Pulmonary Vein PI, Cardiac Function and Remodeling in SGA Fetuses`

To investigate the myocardial performance index (MPI), global sphericity index (GSI) and pulmonary vein pulsatility index (PVPI) changes in FGR fetuses in an Indian population.

In this prospective observational study, 70 fetuses from 26 weeks to term were recruited into two groups: 35 fetuses with appropriate growth (controls) and 35 with EFW < 10th centile, which were further classified into SGA (n = 14) and FGR (n = 21) based on vessel Doppler parameter (umbilical artery PI > 95th centile, CPR < 5th centile). PVPI, MPI and GSI were measured and compared among groups.

Mean PVPI was increased in FGR 0.91 ± 0.23 compared to controls 0.79 ± 0.19 (p = 0.021) and showed an increasing trend across groups-controls, SGA and FGR. The mean GSI was decreased in FGR 1.16 ± 0.12 compared to controls 1.33 ± 0.33 (p = 0.047), indicating a more globular heart. Though the mean MPI did not show a statistically significant difference between the groups, its component ET (ejection time) was shorter in FGR 158.28 ± 17.81 compared to controls 165.54 ± 13.78 (p = 0.047).

Growth-restricted fetuses undergo cardiac remodeling due to hemodynamic redistribution and show a decreased global sphericity index, indicating a more globular heart. Additionally pulmonary vein Doppler changes like increased PVPI reflect atrial dynamic changes which can be used as an early predictor of compromise as these occur before DV changes.