7–11 October 2007, Florence, Italy Oral poster abstracts OP20.07: Table AGA IUGR S1 IUGR S2 IUGR S3 IUGR S4 n 75 37 48 68 23 Echocardiography Aortic isthmus flow index -0.5 (1.3) -0.9 (1.5) -1.3 (4) -2.5 (6.5)** -11.8 (4.2)** Aortic peak velocity -0.04 (1.3) -0.9 (1.3)* -0.8 (1.7)* -0.9 (1.4)* -1.3 (1.8)** Pulmonary peak velocity -0.6 (1.1) -1.3 (1.7)* -1.5 (1.1)* -1.3 (1.4)* -1.5 (1.2)* Aortic valve diameter 0.8 (1.6) 0.1 (1.9)* 0.2 (2.5) 0.7 (2.4) 0.3 (2) Pulmonary valve diameter 0.1 (1.4) -0.3 (2.4) -1.5 (2.4)* 0.1 (1.6) -1.4 (1.1)* Left shortening fraction -1.5 (1.2) -2 (1.6) -1.2 (1.6) -1.7 (3.1) 0.03 (4.3)* Right shortening fraction -0.8 (3) -2.7 (4.3)* -1.2 (3.8) -1.2 (4.7) -0.3 (7.5) Isovolumetric contraction time -0.05 (1.3) 0 (1.9) 0 (1.7) 0.3 (1.8) 0.5 (2.5) Ejection time 0 (1.3) -0.8 (1.8)* -1.3 (1.4)* -1.5 (1.7)* -1.6 (1.2)* Cardiothoracic ratio 0.4 (1.2) 0.3 (1.5) 0.6 (1.8) 1.1 (1)* 2.2 (1)** Left E/A ratio -0.3 (1.4) -0.1 (1.8) 0.4 (1.4)* 0.5 (2.2)* 1.6 (2.7)** Right E/A ratio 0.2 (0.9) 0.3 (1.7) 0.7 (1.5)* 0.6 (1.9)* 1.2 (2.2)* Isovolumetric relaxation time 0.05 (1.3) 0.3 (1.7) 0.5 (2.1) 0.5 (2.6) 1.2 (3.4)** Modified-myocardial performance index -0.1 (1.2) 0.6 (2.3)* 1.1 (2.1)* 1.1 (2.4)* 1.9 (2.1)** Normalized left cardiac output 235 (147) 295 (67)* 344 (155)* 351 (219)* 298 (184)* Normalized right cardiac output 343 (113) 308 (162) 429 (212)* 463 (245)* 554 (119)** Normalized combined cardiac output 570 (166) 512 (180) 749 (318)* 881 (289)* 722 (225)* Biochemical evaluation Cord blood BNP (pg/mL) 20 (26) 48 (51)* 92 (164)* 70 (83)* 410 (340)** Data presented as median (interquartile range). *P < 0.05 compared to AGA, **P < 0.05 compared to IUGR S1. were used as controls. Echocardiographic data were normalized in Z-scores. Results: Echocardiographic and biochemical parameters were significantly different in IUGR compared to AGA fetuses (aortic isthmus flow index (IFI): median -1.6 (interquartile range 6.7) vs. -0.5(1.3); aortic peak velocity -1(1.4) vs. -0.1(1.4); pulmonary peak velocity -1.4(1.1) vs. -0.6(1.1); cardiothoracic ratio 1.1(1.5) vs. 0.4(1.2); left E/A ratio 0.5(2) vs. -0.3(1.4); right E/A ratio 0.7(1.8) vs.0.2(1); isovolumetric contraction time 0.1(1.9) vs.-0.1(1.3); ejection time -1.3(1.6) vs.0(1.4); isovolumetric relaxation time (IRT) 0.5(2.3) vs. 0(1.3); modified-myocardial performance index (Mod-MPI) 1(2.3) vs. -0.1(1.2); cord blood BNP 143 pg/mL(228) vs. 20 pg/mL(26), respectively). Most cardiac parameters were significantly different from early stages of fetal deterioration, although the most remarkable differences occurred at S4. IFI, Mod-MPI, IRT and BNP showed the best progression across the hemodynamic deterioration stages. Conclusions: IUGR fetuses showed echocardiographic and biochem- ical signs of cardiac dysfunction from early stages of IUGR. The clearest differences were observed for IFI, Mod-MPI, IRT and BNP. OP20.08 The use of a cardiac profile improves detection of heart dysfunction and prediction of poor perinatal outcome as compared with ductus venosus alone F. Crispi , E. Hernandez-Andrade, J. A. Benavides-Serralde, N. Padilla, R. Acosta, E. Gratacos Hospital Clinic Barcelona, Spain Objectives: Absent/reverse atrial flow in the ductus venosus (DV) is the main parameter for short-term follow up in IUGR fetuses, with a sensitivity ranging from 50% to 60% for perinatal mortality. We tested whether a composite cardiac profile integrating aortic isthmus flow index (IFI) and modified myocardial performance index (Mod-MPI) could improve DV sensitivity for mortality and adverse outcome in IUGR fetuses. Methods: IFI, Mod-MPI and DV pulsatility index (PI) were analyzed in 67 severe early IUGR fetuses (delivery < 34 weeks) at the last ultrasound examination before delivery or fetal death and classified as normal or abnormal (> 1.6 SD). Fetuses were classified in four stages according to their cardiac profile as: Normal : all three parameters normal; Grade 1 (G1): one abnormal parameter; Grade 2 (G2): at least two abnormal parameters; Grade 3 (G3): G2 plus absent/reverse atrial flow in the DV. Cord blood brain natriuretic peptide (BNP) levels were measured at birth. Perinatal mortality was defined as death occurring prenatally or postnatally (≤ 30 days of life). Adverse perinatal outcome (APO) was defined as the presence of either neonatal parenchymal brain damage, intraventricular hemorrhage, severe pulmonary distress syndrome, necrotizing enterocolitis, renal failure or perinatal death. Results: Overall perinatal mortality was 19%. Absent/reserve atrial flow in the DV identified seven of the 13 deaths, but failed to detect six. Five of these six had a G2 cardiac profile. A cardiac profile ≥ G2 identified almost all perinatal deaths (92%) with a high negative predictive value (NPV) (97%). For APO, a cardiac profile ≥ G2 showed a sensitivity of 84% and a NPV of 88%, as compared with 32% and 70% for G3 alone. Cord blood BNP levels were significantly elevated in all groups with abnormal cardiac profile, and showed a progressive increase across the grades of severity. Normal Cardiac Cardiac Cardiac cardiac dysfunction dysfunction dysfunction function Grade 1 Grade 2 Grade 3 N 15 18 24 10 Clinical data Caucasian 87% 90% 71% 80% Smokers 38% 6% 14% 50% Pre-eclampsia 75% 61% 50% 50% Doppler recordings Uterine artery mean PI 5.8 (3.5) 4.9 (5.1) 6.4 (4.7) 6.4 (1.7) Umbilical artery PI 4.7 (3.1) 5 (5.9) 9.7 (9.5)* 17.3 (19.7)* Middle cerebral artery PI -2.7 (0.9) -2.5 (1.3) -2.2 (1.3) -1.9 (2.2) Cerebro-placental ratio -3 (0.9) -2.9 (0.7) -3.3 (0.7) -3.3 (0.8) DV-PI -0.6 (1.8) 1 (3.4)* 2.7 (2.5)* 6.7 (3.3)* IFI -0.1 (0.1) -0.5 (1.8) -7.4 (9.1)* -10.5 (9.5)* Mod-MPI -0.6 (1.7) 1.9 (1.9)* 1.9 (2.5)* 3.1 (2.6)* BNP concentrations Maternal BNP (pg/mL) 0.9 (1.5) 1.5 (11.3) 1.8 (2.6) 1.5 (1.7) Cord blood BNP (pg/mL) 12 (52) 37 (60) 65 (85)* 318 (470)* Perinatal outcome Gestational age at delivery (weeks) 30 (2.3) 31.7 (3.6) 29.4 (2.7) 27.4 (2.1)* Birth weight (g) 985 (298) 1095 (318) 960 (458) 595 (240)* Birth weight percentile 0 (1) 0 (1) 0 (1) 0 (2) 5-min Apgar < 5 0% 5% 5% 28% Arterial cord pH < 7.20 0% 31% 37%* 80%* Perinatal mortality 0% (0/15) 5% (1/18) 21% (5/24) 70% (7/10)* Adverse perinatal outcome 13% (2/15) 11% (2/18) 54% (13/24)* 80% (8/10)* Data presented as median (interquartile range) or proportions. *P < 0.05 compared to normal cardiac function group. All Doppler parameters are expressed as Z-scores. Conclusions: A cardiac profile combining DV, Mod-MPI and IFI may improve the short-term predictive value for mortality and APO as compared with DV alone in IUGR fetuses. Ultrasound in Obstetrics & Gynecology 2007; 30: 456–546 525