Nonstress Test Research Articles

Hedging securities and Silicon Valley Bank idiosyncrasies

AbstractHedging requires adequacy and timing. This paper finds that banks did not systematically ignore balance‐sheet risks like Silicon Valley Bank (SVB), and instead exercised risk management by asymmetrically increasing hedging activity when security losses increase and scaling back hedging activity as security losses reverse. Banks also hedge against bank runs when risk increases due to a combination of security losses and funding risks from unsecured deposits. Findings suggest SVB's mistakes are idiosyncratic. Results suggest that nonstress test banks target balance‐sheet risks when hedging, stabilizing themselves from interest rate shocks transmitted through fixed‐income securities. Scrutiny of rules‐based outliers like SVB is preferable to increased regulatory burden for all nonstress test banks.

Efficacy of antepartum fetal surveillance for stillbirth prevention

Objective In 2019 the American College of Obstetricians and Gynecologists (ACOG) issued specific recommendations for performance of antepartum fetal surveillance (AFS) based on individual risk factors. As similar recommendations were already in place at our institution, we have evaluated the impact of AFS on stillbirth (SB) occurrence in a 5-year cohort. Methods Retrospective cohort study of all deliveries between 7/1/2013 and 6/30/2018. Excluded were multiples, anomalous fetuses or newborns, and deliveries before 32 0/7 weeks’ gestation. AFS was conducted from 32 weeks with a modified biophysical profile, with a complete biophysical profile as back-up for non-reactive non-stress tests. All cases of SB were prospectively identified and individually reviewed to verify the presence of risk factors, the results of fetal testing if done, and calculate the interval between last fetal test and delivery. The electronic medical records during the study period were queried to identify women who underwent AFS and those who did not. Chi-square was used to compare the rates of SB between the two groups. Results 16,827 women fulfilled the study inclusion and exclusion criteria, 5711 (34%) had risk factors which prompted AFS; 37% had 2 or more risk factors. SB occurred in 1.8‰ of them (10/5711) (3 had 1 risk factor, 5 had 2, and 2 had 3 risk factors). Rates of SB at ≥32.0 weeks were similar between women who had AFS and those who did not (1.8 vs. 2.3‰, p = 0.51, OR = 0.75, 95%CI 0.36–1.55). The false-negative rate at <7 days of a reassuring AFS among compliant women was 1.4‰ (8/5711). Rates of preterm delivery were similar in the tested vs untested population (6.5 vs. 6.0%, p = 0.22). Conclusion Implementation of AFS in women with risk factors similar to those recommended by the ACOG may lower the risk of SB from 32 weeks to that of low-risk pregnancies.

A new effect of intravenous iron treatment in pregnancy: contraction in nonstress test and timing of labor.

The aim of this study was to elucidate the cause and results of contractions occurring in term pregnant women receiving intravenous iron therapy. During 2019-2020, 136 pregnant women beyond 35 weeks of gestation, who received intravenous iron treatment due to iron deficiency anemia, were included through retrospective screening. Iron deficiency anemia was defined as having hemoglobin levels <10 g/dL and ferritin levels <15 ng/mL, and the pregnant women underwent nonstress test before and after treatment. The average treatment week for the pregnant women was 36.82±0.74, and the presence of regular contractions in post-treatment follow-up nonstress tests was 72.1% (n=98). The average week of birth was 38.48±1.60. Pregnant women with contractions who had previous cesarean were found to have a mean delivery week of 36.82±0.67, which was statistically significant earlier than for nulliparous and multiparous women (p<0.001). In pregnant women with iron deficiency anemia who were beyond 35 weeks, temporary regular contractions may be observed in the nonstress test following intravenous iron replacement. We think that this effect may lead to early term birth in pregnant women with a history of cesarean section. It needs to be confirmed by further prospective studies and animal studies.

Comparative study of efficacy of fetal Admission test alone and non-stress test done antenatally with fetal Admission test to evaluate fetal outcome

Aim. Current study evaluated the efficacy of fetal admission test alone and nonstress test (NST) antenatally with fetal admission test in both low and high risk pregnant in relation to fetal outcome to decrease the fetal morbidity and mortality. Methods and material. Study included 240 pregnant women after 34 weeks of pregnancy who were categorized into low and high risk groups. The fetal outcome following Antenatal NST and Admission test studied based on Apgar score of &lt;7 at 5 minutes, Meconium stained liquor, NICU requirement, and mortality. Result. Apgar score &lt;7 at 5 min seen in 8 babies (13.33%), meconium stained liquor in 14(23.33%) and NICU admission in 11 (18.33%) cases in whom both antenatal NST and fetal admission tests were done together. Apgar score &lt;7 at 5 min seen in 14 (23.33%) babies, meconium stained liquor in 18 (30%) and NICU admission in 19 (31.66%) cases in whom only admission test was done. The Antenatal NST for antenatal fetal surveillance shows 96.88% of specificity, 29.17% of sensitivity, 70% of positive predictive value (PPV) and 84.55% of negative predictive value (NPV). The admission test for intrapartum fetal distress shows 99.38% of specificity, 32.91% sensitivity, 75.12% NPV and 96.3% PPV. Both NST and fetal admission test done together significantly decreased the incidence of fetal distress as early intervention was taken to prevent further fetal compromise in high-risk pregnant. NST strongly correlate with admission test result in high-risk pregnant. Conclusion. NST and fetal admission test in high risk pregnant helps for early detection of fetal distress and help to take necessary intervention to improve fetal outcome.

Gastroschisis ultrasound bowel characteristics demonstrate minimal impact on perinatal outcomes.

Bowel dilation and bowel wall thickness are common prenatal ultrasound measurements for fetuses with gastroschisis. Data regarding antenatal sonographic bowel findings and postnatal outcomes are conflicting. Our objective was to evaluate the impact of in utero bowel measurements on perinatal outcomes in gastroschisis pregnancies. Retrospective cohort study of 116 pregnancies complicated by gastroschisis between 2011 and 2020. We reviewed ultrasounds documenting fetal bowel measurements. To evaluate the association of these measurements with antepartum and delivery outcomes, we ran logistic and linear models using generalized estimating equations. Eleven perinatal outcomes reached statistical significance, although with minimal clinical impact given small magnitude of effect. Intra-abdominal bowel dilation was associated with a 0.5 week decrease in delivery gestational age (GA) (95% CI -0.07, -0.03) and a 6.93 g increase in birth weight (95% CI 1.54, 28.73). Intra-abdominal bowel wall thickness was associated with later GA of non-stress test (NST) start of 0.22 weeks (95% CI 0.07, 0.37), increased delivery GA of 0.08 weeks (95% CI 0.02, 0.15), 0.006 decrease in umbilical artery (UA) pH (95% CI -0.009, -0.003), 0.26 increase in UA base deficit (95% CI 0.09, 0.43), and decreased odds of cesarean delivery (OR = 0.83, 95% CI 0.70, 0.99). Extra-abdominal bowel wall thickness was associated with a 0.1 increase in UA base deficit (95% CI 0.02, 0.19) and a 0.05 increase in 5-min APGAR score (95% CI 0.01, 0.09). Stomach cross-section was associated with a 0.01 week decrease in delivery GA (95% CI -0.02, -0.001) and increased odds of receiving betamethasone (OR = 1.02, 95% CI 1.01, 1.04). In utero bowel characteristics reached statistical significance for several outcomes, but with minimal meaningful clinical differences in outcomes.

Small estimated placental volume (EPV) in the setting of decreased fetal movement

Although 60.5 % of clinically unexplained stillbirths can be attributed to placental insufficiency and/or fetal growth restriction, clinicians rarely calculate estimated placental volume (EPV). We present a scenario in which EPV was used to inform patient care of a 28-year-old with decreased fetal movement at 32 weeks and 1 day gestation. Although estimated fetal weight (EFW), amniotic fluid index (AFI), and nonstress test (NST) were normal, EPV was low (<0.1st percentile), which prompted more frequent patient follow-up. Oligohydramnios was detected at 38 weeks and 1 day, and labor was induced. An infant with birthweight in the 12th percentile for gestational age was born. We learned that EPV can precede intrauterine growth restriction (IUGR), oligohydramnios, and low birthweight.

Urgent Follow-up after Outpatient Nonstress Tests and the Potential for Fetal Monitoring at Home.

This study aimed to measure the proportion of patients needing urgent clinical follow-up after an abnormal outpatient nonstress test (NST). We further sought to capture the patient perspective on the acceptability of performing NSTs at home. A retrospective cohort study was performed over a 2-year period to determine the frequency of abnormal NSTs in a hospital-based, antepartum testing unit in patients greater than or equal to 32 weeks' gestation. The proportion of patients who delivered within 24 hours of an abnormal NST was also determined. A cross-sectional, web-based patient survey was conducted to obtain insight into the patient's comfort level with potentially performing NSTs at home. The chart review yielded 665 patients who underwent 2,122 NSTs at greater than or equal to 32 weeks. Of the 2,122 NSTs, 111 were categorized as abnormal and required urgent clinical follow-up, or 5.2% (95% confidence interval [CI] 4.3, 6.3%). Of the 665 patients, 13 delivered within 24 hours of an abnormal NST, or 2.0% (95% CI 1.0, 3.3%). In the web-based survey, the proportion of respondents who would feel comfortable or very comfortable conducting NSTs at home was 87/125, or 69.6% (95% CI 60.9, 77.1%). This study revealed that 5.2% of NSTs performed in a hospital-based antepartum testing unit were abnormal and required urgent clinical follow-up. Of the patients being followed in the antepartum testing unit, 2.0% delivered within 24 hours of an abnormal NST. The majority of the survey respondents indicated they would feel comfortable performing NSTs at home. The present study adds important information regarding the risks and benefits of NSTs at home. · Telehealth for NSTs offers advantages over in-person NSTs.. · The proportion of NSTs that need urgent follow-up was 5.2%.. · A majority of patients are interested in telehealth for NSTs.. · Guidelines are needed before adoption of telehealth for NSTs..

Misoprostol with balloon vs oxytocin with balloon in high-risk pregnancy induction: a randomized controlled trial

Pregnancies at high risk for maternal, fetal, or placental complications often necessitate induction of labor in the late preterm or early term period for delivery. Limited data exist on the safest method of induction to use in this specific patient population. This study aimed to compare the combination of oxytocin plus a Cook balloon vs misoprostol plus a Cook balloon for induction of labor in high-risk pregnancies. We conducted an open-label, randomized controlled trial at a single institution from July 2020 to May 2022. The study was approved by the institutional review board and registered with ClinicalTrials.gov (NCT04492072). Individuals with a high-risk pregnancy, at least ≥22 weeks' gestation, with a singleton in cephalic presentation, Bishop score ≤6, and intact membranes were offered enrollment. A high-risk pregnancy was defined as a pregnancy with any of the following complications: hypertensive disease of pregnancy, fetal growth restriction, oligohydramnios, suspected placental abruption requiring delivery, uncontrolled pregestational diabetes, or abnormal biophysical profile or nonstress test requiring delivery. The primary outcome was the rate of cesarean delivery. Secondary maternal outcomes included induction to delivery interval, number of vaginal deliveries within 24 hours, rates of uterine tachysystole, intraamniotic infection, operative vaginal delivery, and postpartum hemorrhage. Secondary fetal outcomes included fetal heart rate abnormalities, stillbirth, Apgar scores <7 at 5 minutes, admission to the neonatal intensive care unit, arterial umbilical blood pH <7.1, sepsis, and neonatal death. A subgroup analysis was planned for the primary outcome to assess the different indications for cesarean delivery. An intent-to-treat analysis was performed. During the 22 months of the trial, a total of 150 patients were randomized, and 73 (49%) of those were induced with oxytocin and a Cook balloon and 77 (51%) were induced with misoprostol and a Cook balloon. There was no significant difference in the overall rate of cesarean delivery between the study groups, (21.9% vs 31.1%; relative risk, 0.70; 95% confidence interval, 0.41-1.21), nor among those for which the cesarean delivery was performed for a specific indication. There were no differences in the secondary maternal and fetal or neonatal adverse outcomes. In high-risk pregnancies, the rate of cesarean delivery and adverse maternal and fetal outcomes were similar for induction of labor with oxytocin and a Cook balloon and for induction with misoprostol and a Cook balloon.

The effect of aromatherapy and music therapy upon anxiety and non-stress test results during pregnancy: A randomized clinical trial

IntroductionThe non-stress test (NST) is commonly recommended for assessing fetal wellbeing. Anxiety in pregnancy can affect NST results and thus rates of false-positive results can increase. This study aimed to explore whether lavender oil inhalation administered in conjunction with music therapy is more effective in reducing anxiety and NST results during pregnancy than the use of lavender oil alone. MethodsThis randomized clinical trial included 195 primiparous participants who were randomly assigned either to a control group, or one of two intervention groups receiving 1) lavender oil inhalation, 2) lavender oil inhalation and music therapy. Twenty minutes prior undertaking the NST, participants in the intervention groups inhaled four drops of 10% lavender oil. In the lavender/aromatherapy-music group, nature sounds were also played through earphones. Prior to the intervention and 20-minutes following the NST, state anxiety was measured as the primary outcome using the State-Trait Anxiety Inventory (STAI). NST results were assessed as secondary outcomes. For blinding, data was gathered by people unaware of the intervention. ResultsThe mean number of fetal heart rate accelerations, fetal movements, and the number of reactive NST results were more statistically significant in the two intervention groups than in the control group (p < 0.001). After adjusting baseline variation, when compared to control group, the mean score of state anxiety was significantly lower in the lavender/aromatherapy group (β=−7.03,95%confidenceinterval(CI):−8.83,−5.24) and lavender/aromatherapy-music group(β=−9.27,95%CI:−11.1,−7.49)than in the control group. Moreover, when compared to control group, the severity of state anxiety was significantly lower in the lavender/aromatherapy group (β=−3.84,95%CI:−5.58,−2.10) and the lavender/aromatherapy-music group (β=−5.01,95%CI:−7.05,−2.97) than in the control group. No adverse events were observed. ConclusionThe effects of using aromatherapy with lavender oil in conjunction with music therapy on state anxiety and NST results during pregnancy were similar to those resulting from the use of aromatherapy with lavender oil alone. Overall, the application of lavender oil as aromatherapy with or without music therapy is effective in reducing state anxiety during pregnancy and enhancing NST results. Trial registrationThis trial was registered in the Iranian Registry of Clinical Trials 22/12/2020 with code IRCT20090810002324N17. URL of registry: https://fa.irct.ir/trial/51378.

Induction of Labour among Pregnant Women in the Department of Obstetrics and Gynaecology in a Tertiary Care Centre.

Induction of labour is the artificial initiation of uterine contraction by various means such as medical, surgical or mechanical with the aim of achieving vaginal delivery. Misoprostol, a prostaglandin E1 analogue is used popularly for the induction of labour in resource-limited health centres. The aim of the study was to find out the prevalence of induction of labour among pregnant women in the Department of Obstetrics and Gynaecology in a tertiary care centre. A descriptive cross-sectional study was conducted among pregnant women in a tertiary care centre from 3 February 2022 to 31 July 2022. Ethical approval was taken from the Institutional Review Committee. The women with a singleton pregnancy, reactive non-stress test, and adequate pelvis were included. Women with malpresentation, previous cesarean section, placenta previa, and cephalopelvic disproportion were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 1355 pregnant women, the prevalence of induction of labour was found to be 135 (9.96%) (8.37-11.55, 95% Confidence Interval). The prevalence of induction of labour among pregnant women was found to be similar to other studies done in similar settings. induction of labour; misoprostol; pregnancy.

Outpatient Cervical Ripening With Misoprostol to Prevent Post-Term Pregnancy: A Double-Blind Randomized Clinical Trial

Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of &lt;8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P&lt;0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P&gt;0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy.

Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study.

Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients. We reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non-stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7 days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity. Of the 84 antenatally-diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8 weeks, interquartile range (IQR) 33.2-34.3 weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6-36.2] weeks vs. 36.7 [35.6-37.2] weeks, p = 0.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration. Our study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor.

Early Diagnosis and Classification of Fetal Health Status from a Fetal Cardiotocography Dataset Using Ensemble Learning.

(1) Background: According to the World Health Organization (WHO), 6.3 million intrauterine fetal deaths occur every year. The most common method of diagnosing perinatal death and taking early precautions for maternal and fetal health is a nonstress test (NST). Data on the fetal heart rate and uterus contractions from an NST device are interpreted based on a trace printer's output, allowing for a diagnosis of fetal health to be made by an expert. (2) Methods: in this study, a predictive method based on ensemble learning is proposed for the classification of fetal health (normal, suspicious, pathology) using a cardiotocography dataset of fetal movements and fetal heart rate acceleration from NST tests. (3) Results: the proposed predictor achieved an accuracy level above 99.5% on the test dataset. (4) Conclusions: from the experimental results, it was observed that a fetal health diagnosis can be made during NST using machine learning.

The Effect of Sildenafil Citrate on Improving Amniotic Fluid Index in Pregnant Women with Oligohydramnios and Borderline Oligohydramnios: A Randomized Controlled Trial

Background: Oligohydramnios is a common problem in pregnancy that requires therapeutic measures in addition to managing the underlying cause. Objectives: This study aimed to assess sildenafil citrate’s impact on the amniotic fluid index in pregnant women with oligohydramnios and borderline oligohydramnios. Methods: Women with a singleton pregnancy, oligohydramnios, and gestational age of 24 to 36 weeks were included. Patients were randomly divided into two groups. The intervention group also received 50 mg of sildenafil citrate every 8 hours and 3 liters of isotonic solution per day. In the control group, a placebo was given along with hydration therapy, similar to the intervention groups. The amount of amniotic fluid was reassessed one week and two weeks after treatment. Weekly measurements of amniotic fluid volume, biophysical profile, and non-stress test were used twice a week for fetal monitoring. This study analyzed the data using SPSS version 23 with a significance threshold of P ≤ 0.05. Results: Finally, there was a substantial change in the amniotic fluid level between the basic and end of the second week (P ≤ 0.05). There was no apparent distinction between the two groups regarding pharmaceutical side effects or the consequences of pregnancy. Conclusions: Sildenafil citrate enhanced amniotic fluid production, although no significant issues were seen for the mother or fetus.

Expectant management for umbilical artery thrombosis in monochorionic diamniotic twin pregnancies: a case report

BackgroundThrombosis of one of the umbilical arteries is a rare complication of pregnancy and is associated with adverse pregnancy outcomes, including stillbirth and intrauterine growth restriction. Although extremely rare, umbilical artery thrombosis (UAT) in monochorionic diamniotic twins is difficult to diagnose prenatally and manage. UAT has a poor prognosis and is associated with an increased perinatal mortality rate. In most previous cases, emergency cesarean section was performed or intrauterine fetal death occurred at the time of UAT diagnosis. Case presentation: Herein, we report an extremely rare case of sequential UAT in monochorionic diamniotic twins diagnosed via ultrasound at 29+ 5 weeks of gestation in a 34-year-old woman. Following expectant management with intensive monitoring for 16 days, two healthy infants were delivered through an emergency cesarean section. UAT in both fetuses was confirmed by pathological examination. The mother and twins described in this case underwent long-term follow-up and are currently in good health without any complications.ConclusionsBased on our experience, we suggest that expectant management should be undertaken as long as the mother and infants are stable on ultrasonographic scans and are closely monitored. When UAT is suspected, we believe that the best delivery time should be determined by considering complaints of unusual fetal movements, non-stress test evidence, gestational age, amniotic fluid volume, and blood flow in the umbilical artery, middle cerebral artery, and ductus venosus. Obstetricians should ensure that the patients and their families are clearly informed about all potential risks of expectant management for UAT.

Comparison of Inflammatory Factors of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Maternal Platelet Count in Patients with and Without Chorioamnionitis and with Premature Preterm Rupture of Membrane

Background: The present study aimed to compare inflammatory markers of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and maternal platelet count in patients with and without chorioamnionitis with premature preterm rupture of membrane (PPROM). Methods: Women with PPROM and gestational age less than 34 weeks were enrolled in this cohort study. PPROM was confirmed with sterile speculum examination or the AmniSure test. A blood sample was drawn from mothers for complete blood count (CBC) and differential count (Diff) before administering antibiotics and corticosteroids. Another blood sample was drawn for CBC-Diff tests at the time of pregnancy termination. The status of mothers and fetuses was carefully monitored during hospitalization through the following indicators: Vital signs, daily abdominal examination, uterus discharge, daily non-stress test, and weekly ultrasonography. All samples were collected in one year. Results: A total of 110 patients were examined. The reason for pregnancy termination was gestational age of 34 weeks in 30 patients (27.3%), chorioamnionitis in 19 cases (17.3%), pain and dilation in 32 cases (29.1%), and miscellaneous in 29 cases (26.4%). Among the study parameters, only NLR was significantly different between groups, and the order of values from highest to lowest was in the chorioamnionitis, pain and dilatation, miscellaneous, and gestational age of 34 weeks groups. We found that NLR at a cut-off point of 3.2 - 3.5 had an acceptable sensitivity and low specificity to detect the cases of chorioamnionitis. Raised NLR was associated with (95% CI) histological chorioamnionitis with a sensitivity of 86% and a specificity of 43%. Conclusions: According to the findings of our study, NLR can be a suitable indicator for predicting chorioamnionitis in women who deliver preterm without clinical signs and symptoms of infection. It can be used for expectant management for PPROM after 34 weeks.

Clinical features and test indications of 11,087 patients undergoing cardiac magnetic resonance imaging during a decade in a tertiary referral center: A retrospective observational study

Purpose: We evaluated the clinical characteristics of patients undergoing cardiac magnetic resonance (CMR) examinations over 10 years at a tertiary referral hospital.Methods: This retrospective study included 11,087 CMR examinations performed between November 2009 and September 2020. The number of adults aged ≥20 years was 10,648 (72.8% males). A total of 439 children or young adults aged &lt; 20 years underwent CMR (66.5% males). Indications for CMR examinations were classified according to the Consensus Panel recommendations of the Society for Cardiovascular Magnetic Resonance (SCMR).Results: The mean age was 55.9±12.4 years for adults. Forty percent of patients were obese. Leading cardiovascular risk factors were hypertension, dyslipidemia, diabetes mellitus, and current smoking status in 28.2%, 19.1%, 13.8%, and 25.4% of patients, respectively. The proportion of stress CMR examinations performed was 57.2%. For children, the mean age was 12.6±5.3 years. Most children underwent a non-stress CMR test. In adults without congenital heart disease, indication numbers for SCMR classes were 5,682 for class I (49.4%), 772 for class II (6.7%), 313 for class III (0.3%), and 4,714 for investigational group (41.1%). In pediatric patients and adults with congenital heart disease, indication numbers for SCMR classes were 539 for class I (80.3%), 62 for class II (9.2%), and 70 for the investigational group (10.4%).Conclusion: CMR is most commonly performed in men in their 50s or 60s. CMR may be used as the first-line imaging technique (SCMR class I) in around a half of adult patients and in most pediatric patients.

Prognostic role of stress-CMR and SPECT-MPI in patients undergoing intermediate-to-high risk non-cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Data supporting the role of stress test myocardial perfusion imaging (MPI) before non-cardiac surgery (NCS) are sparse and out of date. In particular, there is no specific evidence on the use of stress cardiac magnetic resonance (sCMR) in this setting. The aim of the present study was to evaluate the impact MPI stress test with sCMR and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) on surgery-related cardiac events. Method In this single-centre retrospective study, we included all patients with CAD or at least two cardiovascular risk factors undergoing intermediate-to-high-risk non-cardiac surgery. After a pre-operative cardiological assessment, including EKG and echocardiography, the indication to perform a pre-operative MPI-stress-test relied on the clinical judgement of the cardiologist. Cardiac events occurring within 30 days from surgery were evaluated. A composite primary endpoint included myocardial infarction, unstable angina, cardiac death, cardiogenic shock and pulmonary oedema. The secondary endpoint was the rate of acute coronary syndromes. Results A total of 1590 patients were included, of whom 669 underwent an MPI stress test strategy (287 sCMR, 382 SPECT-MPI). The rate of 30-day cardiac events was lower in the stress test group vs. the non-stress test group (1.2% vs 3.4%; p 0,006; figure 1). Adopting a stress test strategy showed a significant reduction of composite endpoint (OR: 0.334, IC: 0.155 – 0.766, p 0.009) and acute coronary syndrome (OR: 0.414, IC: 0.174 – 0.984, p 0.046) at multivariable analysis. Stress CMR was non-inferior to SPECT in predicting cardiac events and showed a greater accuracy to predict coronary artery revascularizations (AUC for sCMR: 0.95 with a percentage of myocardial ischemia cut-point of 5.5%; figure 2). Conclusions A stress-test strategy is associated with a lower incidence of cardiac events in high-risk patients candidate to intermediate-to-high-risk non-cardiac surgery. The rate of cardiac complications is similarly predicted by sCMR and SPECT-MPI, although sCMR is more accurate in predicting coronary artery revascularizations.

Maternal mood and anxiety effects on the fetal nonstress test

Previous studies have suggested that acute mood states may influence levels of fetal activity. Because the fetal nonstress test relies on markers of fetal activity to suggest fetal wellbeing, its interpretation may be affected by maternal mood. This study sought to determine if there are differences in nonstress test characteristics between pregnant individuals with and without symptoms of mood disorder. In this prospective cohort study, we recruited pregnant individuals undergoing nonstress test in the third trimester and compared the results of the nonstress test between pregnant individuals with scores above and below the cutoff values on validated screening questionnaires for depression and anxiety symptoms, the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7). Demographic information was collected from each participant at the time of recruitment, and medical information was extracted from the electronic medical record. A total of 68 pregnant individuals were enrolled, 10 (15%) of which screened positive for perinatal mood disorders. There was no significant difference in means of time to reactivity (15.6 [4.8] minutes vs 15.0 [8.0] minutes, P=.77), number of accelerations (0.16/min [0.08] vs 0.16/min [0.10], P>.95), number of fetal movements (17.0 [14.7] vs 19.7 [20.4], P=.62), heart rate baseline (138.0 [7.5] bpm vs 139.2 [9.0] bpm, P=.67) or variability (8.5 [2.5] bpm vs 9.1 (4.3) bpm, P=.51) between pregnant individuals who screen positive for mood disorders and those who did not. Fetal heart rate patterns are similar in pregnant individuals with and without symptoms of mood disorder. The results provide reassurance that acute symptoms of anxiety and depression do not have significant effects on the fetal nonstress test.

Effects of music therapy on the fetal outcomes of non-stress test and maternal anxiety

ImportanceThe non-stress test (NST) is an effective method for evaluating fetal movement and heart rate; however, it is associated with a large number of false-positive results. Music therapy induces maternal relaxation and reduces anxiety. ObjectiveThe aim of this study was to evaluate the effect of NST with music therapy on fetal parameters and maternal trait and state anxiety. MethodThis randomized clinical trial included 80 women, who were in gestational age of 32–42 weeks, referred to Asali Hospital. The participants were randomly assigned into two groups; the intervention group received 20minutes of music therapy along with NST whereas the control group did not. Spielberg State-Trait Anxiety Inventory was used to access trait and state anxiety in the two groups. The data were recorded using a questionnaire and statistically analyzed using SPSS. ResultsThe mean age of the participants and gestational age were not significantly different between the two groups (P=0.73 and P=0.95, respectively). The outcomes of the NST test showed that fetal heart rate was not statistically different between the two groups, P=0.09. Acceleration (P=0.01), short-term heart rate variability (P<0.01), long-term heart rate variability (P<0.01), fetal movement (P<0.01), and minimal reactive time (P<0.01) were significantly different between the two groups. Trait and state anxiety were also significantly lower in the intervention group (P=0.01 and P<0.01, respectively). InterpretationMusic therapy is significantly associated with the increase in fetal movement and heart rate and reduced reactive time in NST. State and trait anxiety levels decreased following this intervention.