title: Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus.
abstract: OBJECTIVE
  Fetal cardiac left ventricular function in pregnant women with pregestational or gestational diabetes mellitus was investigated by exploring fetal myocardial performance index (MPI) and E wave/A wave peak velocity (E/A) ratio.
  
  
  METHODS
  Seventy pregnant women with either pregestational or gestational diabetes mellitus and with no other systemic or pregnancy related disorders were compared with 70 gestational age matched healthy controls by means of fetal left ventricular MPI and E/A ratio. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods: ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT), which were employed in the calculation of MPI (MPI = [ICT + IRT]/ET). Statistical analyses were conducted using receiver operating characteristic analysis and independent two-sample t, Mann-Whitney U and chi-square tests.
  
  
  RESULTS
  Fetal left ventricular MPI values were significantly higher in the diabetic group compared with controls (0.56 ± 0.09 vs 0.36 ± 0.04, P < 0.001), whereas E/A ratio was lower (0.66 ± 0.11 vs 0.69 ± 0.09, P = 0.049). The adverse perinatal outcome rate was also higher in the diabetic group. Receiver operating characteristic analysis revealed > 0.39 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 90.9%, specificity: 47.7%, area under the curve: 0.690, 95% confidence interval: 0.598-0.782, P < 0.001).
  
  
  CONCLUSIONS
  We conclude that fetuses of diabetic mothers have significant left ventricular systolic and diastolic dysfunction. MPI may be used in the prediction of adverse perinatal outcome in diabetic pregnancies.
authors.affiliation: Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.
authors.forename: Cem Yasar
authors.initials: CY
authors.lastname: Sanhal
authors.affiliation: Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.
authors.forename: Halil Korkut
authors.initials: HK
authors.lastname: Daglar
authors.affiliation: Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kara
authors.affiliation: Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Uygur
authors.affiliation: Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.
authors.forename: Aykan
authors.initials: A
authors.lastname: Yucel
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000196:embryology* / Q000503:physiopathology; D016640:Diabetes, Gestational / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D009200:Myocardial Contraction; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D016277:Ventricular Function, Left
keywords: diabetes; myocardial performance index; outcome