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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Foetal Cardiac Dimensions in 18-40 Weeks of Gestation from Tamil Nadu, India: A Cross-sectional Study
Correspondence Address :
Dr. Sundara Raja Perumal,
B43, TVS Green Acre, Phase IV, Kolappakkam, New Perungulathur, Chennai, Tamil Nadu, India.
E-mail: majsundp@srmist.edu.in
Introduction: Foetal echocardiography helps in the identification of congenital anomalies of the heart and arrhythmias. It is usually done from 18-22 weeks of gestation but it can also be done as early as 12-13 weeks of gestation through transvaginal ultrasound. Measurement of cardiac dimensions in the foetus plays a major role in the early detection of cardiac defects including hypoplastic right and left heart. In addition, the measurement of foetal cardiac dimensions is useful in the evaluation of foetuses with heart failure due to foetal anaemia, which is secondary to Rh alloimmunisation or Bart’s disease.
Aim: To construct a reference centile curve for foetal cardiac dimensions from 18-40 weeks of gestation for the Indian population residing in Tamil Nadu state.
Materials and Methods: This was a cross-sectional study performed between January 2020 and July 2021. A total of 345 antenatal mothers, who came to the Department of Radiology, SRM Medical College and Research Centre, Chennai, India, for for routine anomaly and growth scans were included in the study. Cardiac longitudinal and transverse diameters were measured on 2D images, when the heart was maximally distended in a four-chamber view at the end of the diastole. Left atrial longitudinal and transverse diameters, right atrial longitudinal and transverse diameters, left ventricular longitudinal and transverse diameters, right ventricular longitudinal and transverse diameters interatrial septum thickness interventricular septum thickness cardiac longitudinal and transverse diameters were measured.
Results: The mean values at 18 and 40 weeks of gestation for left atrial longitudinal and transverse diameters, right atrial longitudinal and transverse diameters, left ventricular longitudinal and transverse diameters, right ventricular longitudinal and transverse diameters, interatrial septum thickness, interventricular septum thickness, cardiac longitudinal, and transverse diameters were 0.73, 0.65, 0.72, 0.66, 0.83, 0.62, 0.75, 0.62, 0.1, 0.1, 1.71, 1.72 cm and 2.22, 1.71, 2.31, 1.9, 3.21, 1.71, 3.3, 1.84, 0.3, 0.3, 5.02, 3.84 cm, respectively.
Conclusion: The normal reference ranges for foetal cardiac dimensions can be a useful tool in the early identification of cardiac remodelling in congenital heart disease.
Foetal echocardiogram, Four-chamber view, Interatrial septum, Interventricle septum
Foetal echocardiography helps in identifying congenital heart anomalies and arrhythmias (1). Out of a thousand live birth two to six foetuses have congenital heart disease and pose significant morbidity and mortality in these children (2). Environmental, genetic, and chromosomal factors are involved in the occurrence of congenital cardiac anomalies (2). Cardiac remodelling means the alterations in the heart’s shape, structure size, and function in response to insults which occur in foetal life (3). Various predisposing factors including gestational diabetes, smoking, alcohol, maternal viral infections, medications and exposure to toxins results in congenital heart disease and foetal growth restriction (1). An adverse event during the development of the foetus can have a major impact on the foetal heart and long-term consequences on the child’s health (4). Measuring foetal cardiac dimensions prenatally helps to detect cardiac defects including hypoplasia of the chambers of the right and left heart (5). In addition, the measurement of dimensions of the foetal heart is helpful in the identification of foetuses with heart failure due to anaemia in the foetus occurring secondary to Rh factor alloimmunisation and Bart’s disease (6). Enlargement of the right heart is commonly seen in the coarctation of aorta (7). The increased cardiothoracic ratio is used as a most sensitive sonographic marker in the detection of foetal haemoglobin Bart’s disease (8). The heart is the first organ to develop prenatally and continuously contracts throughout the entire life (4). Multiple transcription factor networks control the formation of the cardiac chambers during embryonic development (4).
The main ultrasound marker suggestive of a cardiac defect in early gestation is increase in the nuchal translucency of greater of 3 mm (9). Evaluation of the pulsatility index of the ductus venosus flow is said to improve the detection of congenital heart defects (10). Increased pulsatility index is associated with foetal aneuploidy and foetal cardiac defect.
The International Society of Ultrasound in Obstetrics and Gynaecology guidelines in the performance of obstetric ultrasound mandates obtaining four-chamber view along with cardiac outflow tract views in second and third trimester ultrasound scans (11). Four-chamber view, if obtained alone has a low detection rate for conotruncal anomalies (12). Detection of congenital heart disease is 55-65% with four-chamber view but increases to 80-84% if outflow tract view is included (13). Additional views in cardiac ultrasound include aortic arch view, three vessel view bicaval view and three vessel trachea view (14).
Ultrasound of the foetal heart is a non invasive method and the measurement of foetal heart dimensions helps in the early identification of foetal cardiac remodelling in response to stresses and can be useful in diagnosing the cases of congenital heart disease. The present study provided normal reference ranges for foetal cardiac dimensions from 18-40 week in Indian population of Tamil Nadu region.
This cross-sectional study was conducted between January 2020 to July 2021 in the Department of Radiology, SRM Medical College and Research Centre, Chennai, India. Ethical committee clearance was obtained and Ethics clearance number 1819/IEC/2019. A total of 345 antenatal mothers coming to the Department of Radiology for anomaly and growth scans were included in the present study.
Inclusion criteria: Inclusion criteria were normal singleton mothers, antenatal mothers of gestational age 18-40 weeks.
Exclusion criteria: Exclusion criteria were intrauterine growth restriction of the foetus, conception through in-vitro fertilisation, exposure to toxins, gestational diabetes, chronic hypertension HIV (Human Immuno-deficiency Virus) infection, foetal malformations and chromosomal abnormalities.
Study Procedure
Foetal cardiac ultrasound was performed using 2-6 MHz probe of Philips affinity machine. For the purpose of the study, foetal cardiac ultrasound study was done. The normal foetal biometry parameters including biparietal diameter, head circumference, abdominal circumference and femur length were obtained and the amniotic fluid index was calculated. The foetal heart rate was measured. The four-chamber view was attained by a transverse sweep of the probe through the thorax of the foetus above the level of the diaphragm. The apical four-chamber view was obtained parallel to the interventricular septum. The subcostal four-chamber view was obtained in a plane perpendicular to the interventricular septum. The four-chamber view showed the right and left atria and ventricles and also the atrioventricular valves and septa. The cardiac position and axis were determined in this projection. Longitudinal and transverse diameters of the right ventricle and left ventricle were measured on two-dimensional images of a four-chamber view during end diastole. The transverse diameter was measured at the level below the leaflets of the atrioventricular valve and the longitudinal diameter from the atrioventricular valve to the inner myocardium apex. End diastole was the frame in which closure of the atrioventricular valves occurs and ventricles attain maximum size. Longitudinal and transverse diameters of right and left atrium were measured on two dimensional images when the atria was distended to the maximum during end systole, which is defined at the frame just before the opening of atrioventricular valves. Maximum length of longitudinal and transverse atrial diameter was measured. The atrial measurements do not include the pulmonary veins, pulmonary arteries and annulus of the atrioventricular valves.
Interatrial septal thickness and interventricle septal thickness were measured in 2D images of four-chamber view. Maximum thickness of the septum was measured. Longitudinal and transverse diameter of cardiac dimension were measured on two dimensional images when the heart was maximally distended from a four-chamber view during end diastole, the frame in which closure of the atrioventricular values occur and ventricles attain in maximum size. Diagrammatic representation of measurement of both ventricle, both atrium and total cardiac dimension were given in (Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4).
Statistical Analysis
Descriptive analysis was carried out by mean and standard deviations for quantitative variables, frequency and proportion for categorical variables. The association between categorical explanatory variables and quantitative outcome was assessed by comparing the mean values. The mean differences along with their 95% Confidence Interval (CI) were presented. Regression coefficient was used to assess to the relationship between the foetal cardiac dimensions and the gestational age. A p-value of less than 0.05 was considered statistically significant. IBM Statistical Package for the Social Sciences, SPSS, version 21.0, was used for statistical analysis.
The patient age group was in the range of 18-35 years. The youngest patient was 18-year-old and the oldest patient was 35-year-old. Median age group was around 25 years of age. The maximum number of patients was within the age group of 21-25 years accounting to 45.21% of the total cases (Table/Fig 5).
Of the 345 antenatal mothers included in the present study, 87 mothers were primigravida and 258 mothers were multigravida. The mean heart rate at 18-40 weeks of gestation was 142±6 beats per minute. The median heart rate at 18-40 weeks of gestation was 124 beats per minute. The lowest heart rate was 124 beats per minute and the highest heart rate was 164 beats per minute. A linear increase of left atrial longitudinal and transverse diameter was seen throughout the gestational age (Table/Fig 6),(Table/Fig 7).
A linear increase of right atrial longitudinal and transverse diameter was seen throughout the gestational age (Table/Fig 8),(Table/Fig 9).
A linear increase of left ventricular longitudinal and transverse diameter was seen throughout the gestational age (Table/Fig 10),(Table/Fig 11).
A linear increase of right ventricular longitudinal and transverse diameter was seen throughout the gestational age (Table/Fig 12),(Table/Fig 13).
A linear increase of cardiac longitudinal and transverse diameter was seen throughout the gestational age (Table/Fig 14),(Table/Fig 15).
A linear increase of interatrial and interventricular septal thickness was seen throughout the gestational age (Table/Fig 16),(Table/Fig 17).
(Table/Fig 18),(Table/Fig 19) depicted the compiled values of all cardiac measurement for the gestational age of 18-40th weeks. All dimensions show progressive increase with gestational age. Regression coefficient is a statistical measure of the average functional relationship between two or more variables (Table/Fig 20). Thus, it measures the degree of dependence of the dimensions on the gestational age. As the coefficient is high, there is high degree of relationship between dimensions and gestational age. Gestational age is the strong predictor of increase in dimensions. As the p-value of all cardiac dimension measured in the present study is less than 0.05, there is significant relationship between the foetal cardiac dimensions and gestational age.
Among the 345 pregnant women, 87 women were primigravida and 258 pregnant mother were multigravida. Maximum number of pregnant women were in 21-25 years of age group comprising 45% of the study population. Foetal cardiac measurement taken in the present study is seen compared with other studies like Garcia- Otero L et al., Luewan S et al., GU X et al., and Barreto EQ et al., (1),(2),(15),(16).
Garcia-Otero L et al., a cohort study, in which foetal cardiac measurement were taken in 600 and two normal singleton pregnancies (1). Normogram were then constructed for cardiac dimensions of the foetus including transverse, longitudinal atrial, ventricular parameters and whole heart’s area, area of atria and ventricles. According to Garcia-Otero L et al., the mean values for left atrial longitudinal and transverse diameters, right atrial longitudinal, transverse diameters, left and right ventricle longitudinal, transverse diameter, at 18 weeks were 0.7, 0.6, 0.6, 0.7, 0.9, 0.6, 0.8, 0.6 cm, respectively (1). The mean values for total cardiac longitudinal and transverse diameters at 18 weeks were 1.8 and 1.5 cm, respectively. According to Garcia-Otero L et al., the mean values for left atrial longitudinal and transverse diameters, right atrial longitudinal, transverse diameters, left and right ventricle longitudinal, transverse diameter, at 40 weeks are 2.1,1.8,2.2,1.8,3.1,1.8, 3.1,1.8 cm, respectively. The mean values for total cardiac longitudinal and transverse diameters at 40 weeks are 5 cm and 3.9 cm, respectively. Foetal cardiac measurement of the present study seen comparable to the reference value of all cardiac parameters in Garcia-Otero L et al., (Table/Fig 21),(Table/Fig 22) (1),(2),(15).
Barreto EQ et al., a cross-sectional study were conducted on 303 normal singleton pregnancies between their 20th and 34th weeks of gestation (16). The mean distance between the apex and base of the foetal heart was measured. The mean distance between the apex and base of the foetal heart at 20 weeks of gestation ranges from 12.1 mm to 17.1 mm. These reference values were seen comparable with the mean value of cardiac longitudinal, transverse dimensions in the present study.
GU X et al., conducted a study on a total of 4396 normal foetuses from 20-34 weeks of gestation (15). Measurements including the interior diameters of the cardiac chambers of the foetus and its arteries, the isthmus of the aortic arch, the descending aorta, the ductus-arteriosus and the diameter of foramen ovale were calculated. The normal reference value for left and right atrial diameter, left ventricle diameter, and right ventricular diameter at 20 weeks is 0.7, 0.7, 0.66 and 0.69 cm, respectively. These right and left atrial, right and left ventricular longitudinal and transverse diameters were comparable to the reference value of the present study.
The present study provides normal referral diameter for all cardiac variables, as mentioned above and can be used for the Indian population. It also helps in the early identification of foetal cardiac defects and early intervention and management of the patient.
Limitation(s)
Limitation of the present study is less number of sample size. Electrocardiography (ECG) gating is not used while measuring the cardiac dimensions. The area of cardiac chambers was not measured in the present study.
The present study gives reference ranges for cardiac dimensions of the foetus from 18-40 weeks of gestational age and provides the normal reference ranges for foetal cardiac dimensions in the Indian population. These measurements can be a helpful tool in the early identification of congenital cardiac defects. These, in turn, can be used to enable early intervention and long-term consequences of the cardiovascular system can be minimised.
DOI: 10.7860/JCDR/2023/59629.17867
Date of Submission: Aug 12, 2022
Date of Peer Review: Nov 11, 2022
Date of Acceptance: Dec 27, 2022
Date of Publishing: Apr 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
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