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Vasciaveo L, Zanzarelli E, D'Antonio F. Fetal cardiac function evaluation: A review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:215-224. [PMID: 36785505 DOI: 10.1002/jcu.23421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
The aim of this review is to provide an up to date on the current use of fetal echocardiography in assessing the fetal cardiac function and its potential research and clinical applications. Despite classically is been used for prenatal diagnosis of fetal heart defects, assessment of fetal cardiac function has been recently proposed as a fundamental tool to assess pregnancies complicated by several disorders with long-term impact on post-natal cardiovascular health, such as placental insufficiency and fetal growth restriction. In this review we present anatomical and functional fetal cardiac development mechanisms and an overview of the currently available techniques for evaluating fetal heart function.
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Affiliation(s)
- Lorenzo Vasciaveo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Erika Zanzarelli
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Francesco D'Antonio
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Fujita Y, Kiyokoba R, Yumoto Y, Kato K. Max dD/Dt: A Novel Parameter to Assess Fetal Cardiac Contractility and a Substitute for Max dP/Dt. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1433-1438. [PMID: 29622500 DOI: 10.1016/j.ultrasmedbio.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
Aortic pulse waveforms are composed of a forward wave from the heart and a reflection wave from the periphery. We focused on this forward wave and suggested a new parameter, the maximum slope of aortic pulse waveforms (max dD/dt), for fetal cardiac contractility. Max dD/dt was calculated from fetal aortic pulse waveforms recorded with an echo-tracking system. A normal range of max dD/dt was constructed in 105 healthy fetuses using linear regression analysis. Twenty-two fetuses with suspected fetal cardiac dysfunction were divided into normal and decreased max dD/dt groups, and their clinical parameters were compared. Max dD/dt of aortic pulse waveforms increased linearly with advancing gestational age (r = 0.93). The decreased max dD/dt was associated with abnormal cardiotocography findings and short- and long-term prognosis. In conclusion, max dD/dt calculated from the aortic pulse waveforms in fetuses can substitute for max dP/dt, an index of cardiac contractility in adults.
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Affiliation(s)
- Yasuyuki Fujita
- Department of Obstetrics and Gynecology, Kyushu University, Fukuoka, Japan.
| | - Ryo Kiyokoba
- Department of Obstetrics and Gynecology, Kyushu University, Fukuoka, Japan
| | - Yasuo Yumoto
- Department of Obstetrics and Gynecology, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Kyushu University, Fukuoka, Japan
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Vargas-Quintero L, Escalante-Ramírez B, Camargo Marín L, Guzmán Huerta M, Arámbula Cosio F, Borboa Olivares H. Left ventricle segmentation in fetal echocardiography using a multi-texture active appearance model based on the steered Hermite transform. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 137:231-245. [PMID: 28110728 DOI: 10.1016/j.cmpb.2016.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/31/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Fetal echocardiographic analysis is essential for detecting cardiac defects at early gestational ages. Fetal cardiac function can be assessed by performing some measurements regarding the dimension and shape of the heart cavities. In this work we propose an automatic segmentation method applied to the analysis of the left ventricle in fetal echocardiography. METHODS For segmentation of the left ventricle, we designed a novel multi-texture active appearance model (AAM) based on the Hermite transform (HT). Local orientation analysis is addressed by steering the coefficients obtained with the HT. The method basically consists of an AAM-based scheme which uses the steered HT to efficiently code texture patterns of the input image. A wider and detailed description of the image features can be obtained with this method. Compared with classic AAM methods, the segmentation performance is substantially improved with the proposed scheme. Since AAM-based approaches process local information, an automatic method is also proposed to initialize the multi-texture AAM. For this purpose, a database of pre-segmented images was built. Then, techniques such as thresholding, mathematical morphology and correlation are combined to identify the position and orientation of the left ventricle. Typical issues found in fetal cardiac ultrasound images such as different orientations and shape variations of the heart cavities can be easily handled with the designed method. RESULTS Several images of fetal echocardiography were used to evaluate the proposed segmentation method. The algorithm performance was validated using different metrics. We used a database of 143 real images of fetal hearts acquired for different phases of the cardiac cycle. We obtained an average Dice coefficient of 0.8631 and a point-to-curve distance of 2.027 pixels. The proposed algorithm was also validated by comparing it with other segmentation methods. CONCLUSIONS We have designed an automatic algorithm for left ventricle segmentation in fetal echocardiography. The reported results demonstrate that the proposed approach can achieve an efficient segmentation of the left ventricular cavity. Typical problems found in images of fetal echocardiography are satisfactorily handled with the proposed multi-texture AAM scheme.
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Affiliation(s)
- Lorena Vargas-Quintero
- Universidad Nacional Autónoma de México, Facultad de Ingeniería, C.U., Mexico D.F., Mexico.
| | | | | | | | - Fernando Arámbula Cosio
- Centro de Ciencias Aplicadas y Desarrollo Tecnológico (CCADET), Universidad Nacional Autónoma de México, Mexico D.F., Mexico
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Nair A, Radhakrishnan S. Fetal left ventricular myocardial performance index: Defining normal values for Indian population and a review of literature. Ann Pediatr Cardiol 2016; 9:132-6. [PMID: 27212847 PMCID: PMC4867797 DOI: 10.4103/0974-2069.177516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: The aim of this study was to determine normal values for fetal left ventricular (LV)-myocardial performance index (MPI) in Indian population and to assess its relation to advancing gestation and fetal heart rate (FHR). Materials and Methods: Two hundred pregnant women without any pregnancy-related complications and whose fetuses were shown to have structurally normal hearts were enrolled in this study. Doppler waveform involving simultaneous display of mitral inflow and LV outflow was obtained in all. Various intervals including isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), and ejection time (ET) were measured and then the MPI was calculated using the formula IVCT + IVRT/ET. Also the correlation between MPI and gestation age and FHR was assessed. We also reviewed the literature on the use of MPI for the assessment of fetal LV function. Results: The normal MPI in second and third trimester fetuses of Indian population was 0.42 ± 0.03. The mean IVCT was 33 ± 4 milliseconds (ms), mean IVRT was 39 ± 5 ms, and mean ET was 169 ± 9 ms. The mean heart rate was 148 ± 8 bpm and the mean PR interval was 111 ± 10 ms. There was no significant association of LV-MPI with either FHR or advancing gestation. Conclusion: MPI is a useful parameter for the assessment global cardiac function. MPI has the advantage of not being affected by FHR, ventricular size, and geometry or image quality. The review of literature shows its significant importance in monitoring complicated pregnancies.
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Affiliation(s)
- Anupama Nair
- Department of Pediatric Cardiology, Fortis-ESCORT Heart Institute, New Delhi, India
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Yeo L, Romero R. How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart: Part 1. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1021-42. [PMID: 27091914 PMCID: PMC8475630 DOI: 10.7863/ultra.16.01081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/29/2016] [Indexed: 05/13/2023]
Abstract
Four-dimensional sonography with spatiotemporal image correlation (STIC) technology allows acquisition of a fetal cardiac volume data set and displays a cine loop of a complete single cardiac cycle in motion. Part 1 of this 2-part article reviews STIC technology and its features, the importance of operator training/experience, and acquisition of high-quality STIC volumes, as well as factors that affect STIC volume acquisition rates. We also propose a detailed and practical stepwise approach to performing 4-dimensional sonography with STIC and begin herein by providing general recommendations. Part 2 will discuss specifics of the approach, along with how to determine whether such volumes are appropriate for analysis.
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Affiliation(s)
- Lami Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Detroit Medical Center, Hutzel Women’s Hospital, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Molecular Obstetrics and Genetics, Wayne State University, Detroit, MI, USA
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Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 719] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
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7
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Guo Y, Wang Y, Nie S, Yu J, Chen P. Automatic Segmentation of a Fetal Echocardiogram Using Modified Active Appearance Models and Sparse Representation. IEEE Trans Biomed Eng 2014; 61:1121-33. [DOI: 10.1109/tbme.2013.2295376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pares DBS, Lima AIF, Araujo Júnior E, Nardozza LMM, Martins WP, Moron AF. Fetal heart assessment in the first trimester of pregnancy: influence of crown-rump length and maternal body mass index. Braz J Cardiovasc Surg 2014; 28:477-81. [PMID: 24598952 PMCID: PMC4389422 DOI: 10.5935/1678-9741.20130078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the influence of the crown-rump length and body mass index on sonographic evaluation of the fetal heart using abdominal and vaginal routes in the first trimester of pregnancy. METHODS We conducted a cross-sectional study with 57 pregnant women between 12-14 weeks (CRL< 84 mm). We evaluated the following fetal cardiac plans using the abdominal and vaginal routes: four-chamber view, right ventricle outflow tract, left ventricle outflow tract and aortic arch. We used the B-mode, color Doppler and four-dimensional ultrasonography (spatio-temporal image correlation). To evaluate the influence of crown-rump length and body mass index in the assessment of fetal cardiac planes, we used the t test unpaired. RESULTS There were no statistically significant differences in the rates of success and failure between abdominal and vaginal routes in relation to body mass index, however, there was a higher failure rate in vaginal assessment using B mode associated with color Doppler (P<0.01). CONCLUSION The crown-rump length and body mass index had no interference in fetal cardiac assessment in the first trimester of pregnancy.
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Affiliation(s)
| | | | - Edward Araujo Júnior
- Federal University of São Paulo (UNIFESP). São Paulo, SP, Brazil
- Correspondence address: Edward Araújo Júnior, Obstetric Department of
the Federal University of São Paulo (UNIFESP), Rua Napoleão de Barros, 875 - Vila
Clementino, São Paulo, SP, Brazil - Zip Code: 04024-002. E-mail:
| | | | - Wellington P. Martins
- Faculty of Medicine of Ribeirão Preto of the University of São Paulo
(FMRP USP), Ribeirão Preto, SP, Brazil
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Hamill N, Romero R, Hassan S, Lee W, Myers SA, Mittal P, Kusanovic JP, Balasubramaniam M, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Goncalves LF, Mazaki-Tovi S, Erez O, Hernandez-Andrade E, Yeo L. The fetal cardiovascular response to increased placental vascular impedance to flow determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis. Am J Obstet Gynecol 2013; 208:153.e1-13. [PMID: 23220270 DOI: 10.1016/j.ajog.2012.11.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/05/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to determine if increased placental vascular impedance to flow is associated with changes in fetal cardiac function using spatiotemporal image correlation and virtual organ computer-aided analysis. STUDY DESIGN A cross-sectional study was performed in fetuses with umbilical artery pulsatility index >95th percentile (abnormal [ABN]). Ventricular volume (end-systole, end-diastole), stroke volume, cardiac output (CO), adjusted CO, and ejection fraction were compared to those of 184 normal fetuses. RESULTS A total of 34 fetuses were evaluated at a median gestational age of 28.3 (range, 20.6-36.9) weeks. Mean ventricular volumes were lower for ABN than normal cases (end-systole, end-diastole) with a proportionally greater decrease for left ventricular volume (vs right). Mean left and right stroke volume, CO, and adjusted CO were lower for ABN (vs normal) cases. Right ventricular volume, stroke volume, CO, and adjusted CO exceeded the left in ABN fetuses. Mean ejection fraction was greater for ABN than normal cases. Median left ejection fraction was greater (vs right) in ABN fetuses. CONCLUSION Increased placental vascular impedance to flow is associated with changes in fetal cardiac function.
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Votino C, Jani J, Damry N, Dessy H, Kang X, Cos T, Divano L, Foulon W, De Mey J, Cannie M. Magnetic resonance imaging in the normal fetal heart and in congenital heart disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:322-329. [PMID: 21837757 DOI: 10.1002/uog.10061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate prospectively the feasibility of magnetic resonance imaging (MRI) for assessment of the fetal heart for congenital heart disease (CHD). METHODS This was a cross-sectional study, including 66 fetuses with a normal heart and 40 with CHD. The fetal heart was examined on MRI using axial steady-state free precession (SSFP) sequences. Regression analysis was used to investigate the effect on the ability to visualize cardiac anatomy of gestational age at examination, maternal body mass index, presence of fetal cardiac abnormality, fetal movements, fetal lie and twinning. The sensitivity and specificity of detecting cardiac defects were calculated. RESULTS The four-chamber view was visualized in 98.1% of fetuses. The sensitivity of detecting a cardiac defect on the four-chamber view was 88% and the specificity 96%. The ability to visualize the left and right outflow tracts was only influenced by the presence of fetal movements: for the left outflow tract 94.4 vs. 50.0% visualization and for the right outflow tract 92.6 vs. 53.8% visualization without and with fetal movements, respectively. The sensitivity of detecting a cardiac defect of the left outflow tract was 63% and the specificity 100%, while sensitivity and specificity were 59 and 97%, respectively, for the right outflow tract. CONCLUSIONS Despite the use of SSFP sequences, MRI in the fetal heart remains of limited value. It can only be used as a second-line approach for abnormalities of the four-chamber view suspected at prenatal ultrasound.
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Affiliation(s)
- C Votino
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium
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Hamill N, Yeo L, Romero R, Hassan SS, Myers SA, Mittal P, Kusanovic JP, Balasubramaniam M, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Goncalves LF, Lee W. Fetal cardiac ventricular volume, cardiac output, and ejection fraction determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis. Am J Obstet Gynecol 2011; 205:76.e1-10. [PMID: 21531373 PMCID: PMC3175283 DOI: 10.1016/j.ajog.2011.02.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 01/18/2011] [Accepted: 02/14/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to quantify fetal cardiovascular parameters using spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). STUDY DESIGN A cross-sectional study was performed in normal pregnancies (19-42 weeks) to evaluate ventricular volume, stroke volume (SV), cardiac output (CO), and ejection fraction (EF). The CO was also expressed as a function of estimated fetal weight and biometric parameters. RESULTS The following results were found: (1) 184 STIC datasets; (2) with advancing gestation, ventricular volume, SV, CO, and adjusted CO increased, whereas EF decreased; (3) right ventricular (RV) volume was larger than the left ventricular (LV) volume in systole (0.50 vs 0.27 mL; P < .001) and diastole (1.20 vs 1.03 mL; P < .001); (4) there were no differences between the LV and RV in SV, CO, or adjusted CO; and (5) LV EF was greater than the RV EF (72.2 vs 62.4%; P < .001). CONCLUSION Normal fetal cardiovascular physiology is characterized by a larger RV volume and a greater LV EF, resulting in similar LV and RV SV and CO.
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Affiliation(s)
- Neil Hamill
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | | | - Pooja Mittal
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | | | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
| | - Luis F. Goncalves
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Wesley Lee
- William Beaumont Hospital, Royal Oak, Michigan, USA
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Tutschek B, Schmidt KG. Techniques for assessing cardiac output and fetal cardiac function. Semin Fetal Neonatal Med 2011; 16:13-21. [PMID: 21051302 DOI: 10.1016/j.siny.2010.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fetal echocardiography was initially used to diagnose structural heart disease, but recent interest has focused on functional assessment. Effects of extracardiac conditions on the cardiac function such as volume overload (in the recipient in twin-twin transfusion syndrome), a hyperdynamic circulation (arterio-venous malformation), cardiac compression (diaphragmatic hernia, lung tumours) and increased placental resistance (intrauterine growth restriction and placental insufficiency) can be studied by ultrasound and may guide decisions for intervention or delivery. A variety of functional tests can be used, but there is no single clinical standard. For some specific conditions, however, certain tests have shown diagnostic value.
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Affiliation(s)
- Boris Tutschek
- Department of Obstetrics, Bern University Hospital, Effingerstrasse 102, 3010 Bern, Switzerland.
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13
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Strehlow SL, Pathak B, Goodwin TM, Perez BM, Ebrahimi M, Lee RH. The mechanical PR interval in fetuses of women with intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol 2010; 203:455.e1-5. [PMID: 20684945 DOI: 10.1016/j.ajog.2010.05.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/23/2010] [Accepted: 05/19/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the fetal mechanical PR interval in intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN Fetal echocardiography was performed for women with ICP and control subjects. Clinical characteristics, total bile acids, and liver profile tests were compared between groups. RESULTS Fourteen women with ICP and 7 control subjects were enrolled. Total bile acids (28.3 vs 6.2 μmol/L; P < .001), aspartate aminotransferase (53 vs 23 IU/L; P = .002), alanine aminotransferase (63 vs 19 IU/L; P = .002), and the PR interval (124 vs 110 msec; P = .006) were significantly higher in fetuses with ICP than in control fetuses. On multivariable linear regression analysis, only the presence of ICP was associated significantly with an increase in the PR interval (95% confidence interval, 4-24 msec; P = .01). CONCLUSION The fetal cardiac conduction system is altered in ICP. Further investigation is needed to determine whether fetal echocardiography can help to predict which fetuses are at risk for death that is associated with ICP.
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Affiliation(s)
- Stacy L Strehlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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14
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Uittenbogaard LB, Haak MC, Tromp CHN, Terwee CB, Van Vugt JMG. Reliability of fetal cardiac volumetry using spatiotemporal image correlation: assessment of in-vivo and in-vitro measurements. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:308-314. [PMID: 20131339 DOI: 10.1002/uog.7582] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the reliability of measurement of fetal cardiac ventricular volume, stroke volume, and ejection fraction with four-dimensional ultrasound using spatiotemporal image correlation (STIC). METHODS Volume datasets were collected from two sources: 24 from fetuses over a range of gestational ages and 12 from a miniature balloon model. Datasets were analyzed by three observers, repeatedly in 12 fetal datasets and all balloon datasets. Volume calculations were obtained by manually tracing multiple parallel slices (three-dimensional (3D) slice method). Measurement error was assessed by calculating standard errors of measurement (SEM) and coefficients of variation (CV). Reliability was assessed by calculating interobserver and intraobserver intraclass correlation coefficients (ICC). RESULTS Measurement errors of balloon volumes were small and reliability was good (SEM <or= 0.07 mL, ICC 0.98-1.00). Fetal ventricle volume measurement error ranged from 0.09 to 0.20 mL and CV from 14.6 to 28.3%. Ventricular volume reliabilities for intra- and interobserver comparisons were greater than or equal to 0.94 and 0.75, respectively. Fetal stroke volume measurement error (SEM 0.17 mL), CV (21.9%) and reliability were measured (intraobserver ICC: left ventricle stroke volume (LVSV), 0.93 vs. right ventricle stroke volume (RVSV), 0.88; interobserver ICC: LVSV, 0.75 vs. RVSV, 0.86). The measurement error decreased with increasing operator experience. The reliability of ejection fraction calculations was poor (ICC < 0.7) for intra- and interobserver comparisons. CONCLUSIONS Volume measurements obtained with STIC and 3D slice methods using a balloon model were reliable. In the fetus, measurement errors decreased with increasing operator experience, and reliability was better for stroke volume than for ejection fraction.
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Affiliation(s)
- L B Uittenbogaard
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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15
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Uittenbogaard LB, Haak MC, Peters RJH, van Couwelaar GM, Van Vugt JMG. Validation of volume measurements for fetal echocardiography using four-dimensional ultrasound imaging and spatiotemporal image correlation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:324-331. [PMID: 20084644 DOI: 10.1002/uog.7561] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess the accuracy and reliability of four-dimensional (4D) ultrasound imaging using spatiotemporal image correlation (STIC) employing three different techniques to measure volumes in vitro. METHODS Customized miniature balloons attached to a pump system were used to mimic fetal cardiac chambers. After the balloon model had been immersed in a bath filled with viscous gel, 4D datasets were acquired and three methods were used for volume analysis: three dimensional (3D) slice method, Virtual Organ Computer-aided AnaLysis (VOCAL) and VOCAL combined with inversion mode. Accuracy and measurement error were measured as the difference between the volume measurements and the actual volumes. Intraobserver reliability was assessed by computing coefficients of variation (CV) and intraclass correlation (ICC). RESULTS Measurement of 76 different volumes, ranging from 0.30 to 4.95 mL, resulted in a total of 912 measurements. The 3D slice method had a mean error of -3.3%, the inversion method underestimated the volumes with a mean error of -6.1%, and VOCAL had a mean error of -2.9%. The 3D slice method had the best agreement (95% limits of agreement (LOA), -11.2 to 4.7%), followed by VOCAL (95% LOA, -14.1 to 8.3%); the inversion mode demonstrated the worst agreement (95% LOA, -21.4 to 9.2%). All three methods were reliable with CV < 10% and ICC > 0.95. CONCLUSIONS 4D ultrasonography with STIC is a feasible and accurate method for calculating volumes of 0.30 mL upwards. In an in-vitro model the 3D slice method proved accurate, was the least time consuming, had the best reliability and had the smallest LOA. This method may prove useful when applied to in-vivo investigations.
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Affiliation(s)
- L B Uittenbogaard
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Rizzo G, Capponi A, Pietrolucci ME, Arduini D. Role of sonographic automatic volume calculation in measuring fetal cardiac ventricular volumes using 4-dimensional sonography: comparison with virtual organ computer-aided analysis. JOURNAL OF ULTRASOUND IN MEDICINE 2010; 29:261-70. [PMID: 20103798 DOI: 10.7863/jum.2010.29.2.261] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the agreement and reliability of virtual organ computer-aided analysis (VOCAL) and sonographic automatic volume calculation (sonoAVC) for measurements of ventricular volume from fetal heart data sets acquired by 4-dimensional sonography with spatiotemporal image correlation (STIC). METHODS We studied 45 volumes from fetuses with normal (n = 30) and abnormal (n = 15) hearts. Spatiotemporal image correlation data sets were frozen in end systole and end diastole, and ventricular volumes were measured with VOCAL and sonoAVC. The stroke volume was calculated from these measurements. Reliability and agreement of the two techniques were evaluated with intraclass correlation coefficients (ICCs), and proportionate Bland-Altman plots were constructed. The time necessary to complete the measurements with either technique was compared. Intraobserver and interobserver agreement of measurements was calculated. RESULTS All data sets could be measured with both techniques. A high degree of reliability was observed between VOCAL and sonoAVC (left ventricular stroke volume ICC, 0.978; 95% confidence interval [CI], 0.957-0.989; right ventricular stroke volume ICC, 0.985; 95% CI, 0.972-0.992). The time necessary to measure the stroke volume was significantly shorter with sonoAVC (2.8 versus 11.7 minutes; P < .0001) than with VOCAL. Bland-Altman tests showed no clinically significant mean percent differences between stroke volume measurements obtained from each ventricle by the same observer or by 2 independent observers using either VOCAL or sonoAVC. CONCLUSIONS There was good agreement between cardiac volumes measured with VOCAL and sonoAVC. Sonographic automatic volume calculation represents a rapid technique for estimating fetal stroke volume and promises to become the method of choice.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli S. Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.
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Manganaro L, Savelli S, Di Maurizio M, Perrone A, Francioso A, La Barbera L, Totaro P, Fierro F, Tomei A, Coratella F, Giancotti A, Ballesio L, Ventriglia F. Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)? Eur J Radiol 2009; 72:172-80. [DOI: 10.1016/j.ejrad.2008.06.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 05/28/2008] [Accepted: 06/06/2008] [Indexed: 11/27/2022]
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Uittenbogaard LB, Haak MC, Spreeuwenberg MD, van Vugt JMG. Fetal cardiac function assessed with four-dimensional ultrasound imaging using spatiotemporal image correlation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:272-281. [PMID: 19212969 DOI: 10.1002/uog.6287] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The goal of this study was to use spatiotemporal image correlation (STIC) to provide reference values for left and right ventricle volumes, and indices of fetal cardiac function. METHODS In this prospective longitudinal study, STIC volumes were acquired periodically from 12 weeks of gestation onwards. The STIC volumes were frozen in end-systole and end-diastole, and volumetric data were measured by manual tracing and summation of multiple slices. These ventricle volumes were used to calculate stroke volume, ejection fraction and cardiac output. RESULTS Some 202 STIC volumes of 63 fetuses were included in the analysis. Mean left and right ventricle stroke volume increased from 0.02 mL at 12 weeks to 1.41 mL and 1.46 mL, respectively, at 30 weeks, while the mean right to left stroke volume ratio remained stable at around 1.2. Mean left and right ventricle cardiac output increased from 2.40 mL/min and 2.60 mL/min at 12 weeks to 197.74 mL/min and 204.81 mL/min, respectively, at 30 weeks. Both left and right mean ejection fraction remained constant at around 0.45 with advancing gestational age. Bland-Altman analysis showed a coefficient of variation for measured stroke volume of 13.7%. CONCLUSIONS This study establishes reference values for fetal cardiac volumes and indices for fetal cardiac function from 12 to 30 weeks of gestation using STIC. STIC seems to overcome many of the pitfalls of conventional ultrasound methods and has the potential to become the method of choice.
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Affiliation(s)
- L B Uittenbogaard
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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19
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Abstract
PURPOSE OF REVIEW Over the last few years, great progress has been made in imaging technology, which is changing the way prenatal visualization of the fetal heart is used for diagnosis and therapy. RECENT FINDINGS This paper reviews recent clinical research using these new techniques, namely dynamic three-dimensional (4D) echocardiography, myocardial Doppler imaging, B-flow ultrasonography, endoscopic ultrasound, and magnetic resonance imaging. Of them, 4D echocardiography is the most significant development and is discussed in greater detail. This includes real-time volumetric data acquisition using matrix-array transducer technology, motion artefact elimination using spatio-temporal image correlation, and various display options. The advantages and limitations of each are also addressed. SUMMARY These techniques can provide (1) sequential assessment of the entire heart using a full 4D dataset, (2) 4D delineation of trabeculation patterns on the ventricular walls, en-face dynamic shapes of ventricular septal defects and spatially complex malformations, (3) derivation of cardiac indices to myocardial contractility and strain rate by Doppler tissue imaging, and/or (4) the use of transoesophageal ultrasound to guide in-utero cardiac intervention. All of these techniques expand our ability to evaluate the morphology and function of the in-utero heart.
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Affiliation(s)
- Jing Deng
- Department of Medical Physics and Bioengineering, University College London, London, UK.
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Manganaro L, Savelli S, Di Maurizio M, Perrone A, Tesei J, Francioso A, Angeletti M, Coratella F, Irimia D, Fierro F, Ventriglia F, Ballesio L. Potential role of fetal cardiac evaluation with magnetic resonance imaging: preliminary experience. Prenat Diagn 2008; 28:148-56. [DOI: 10.1002/pd.1945] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Rizzo G, Capponi A, Cavicchioni O, Vendola M, Arduini D. Fetal cardiac stroke volume determination by four-dimensional ultrasound with spatio-temporal image correlation compared with two-dimensional and Doppler ultrasonography. Prenat Diagn 2007; 27:1147-50. [PMID: 17968855 DOI: 10.1002/pd.1870] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the agreement of stroke volume (SV) measured with two-dimensional (2D) ultrasonography with Doppler capability (vs) four-dimensional (4D) with spatiotemporal image correlation (STIC) in normal and growth restricted fetuses. METHODS 2D Doppler and 4D STIC were used to measure SV of 40 normal fetuses at 20 to 22 and 28 to 32 weeks, and 16 growth-restricted fetuses at 26 to 34 weeks of gestation. Intraclass correlation was used to evaluate the agreement between left and right SV obtained by the two techniques, and proportionate Bland-Altman plots constructed. The time necessary to obtain SV was analyzed. RESULTS The intraclass correlation coefficient between 2D Doppler and 4D STIC measurements for the left ventricle were 0.977 and 0.980 for the right ventricle. The proportionate limits of agreement between the two methods were 18.7 to 23.9% for the left ventricle and - 20.9 to 21.7% for the right ventricle. The time necessary to measure SV was significantly shorter with 4D STIC (3.1 (vs) 7.9 min p < 0.0001) than with 2D Doppler. CONCLUSIONS There is a good agreement between SV measured either by 2D Doppler or by 4D STIC. The 4D STIC represents a simple and rapid technique to estimate fetal SV and promises to become the method of choice.
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Affiliation(s)
- Giuseppe Rizzo
- Department Obstetrics and Gynecology, Università di Roma "Tor Vergata", Italy.
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:429-34. [PMID: 15948307 DOI: 10.1002/pd.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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