Z-score reference ranges for pulsed-wave Doppler indices of the cardiac outflow tracts in normal fetuses

Int J Cardiovasc Imaging. 2019 May;35(5):811-825. doi: 10.1007/s10554-018-01517-1. Epub 2019 Jan 8.


To determine Z-score equations and reference ranges for Doppler flow velocity indices of cardiac outflow tracts in normal fetuses. A prospective cross-sectional echocardiographic study was performed in 506 normal singleton fetuses from 18 to 40 weeks. Twelve pulsed-wave Doppler (PWD) measurements were derived from fetal echocardiography. The regression analysis of the mean and the standard deviation (SD) for each parameter were performed against estimated fetal weight (EFW) and gestational age (GA), in order to construct Z-score models. The correlation between these variables and fetal heart rate were also investigated. Strong positive correlations were found between the twelve PWD indices and the independent variables. A linear-quadratic regression model was the best description of the mean and SD of most parameters, with the exception of the velocity time interval (VTI) of ascending aorta against EFW, which was best fitted by a fractional polynomial. Z-score equations and reference values for PWD indices of fetal cardiac outflow tracts were proposed against GA and EFW, which may be useful for quantitative assessment of potential hemodynamic alternations, particularly in cases of intrauterine growth retardation and structural cardiac defects.

Keywords: Doppler flow velocity waveform; Fetal cardiac outflow tract; Fetal echocardiography; Reference ranges; Z-score.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Echocardiography, Doppler, Pulsed* / standards
  • Female
  • Fetal Heart / diagnostic imaging*
  • Fetal Heart / physiology
  • Gestational Age
  • Heart Rate, Fetal
  • Humans
  • Predictive Value of Tests
  • Pregnancy
  • Prospective Studies
  • Reference Values
  • Reproducibility of Results
  • Ultrasonography, Prenatal / methods*
  • Ultrasonography, Prenatal / standards