CMECNE

Echogenic Intracardiac Focus – What is the Clinical Significance?

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Define EIF
2. Explain the association of EIF with Trisomy 21

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Genoox, Inc., and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

An echogenic intracardiac focus (EIF) is a relatively common finding, even in otherwise normal fetuses. It is not a structural abnormality, but rather represents calcified deposits in the fetal heart that appear as bright spots on prenatal ultrasound.

When seen in isolation, with no other fetal abnormalities:

If aneuploidy screening has not yet been done, then screening should be offered
If aneuploidy screen result is negative, no further evaluation is required
- Counsel patients that screening tests are not diagnostic and therefore there is still residual risk for chromosomal anomalies
- ACOG guidance recommends offering prenatal screening for aneuploidy as an option for all pregnant women
If aneuploidy screen result is positive, refer for genetic counseling and consideration of diagnostic testing options

If other anomalies are detected:

ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound

SYNOPSIS:

An EIF is the presence of echogenic tissue in one or both of the cardiac ventricles, and is observed on the four chamber fetal cardiac view. EIFs may also be referred to as a Papillary Muscle Calcification. EIFs are a fairly common second trimester subjective finding, seen in 4-7% of euploid fetuses and in 15-30% of fetuses with Trisomy 21/Down syndrome. Multiple, bilateral or prominent EIFs are associated with slightly higher aneuploidy risk in some studies.

KEY POINTS:

Rarely associated with Down syndrome in the absence of other markers/anomalies
Fetal echocardiogram is rarely indicated, unless structural cardiac defects are suspected
Follow-up sonogram is not indicated for an isolated echogenic intracardiac focus with normal aneuploidy screening results
EIFs generally resolve by the third trimester, irrespective of fetal outcome, and should not impact long term cardiac function