{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:24:12Z","timestamp":1789611852803,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The primary aim of this study was to evaluate the feasibility of automated measurement of fetal atrioventricular (AV) plane displacement (AVPD) over several cardiac cycles using myocardial velocity traces obtained by color tissue Doppler imaging (cTDI). The secondary objectives were to establish reference ranges for AVPD during the second half of normal pregnancy, to assess fetal AVPD in prolonged pregnancy in relation to adverse perinatal outcome and to evaluate AVPD in fetuses with a suspicion of intrauterine growth restriction (IUGR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The population used to develop the reference ranges consisted of women with an uncomplicated singleton pregnancy at 18\u201342\u2009weeks of gestation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009201). The prolonged\u2010pregnancy group comprised women with an uncomplicated singleton pregnancy at \u2265\u200941\u2009+\u20090\u2009weeks of gestation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009107). The third study cohort comprised women with a singleton pregnancy and suspicion of IUGR, defined as an estimated fetal weight &lt;\u20092.5\n                      <jats:sup>th<\/jats:sup>\n                      centile or an estimated fetal weight &lt;\u200910\n                      <jats:sup>th<\/jats:sup>\n                      centile and umbilical artery pulsatility index &gt;\u200997.5\n                      <jats:sup>th<\/jats:sup>\n                      centile (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935). Cineloops of the four\u2010chamber view of the fetal heart were recorded using cTDI. Regions of interest were placed at the AV plane in the left and right ventricular walls and the interventricular septum, and myocardial velocity traces were integrated and analyzed using an automated algorithm developed in\u2010house to obtain mitral (MAPSE), tricuspid (TAPSE) and septal (SAPSE) annular plane systolic excursion. Gestational\u2010age specific reference ranges were constructed and normalized for cardiac size. The correlation between AVPD measurements obtained using cTDI and those obtained by anatomic M\u2010mode were evaluated, and agreement between these two methods was assessed using Bland\u2013Altman analysis. The mean\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010scores of fetal AVPD in the cohort of prolonged pregnancies were compared between cases with normal and those with adverse outcome using Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      \u2010test. The mean\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010scores of fetal AVPD in IUGR fetuses were compared with those in the normal reference population using Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      \u2010test. Inter\u2010 and intraobserver variability for acquisition of cTDI recordings and offline analysis was assessed by calculating coefficients of variation (CV) using the root mean square method.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fetal MAPSE, SAPSE and TAPSE increased with gestational age but did not change significantly when normalized for cardiac size. The fitted mean was highest for TAPSE throughout the second half of gestation, followed by SAPSE and MAPSE. There was a significant correlation between MAPSE (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.64;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), SAPSE (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.72;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and TAPSE (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.84;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) measurements obtained by M\u2010mode and those obtained by cTDI. The geometric means of ratios between AVPD measured by cTDI and by M\u2010mode were 1.38 (95% limits of agreement (LoA), 0.84\u20132.25) for MAPSE, 1.00 (95%\u2009LoA, 0.72\u20131.40) for SAPSE and 1.20 (95%\u2009LoA, 0.92\u20131.57) for TAPSE. In the prolonged\u2010pregnancy group, the mean\u2009\u00b1\u2009SD\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010scores for MAPSE (0.14\u2009\u00b1\u20090.97), SAPSE (0.09\u2009\u00b1\u20091.02) and TAPSE (0.15\u2009\u00b1\u20090.90) did not show any significant difference compared to the reference ranges. Twenty\u2010one of the 107 (19.6%) prolonged pregnancies had  adverse perinatal outcome. The AVPD\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010scores were not significantly different between pregnancies with normal and those with adverse outcome in the prolonged\u2010pregnancy cohort. The mean\u2009\u00b1\u2009SD\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010scores for SAPSE (\u22120.62\u2009\u00b1\u20091.07;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006) and TAPSE (\u22120.60\u2009\u00b1\u20090.89;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002) were significantly lower in the IUGR group compared to those in the normal reference population, but the differences were not significant when the values were corrected for cardiac size. The interobserver CVs for the automated measurement of MAPSE, SAPSE and TAPSE were 28.1%, 17.7% and 15.3%, respectively, and the respective intraobserver CVs were 33.5%, 15.0% and 17.9%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study showed that fetal AVPD can be measured automatically by integrating cTDI velocities over several cardiac cycles. Automated analysis of AVPD could potentially help gather larger datasets to facilitate use of machine\u2010learning models to study fetal cardiac function. The gestational\u2010age associated increase in AVPD is most likely a result of increasing cardiac size, as the AVPD normalized for cardiac size did not change significantly between 18 and 42\u2009weeks. A decrease was seen in TAPSE and SAPSE in IUGR fetuses, but not after correction for cardiac size. \u00a9 2021 The Authors.\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.23703","type":"journal-article","created":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T09:53:06Z","timestamp":1623059586000},"page":"853-863","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Automated quantitative evaluation of fetal atrioventricular annular plane systolic 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Medicine, Department of Obstetrics and Gynecology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Zamprakou","sequence":"additional","affiliation":[{"name":"Department of Clinical Science Intervention and Technology \u2010 CLINTEC, Karolinska Institutet  Stockholm Sweden"},{"name":"Pregnancy and Delivery Medical Unit, Department of Obstetrics and Gynecology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Westgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Science Intervention and Technology \u2010 CLINTEC, Karolinska Institutet  Stockholm Sweden"},{"name":"Center for Fetal Medicine, Department of Obstetrics and Gynecology Karolinska University Hospital  Stockholm 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