    ABSTRACT: Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 01/2015; DOI:10.1159/000367805 · 2.30 Impact Factor
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    ABSTRACT: We report the successful use of fetoscopy to treat a case of severe low urinary tract obstruction (LUTO) secondary to a congenital megalourethra. A second trimester male fetus presented at 21 weeks of gestation with massive dilatation of the penile urethra. In addition, bilateral hydronephrosis, an enlarged and hypertrophic bladder, with progressive oligohydramnios were found, suggesting poor prognosis. Extensive counselling was performed and, after the approval from the local ethics committee and informed consent, patients accepted fetal therapy by fetoscopy. The procedure consisted in fetoscopic identification of the tip of the penis and confirmation of the complete absence of the urethral meatus. Thereafter, under combined endoscopic and ultrasound guidance a perforation of the tip of the penis was performed with contact diode laser, until an opening into the urethra was achieved. After the operation, resolution of the cystic penile dilation, with reduction of the penile size, and normalization of the amniotic fluid volume were observed. The pregnancy continued uneventfully and a normal male infant was born at term at the local hospital. The baby was developing normally with normal renal function at 6 months of age. Our report demonstrates that fetoscopic decompression of a distal urethra obstruction can achieve neonatal survival in the rare event of congenital megalourethra. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 01/2015; DOI:10.1159/000365988 · 2.30 Impact Factor
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    ABSTRACT: Objective To examine whether a first-trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women.Methods The anxiety levels of a cohort of women screened for preeclampsia at first trimester were measured by the Spielberg State Anxiety Inventory [STAI-S] and compared between women screened as low and high risk. In a subgroup of women the anxiety levels were additionally measured at second and third trimester. A General Linear Model (GLM) model for repeated measurements was performed to adjust for potential confounders (age, nulliparity and socio-economic level).ResultsA total of 255 women (135 low-risk and 120 high-risk) were evaluated. No differences were found in the mean STAI-S scores between low and high risk women: 35 (SD 9.9) and 34.6 (SD 10.1) (p = 0.77). The proportion of women with high anxiety was not significantly different between groups (28/134[20.7%]vs.24/120 [20%]; p = 0.88). No differences were found in the subgroups (51 low-risk and 50 high-risk) in which the anxiety levels were also measured at second and third trimester: 35.8 (SD 8.8)vs.35.2 (SD9.7) [p = 0.74] and 37.2 (SD 9.4)vs.35.3 (SD 8.6) [p = 0.3]. These differences remained non-significant after adjustment for potential confounders.ConclusionA strategy of first-trimester screening for preeclampsia does not increase maternal anxiety. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 01/2015; 35(1). DOI:10.1002/pd.4485 · 2.51 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S103. DOI:10.1016/j.ajog.2014.10.223 · 3.97 Impact Factor
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    ABSTRACT: Background: Intrauterine growth restriction (IUGR) induces fetal cardiac remodelling and dysfunction, which persists postnatally and may explain the link between low birth weight and increased cardiovascular mortality in adulthood. However, the cellular and molecular bases for these changes are still not well understood. We tested the hypothesis that IUGR is associated with structural and functional gene expression changes in the fetal sarcomere cytoarchitecture, which remain present in adulthood. Methods and Results: IUGR was induced in New Zealand pregnant rabbits by selective ligation of the utero-placental vessels. Fetal echocardiography demonstrated more globular hearts and signs of cardiac dysfunction in IUGR. Second harmonic generation microscopy (SHGM) showed shorter sarcomere length and shorter A-band and thick-thin filament interaction lengths, that were already present in utero and persisted at 70 postnatal days (adulthood). Sarcomeric M-band (GO: 0031430) functional term was over-represented in IUGR fetal hearts. Conclusion: The results suggest that IUGR induces cardiac dysfunction and permanent changes on the sarcomere.
    PLoS ONE 11/2014; 9(11):e113067. DOI:10.1371/journal.pone.0113067 · 3.53 Impact Factor
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    ABSTRACT: Congenital diaphragmatic hernia (CDH) may be isolated or associated with other structural anomalies, the latter with poor prognosis. The defect allows viscera to herniate through the defect into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. When isolated, survival chances can be predicted by antenatal measurement of lung size and liver herniation. Chromosomal microarrays and exome sequencing contribute to understanding genetic factors underlying isolated CDH. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion (FETO) under local anesthesia. The Tracheal Occlusion To Accelerate Lung growth trial (www.totaltrial.eu) is an international randomized trial investigating the role of fetal therapy for severe and moderate pulmonary hypoplasia. Despite an apparent increase in survival following FETO, the search for lesser invasive and more potent prenatal interventions must continue. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Seminars in Fetal and Neonatal Medicine 11/2014; DOI:10.1016/j.siny.2014.09.006 · 3.13 Impact Factor
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    ABSTRACT: Objective To evaluate the clinical value of uterine artery Doppler in the prediction of hemodynamic deterioration and adverse perinatal outcome in term small-for-gestational-age (SGA) fetuses.Study DesignUterine artery (UtA) Doppler, cerebroplacental ratio (CPR), and middle cerebral artery (MCA) pulsatility indices (PI) were weekly evaluated from diagnosis until 24 hrs before labor induction in a cohort of 327 SGA fetuses with normal umbilical artery PI (<95th centile) delivered above 37 weeks. Differences in the sequence of changes of CPR and MCA PI <5th centile between the group with normal and abnormal uterine artery Doppler at diagnosis were analyzed by survival analysis. In addition, the value of uterine artery Doppler, alone or in combination with brain Doppler before delivery, to predict cesarean delivery (CD), CD for nonreassuring fetal status (NRFS), neonatal acidosis (NA) and neonatal hospitalization was evaluated by logistic regression adjusted by gestational age at birth and birthweight percentile.ResultsAbnormal uterine artery at diagnosis was associated with a higher risk of developing abnormal brain Doppler before labor induction (62.7% vs. 34.6%, p < 0.01). Abnormal UtA Doppler was associated with a higher risk of intrapartum CD (52.2% vs. 37.3% with normal UtA Doppler, p = 0.03), CD for NRFS (35.8% vs. 23.1%, p = 0.03), NA (10.4% vs. 7.7%, p = 0.47) and neonatal hospitalization (23.9% vs. 16.5%, respectively, p = 0.16). Logistic regression analysis indicated that UtA Doppler had not significant association with adverse perinatal outcome independently of brain Doppler.Conclusion Uterine artery Doppler predicts adverse outcome, but it does not help to improve the predictive value of brain Doppler. However, at the time of diagnosis it identifies the subgroup of fetuses at highest risk of progression to abnormal brain Doppler.
    Ultrasound in Obstetrics and Gynecology 10/2014; 45(3). DOI:10.1002/uog.14706 · 3.14 Impact Factor
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    ABSTRACT: Objective The objective of this study was to develop an integrated model with the best performing criteria to predict adverse outcome in small-for-gestational age (SGA) pregnancies.Methods Cohort of 509 pregnancies with suspected SGA fetus eligible for trial of labor was recruited prospectively, and data on the perinatal outcome recorded. A predictive model for the occurrence of emergency cesarean delivery for non-reassuring fetal status or neonatal acidosis was constructed using the Decision Tree Analysis algorithm (SPSS 19.0), with predictors: maternal age, body mass index, smoking, nulliparity, gestational age at delivery, labor onset (induced vs. spontaneous), estimated fetal weight (EFW), umbilical artery pulsatility index (PI), mean uterine artery (UtA) PI, middle cerebral artery PI, and cerebroplacental ratio (CPR).ResultsAn adverse outcome occurred in 134 (26.3%) cases. The best performing combination to define high risk SGA was the presence of CPR < 10th centile, a mean UtA PI > 95th centile or an EFW < 3rd centile. The algorithm showed a sensitivity, specificity, positive and negative predicted value for adverse outcome of 82.8% (95% CI 75.1%-88.6%), 47.7% (95% CI 42.6%-52.9%), 36.2% (95% CI 30.8%-41.8%) and 88.6% (95% CI 83.2%-92.5%), respectively. Positive and negative likelihood ratios were 1.58 and 0.36.Conclusions Our model could be used as a diagnostic tool to discriminate SGA pregnancies at risk of adverse perinatal outcome.
    Ultrasound in Obstetrics and Gynecology 10/2014; 45(3). DOI:10.1002/uog.14714 · 3.14 Impact Factor
  • Geburtshilfe und Frauenheilkunde 09/2014; 74(S 01). DOI:10.1055/s-0034-1388032 · 0.96 Impact Factor
  • Geburtshilfe und Frauenheilkunde 09/2014; 74(S 01). DOI:10.1055/s-0034-1388050 · 0.96 Impact Factor
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    ABSTRACT: Objectives Myocardial performance index (MPI) is increasingly used in fetal medicine research, but wide variations in normal values are still reported. The aim of this study was to compare left MPI values and reproducibility using different settings and ultrasound equipment in order to standardize optimal machine settings.Methods Left MPI was prospectively evaluated by one observer performing conventional Doppler in 62 fetuses (28 to 36 weeks) using different settings (changing sweep speed, gain and wall motion filter (WMF)) and two different ultrasound devices (Siemens Antares, Siemens; Voluson E8, General Electric). Intraclass coefficients of agreement (ICC) were calculated by Bland Altman.ResultsUsing baseline settings, mean MPI was 0.44 (SD 0.05) with an ICC of 0.81. Decreasing the sweep speed resulted in decreasing average MPI values (0.43) and decreasing ICC (0.61). Lowering gain also influenced average MPI values (0.46) and ICC (0.76). Raising gain resulted in similar MPI values (0.45) with better ICC (0.90) as compared to baseline settings. Raising WMF provided the best ICC (0.94) compared to the other settings. Changing the ultrasound equipment resulted in ICC of 0.64. The optimal settings to achieve the highest reproducibility in MPI were sweep speed 8 cm/s, gain 60 dB and WMF 281Hz for Siemens; and sweep speed 5 cm/s, gain −10 dB and WMF 210 Hz for Voluson.Conclusions Changing ultrasound settings or equipment may affect MPI values calculation and repeatability. A strict standardization of methods improves the variability of this parameter for fetal cardiac function assessment.
    Ultrasound in Obstetrics and Gynecology 09/2014; 43(6). DOI:10.1002/uog.13365 · 3.14 Impact Factor
  • Geburtshilfe und Frauenheilkunde 09/2014; 74(S 01). DOI:10.1055/s-0034-1388052 · 0.96 Impact Factor

Publication Stats

5k Citations
1,702.48 Total Impact Points


  • 1993–2015
    • University of Barcelona
      • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      Barcino, Catalonia, Spain
  • 2006–2014
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1994–2014
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Materno Fetal
      Barcino, Catalonia, Spain
  • 2009–2013
    • Centro de Investigación Biomédica en Red de Enfermedades Raras
      Valenza, Valencia, Spain
  • 2008–2012
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 2011
    • IDIBELL Bellvitge Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 2005–2010
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2002–2009
    • Universitair Ziekenhuis Leuven
      • Department of Gynaecology and obstetrics
      Louvain, Flemish, Belgium
  • 2001–2009
    • University Hospital Vall d'Hebron
      • Department of Obstetrics
      Barcino, Catalonia, Spain
      Ayrivan, Yerevan, Armenia
  • 2002–2008
    • Autonomous University of Barcelona
      • Department of Biochemistry and Molecular Biology
      Cerdanyola del Vallès, Catalonia, Spain
  • 2006–2007
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
  • 2004
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
    • University of Rochester
      Rochester, New York, United States
  • 1999–2003
    • KU Leuven
      • Faculty of Medicine
      Leuven, VLG, Belgium
  • 2000
    • University of Milan
      Milano, Lombardy, Italy