title: The cardiac state diagram as a novel approach for the evaluation of pre- and post-ejection phases of the cardiac cycle in asphyxiated fetal lambs.
abstract: The aim of this study was to investigate myocardial wall motion using echocardiography and color-coded tissue velocity imaging and to generate a cardiac state diagram for evaluation of the duration of the pre- and post-ejection phases in asphyxiated fetal lambs. Six near-term lambs were partly exteriorized and brought to cardiac arrest through asphyxia. Echocardiography measurements were recorded simultaneously with arterial blood sampling for lactate and blood gases. All fetal lambs exhibited prolongation of the pre- and post-ejection phases at the time when the most pronounced changes in lactate concentration and pH occurred. The mean change in duration of the pre- and post-ejection phases for all fetal lambs was 36 ± 7 ms (p < 0.002) and 77 ± 17 ms (p < 0.019), respectively, and the percentage change was 50% (p < 0.001) and 38% (p < 0.049), respectively. As asphyxia progressed in fetal lambs, the duration of the pre- and post-ejection phases increased. The cardiac state diagram has the potential to be a comprehensible tool for detecting fetal asphyxia.
authors.affiliation: Department of Obstetrics and Gynecology, Center of Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden. elle.wagstrom@karolinska.se
authors.forename: Elle
authors.initials: E
authors.lastname: Wågström
authors.forename: Jonas
authors.initials: J
authors.lastname: Johnson
authors.forename: Kjerstin
authors.initials: K
authors.lastname: Ferm-Widlund
authors.forename: Nina
authors.initials: N
authors.lastname: Elmstedt
authors.forename: Karina
authors.initials: K
authors.lastname: Liuba
authors.forename: Britta
authors.initials: B
authors.lastname: Lind
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Brodin
authors.forename: Stig
authors.initials: S
authors.lastname: Lundbäck
authors.forename: Magnus
authors.initials: M
authors.lastname: Westgren
mesh_terms: D000465:Algorithms; D000818:Animals; D001238:Asphyxia Neonatorum / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003198:Computer Simulation; D005311:Fetal Hypoxia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008955:Models, Cardiovascular; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012756:Sheep; D013318:Stroke Volume; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Asphyxia; Cardiac state diagram; Cardiac time intervals; Doppler; Echocardiography; Fetal physiology; Myocardial motion; Tissue velocity imaging