Person: Galindo Izquierdo, Alberto
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First Name
Alberto
Last Name
Galindo Izquierdo
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Medicina
Department
Salud Pública y Materno-Infantil
Area
Obstetricia y Ginecología
Identifiers
3 results
Search Results
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Item Prediction of perinatal survival in early‐onset fetal growth restriction: role of placental growth factor(Ultrasound in Obstetrics & Gynecology, 2023) Rodríguez Calvo, Jesús; Villalaín González, Cecilia; Gómez Arriaga, Paula Isabel; Quezada Rojas, María Soledad; Herraiz García, Ignacio; Galindo Izquierdo, AlbertoObjective To analyze the ability to predict perinatal survival and severe neonatal morbidity of cases with early-onset fetal growth restriction (eoFGR) using maternal variables, ultrasound parameters and angiogenic markers at the time of diagnosis. Methods This was a prospective observational study in a cohort of singleton pregnancies with a diagnosis of eoFGR (< 32 weeks of gestation). At diagnosis of eoFGR, complete assessment was performed, including ultrasound examination (anatomy, biometry and Doppler assessment) and maternal serum measurement of the angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Logistic regression models for the prediction of perinatal survival (in cases diagnosed at < 28 weeks) and severe neonatal morbidity (in all liveborn cases) were calculated. Results In total, 210 eoFGR cases were included, of which 185 (88.1%) survived perinatally. The median gestational age at diagnosis was 27 + 0 weeks. All cases diagnosed at ≥ 28 weeks survived. In cases diagnosed < 28 weeks, survivors (vs non-survivors) had a higher gestational age (26.1 vs 24.4 weeks), estimated fetal weight (EFW; 626 vs 384 g), cerebroplacental ratio (1.1 vs 0.9), PlGF (41 vs 18 pg/mL) and PlGF multiples of the median (MoM; 0.10 vs 0.06) and lower sFlt-1/PlGF ratio (129 vs 479) at the time of diagnosis (all P < 0.001). The best combination of two variables for predicting perinatal survival was provided by EFW and PlGF MoM (area under the receiver-operating-characteristics curve (AUC), 0.84 (95% CI, 0.75–0.92)). These were also the best variables for predicting severe neonatal morbidity (AUC, 0.73 (95% CI, 0.66–0.80)). Conclusions A model combining EFW and maternal serum PlGF predicts accurately perinatal survival in eoFGR cases diagnosed before 28 weeks of gestation. Prenatal prediction of severe neonatal morbidity in eoFGR cases is modest regardless of the model used. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Item Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta‐analysis(Ultrasound in Obstetrics & Gynecology, 2024) Villalaín González, Cecilia; Gómez Montes, María Enery; Herraiz García, Ignacio; Deiros Bronte, Lucía; Galindo Izquierdo, AlbertoObjective: To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA). Methods: An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model. Results: The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio < 0.7, hypoplastic aortic arch (all P < 0.001), aortic isthmus diameter Z-score of < -2 in the sagittal (P = 0.003) and three-vessel-and-trachea (P < 0.001) views, pulmonary artery/ascending aorta diameter ratio > 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield. Conclusions: Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Item Prediction of postnatal circulation in pulmonary atresia/critical stenosis with intact ventricular septum: systematic review and external validation of models(Ultrasound in Obstetrics & Gynecology, 2023) Villalaín González, Cecilia; Moon Grady, A. J.; Herberg, U.; Strainic, J.; Cohen, J. L.; Shah, A.; Levi, D. S.; Gómez Montes, María Enery; Herraiz García, Ignacio; Galindo Izquierdo, AlbertoObjetivo: Un pronóstico postnatal favorable en los casos de atresia pulmonar/estenosis crítica con tabique ventricu-lar intacto (AP/EVC-IVS) se equipara generalmente con la posibilidad de lograr una reparación biventricular (BV). La identificación de los fetos que tendrán circulación univentricular (UV) postnatal es clave para el asesoramiento prenatal, la optimización de los cuidados perinatales y la toma de decisiones relativas al tratamiento fetal. Nos propusimos evaluar la precisión de los modelos publicados para predecir la circulación postnatal en la SVI-PA/CS utilizando una gran cohorte de validación derivada internacionalmente. Correspondencia a: Dr. C. Villala, Departamento de Obstetricia y Ginecología, Hospital Universitario 12 de Octubre, Avenida de Córdoba, Madrid 28041, España (e-mail: ceci.gvillalain@gmail.com)Aceptada: 23 de enero de 2023. Métodos: Se trata de una revisión sistemática de los modelos uniparamétricos y multiparamétricos publicados para la predicción de la circulación postnatal basados en hallazgos ecocardiográficos entre las semanas 20 y 28 de gestación. Los modelos se validaron externamente utilizando datos del Registro Internacional de Intervenciones Cardiacas Fetales. Se calcularon la sensibilidad, la especificidad, los valores predictivos, el área bajo las curvas de características operativas del receptor (AUC) y la proporción de casos con resultados predichos reales.ResultadosSe identificaron siete estudios publicados que informaban de parámetros pronósticos de la circulación postnatal. Los modelos variaron ampliamente en cuanto al resultado principal (UV (n=3), no-BV (n=3), BV (n=3), circulación coronaria dependiente del ventrículo derecho (n=1) o tamaño de la válvula tricúspide al nacer (n=1)) y en cuanto a los predictores incluidos (parámetros únicos (n=6), puntuación multiparamétrica (n=4) o ambos (n=1)), y se desarrollaron con muestras de pequeño tamaño (rango, 15 - 38). No se validaron externamente nueve modelos, dada la disponibilidad de los parámetros necesarios en la cohorte de validación. La puntuación Z del diámetro de la válvula tricúspide, la regurgitación tricúspide, las relaciones entre las estructuras cardiacas derecha e izquierda y la presencia. La circulación postnatal en la atresia pulmonar15 de conexiones ventriculocoronarias (CCV) fueron los parámetros evaluados con mayor frecuencia. Los modelos multiparamétricos que incluían hasta cuatro variables (relación entre las estructuras derecha e izquierda, duración del flujo ventricular derecho, presencia de CCV y regurgitación tricuspídea) obtuvieron los mejores resultados (AUC, 0,80 - 0,89). En general, la mayoría de los modelos subestimaron el riesgo de UV y sobrestimaron el de BV. Conclusiones: Los modelos multiparamétricos para la predicción de la circulación UV y no-BV funcionan bien en la identificación de pacientes con VB, pero tienen una baja sensibilidad, subestimando la tasa de fetos que finalmente tendrán circulación UV. Hasta que se consiga una mejor discriminación, es posible que las intervenciones fetales deban limitarse únicamente a aquellos casos en los que la circulación postnatal sin VB sea segura.