Diagnostic value of combined maternal cardiac work and fetoplacental circulation parameters in detecting fetal intrauterine hypoxia in preeclamptic women

Abstract

To investigate the correlation between fetoplacental circulation and maternal left ventricular myocardial work (MW) parameters in patients with preeclampsia (PE) and the prediction of fetal hypoxia. Seventy-eight PE patients (PE group) were assigned to intrauterine-hypoxia (27) and non-intrauterine-hypoxia (51) groups, and 45 healthy pregnant women were controls. The receiver operating characteristic (ROC) curve evaluated the diagnostic efficacy of each parameter for fetal intrauterine hypoxia. Relative to the controls and the non-intrauterine-hypoxia group, the umbilical artery (UA) S/D, PI, and RI, as well as the global work index (GWI), global effective work, and global ineffective work, increased in the PE group and intrauterine-hypoxia group (P < 0.05), respectively, while the cerebroplacental ratio (CPR) and global work efficiency decreased (P < 0.05). Relative to the controls group, the middle cerebral artery S/D, PI, and RI decreased in the PE group (P < 0.05). Correlation analysis showed that the fetoplacental circulation parameters were correlated with MW parameters (P < 0.05), and CPR achieved the highest correlation. ROC curves showed that UA-S/D, combined with GWI, produced the highest predictive value for fetal hypoxia in PE patients. There was a linear correlation between MW parameters and fetoplacental parameters, and CPR showed the highest correlation with MW. UA-S/D, combined with GWI, exhibited optimal diagnostic efficacy in predicting fetal intrauterine hypoxia in PE patients.

Keywords: Fetal intrauterine hypoxia; Fetoplacental circulation; Myocardial work; Preeclampsia.

Fig. 1

(A) Non-invasive LV pressure-strain loop diagram. The area within the loop is estimated as global MW. (B) Bull’s eye plot of MW in pre-eclampsia with intrauterine hypoxia (GLS, − 17%; GWI, 2472 mmHg%; GCW, 3043 mmHg%; GWW, 322 mmHg%; GWE, 90%; BP, 170/110 mmHg); the red area represents a significant increase in GWI at the apex. (C) Bar graph of GCW and GWW in preeclampsia patients with intrauterine hypoxia. LV left ventricle, GLS global longitudinal strain, MW myocardial work, GWI global work index, GCW global constructive work, GWW global wasted work, GWE global work efficiency, BP blood pressure.

Fig. 2

ROC curves of UA-S/D combined with GWI, UA-S/D, and GWI in predicting fetal intrauterine hypoxia in PE patients. ROC Receiver operating characteristic, UA-S/D umbilical artery systolic/diastolic ratio, GWI global work index.