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Zhu C, Li M, Xu CJ, Ding MJ, Xiong Y, Liu R, Ren YY. Comparison of the left and right ventricular size and systolic function of low-risk fetuses in the third trimester: Which is more dominant? Front Cardiovasc Med 2023; 10:1052178. [PMID: 37008336 PMCID: PMC10063784 DOI: 10.3389/fcvm.2023.1052178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectiveTo quantify fetal cardiovascular parameters utilizing fetal-specific 2D speckle tracking technique and to explore the differences in size and systolic function of the left and right ventricles in low-risk pregnancy.MethodsA prospective cohort study was performed in 453 low-risk single fetuses (28+0–39+6 weeks) to evaluate ventricular size [i.e., end-diastolic length (EDL), end-systolic length (ESL), end-diastolic diameter (ED), end-systolic diameter (ES), end-diastolic area, end-systolic area, end-diastolic volume (EDV), and end-systolic volume (ESV)] and systolic function [i.e., ejection fraction (EF), stroke volume (SV), cardiac output (CO), cardiac output per kilogram (CO/KG), and stroke volume per kilogram (SV/KG)].ResultsThis study showed that (1) the reproducibility of the interobserver and intraobserver measurements was good to excellent (ICC 0.626–0.936); (2) with advancing gestation, fetal ventricular size and systolic function increased, whereas right ventricular (RV) EF decreased and left ventricular (LV) EF was not significantly changed; (3) LV length was longer than RV length in diastole (2.24 vs. 1.96 cm, P < 0.001) and systole (1.72 vs. 1.52 cm, P < 0.001); (4) LV ED-S1 and ES-S1 were shorter than the RV ED-S1 and ES-S1 (12.87 vs. 13.43 mm, P < 0.001; 5.09 vs. 5.61 mm, P < 0.001); (5) there were no differences between the LV and RV in EDA or EDV; (6) the mean EDV ratio of right-to-left ventricle was 1.076 (95% CI, 1.038–1.114), and the mean ESV ratio was 1.628 (95% CI, 1.555–1.701); (7) the EF, CO and SV of the LV were greater than the RV (EF: 62.69% vs. 46.09%, P < 0.001; CO: 167.85 vs. 128.69 ml, P < 0.001; SV: 1.18 vs. 0.88 ml, P < 0.001); (8) SV and CO increased with ED-S1 and EDL, but EF was not significantly changed.ConclusionLow-risk fetal cardiovascular physiology is characterized by a larger RV volume (especially after 32 weeks) and greater LV outputs (EF, CO, SV, SV/KG and CO/KG).
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Affiliation(s)
- Chen Zhu
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Man Li
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Cheng-Jie Xu
- Department of Information Technology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Meng-Juan Ding
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yu Xiong
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Rui Liu
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yun-Yun Ren
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Correspondence: Yun-Yun Ren
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Rizzo G, Pietrolucci ME, Mappa I. Which is the best time to perform balloon valvuloplasty in critically fetal aortic stenosis: Prenatally or after birth? JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1286-1287. [PMID: 36353906 DOI: 10.1002/jcu.23338] [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: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
Fetal aortic valvuloplasty may prevent the progression of severe fetal aortic stenosis to hypoplastic left heart syndrome at birth. Since it is an high risk procedure a careful selection of fetuses that can benefit from the prenatal treatment instead of waiting for postnatal intervention.
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Affiliation(s)
- Giuseppe Rizzo
- Università di Roma Tor Vergata Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma, Italy
| | - Maria Elena Pietrolucci
- Università di Roma Tor Vergata Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma, Italy
| | - Ilenia Mappa
- Università di Roma Tor Vergata Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma, Italy
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4D imaging of fetal right ventricle-feasibility study and a review of the literature. Int J Cardiovasc Imaging 2021; 38:319-329. [PMID: 34545461 PMCID: PMC8888475 DOI: 10.1007/s10554-021-02407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/02/2021] [Indexed: 12/02/2022]
Abstract
Functional analysis of the fetal cardiovascular system is crucial for the assessment of fetal condition. Evaluation of the right ventricle with standard 2D echocardiography is challenging due to its complex geometry and irregular muscle fibers arrangement. Software package TOMTEC 4D RV-Function is an analysis tool which allows assessment of right ventricular function based on volumetric measurements and myocardial deformation. The aim of this study was to determine the feasibility of this method in fetal echocardiography. The retrospective study was conducted in the high-flow Referral Center for Fetal Cardiology. We recorded 4D echocardiographic sequences of 46 fetuses with normal hearts. Following parameters were calculated: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), right ventricle longitudinal free-wall (RVLS free-wall) and septal strain (RVLS septum). Tei index was calculated as a standard measure or RV function for comparison. 4D assessment was feasible in 38 out of 46 fetuses (83%). RV volumetric parameters—EDV, ESV and SV—increased exponentially with gestational age. Functional parameters—RV Tei index, EF and strains—were independent of gestational age. Mean EF was 45.2% (± 6%), RV free-wall strain was − 21.2% and RV septal strain was − 21.5%. There was a statistically significant correlation between septal and free-wall strains (r = 0.51, p = 0.001) as well as between EF and RV free-wall strain (r = − 0.41, p = 0.011). 4D RV assessment is feasible in most fetuses. Its clinical application should be further investigated in larger prospective studies.
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Abduljalil K, Pan X, Clayton R, Johnson TN, Jamei M. Fetal Physiologically Based Pharmacokinetic Models: Systems Information on Fetal Cardiac Output and Its Distribution to Different Organs during Development. Clin Pharmacokinet 2021; 60:741-757. [PMID: 33486719 DOI: 10.1007/s40262-020-00973-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Fetal circulation is unique and the parameters describing hemodynamic status during development are critical for constructing a fetal physiologically based pharmacokinetic model. To date, a comprehensive review of circulatory changes during fetal development, with a specific focus on developing these models, has not been reported. The objective of this work was to collate, analyze, and mathematically describe physiological information on fetal cardiac output and tissue blood flows during development. METHODS A comprehensive literature search was carried out to collate and evaluate the changes to fetal cardiac output and fetal tissue blood flows during growth. The collated data were assessed, integrated, and analyzed to establish continuous mathematical functions describing the average parameter changes and variability during development. RESULTS Data were available for fetal cardiac output (14 Doppler studies), blood flow through the fetal umbilical vein (15 studies), ductus venosus (6 studies), liver veins (5 studies), brain (4 studies), lungs (5 studies), and kidneys (2 studies). Fetal cardiac output is described as either an age- or weight-dependent function. The latter is preferred as it generates an individualized cardiac output that is correlated to the fetal body weight. Blood flow as a proportion of fetal cardiac output to the liver, placenta, brain, kidneys, and lungs was age varying, whilst for the adipose, bone, heart, muscle, and skin the blood flow proportions were fixed. The pattern of change (with respect to direction and pace) for each of these parameters was different. CONCLUSIONS Despite limitations in the availability of some values, the collected data provide a useful resource for fetal physiologically based pharmacokinetic modeling. Potential applications of these data include predicting xenobiotic exposure and risk assessment in the fetus following the administration of maternally dosed drugs or unintended exposure to environmental toxicants.
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Affiliation(s)
- Khaled Abduljalil
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK.
| | - Xian Pan
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Ruth Clayton
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Trevor N Johnson
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Masoud Jamei
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
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Bravo-Valenzuela NJ, Peixoto AB, Carrilho MC, Siqueira Pontes AL, Chagas CC, Simioni C, Araujo Júnior E. Fetal cardiac function by three-dimensional ultrasound using 4D-STIC and VOCAL - an update. J Ultrason 2019; 19:287-294. [PMID: 32021711 PMCID: PMC6988455 DOI: 10.15557/jou.2019.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023] Open
Abstract
Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.
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Affiliation(s)
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Milene Carvalho Carrilho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Caroline Cevante Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Christiane Simioni
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Lobo L, Stevenson G, Alphonse J, Welsh A, Oei JL, Schindler T. Four-Dimensional Ultrasound for Evaluating Newborn Cardiac Output: A Pilot Study of Healthy Infants. Neonatology 2019; 116:115-122. [PMID: 31137032 DOI: 10.1159/000496452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is currently no reliable non-invasive method of measuring cardiac output in neonatal intensive care. Spatiotemporal image correlation (STIC) is a novel four-dimensional (4D) ultrasound technique that was developed to assess the foetal heart, and it may be a useful way to assess neonatal haemodynamics. OBJECTIVE This study aimed to evaluate the feasibility and reproducibility of determining neonatal cardiac output using STIC ultrasound in newborn infants. DESIGN Infants were recruited opportunistically from a neonatal intensive care unit and then examined by 2 independent observers. STIC was used to obtain images of the heart. End-diastolic and end-systolic ventricular volumes were measured using virtual organ computer-aided analysis (VOCAL) and used to calculate cardiac output. Reproducibility was assessed with intraclass correlation coefficients (ICC) and agreement with Bland-Altman analysis. RESULTS Twenty-four clinically stable infants of 34-43 weeks corrected gestational age were assessed. Both observers successfully acquired 4D STIC volumes in all infants. Left ventricular output showed good reproducibility, with an intra-observer ICC of 0.86 (0.69-0.94) and inter-observer ICC of 0.87 (0.70-0.95). Right ventricular output also showed good reproducibility, with an intra-observer ICC of 0.88 (0.70-95) and inter-observer ICC of 0.84 (0.63-0.93). CONCLUSIONS Determining cardiac output using 4D STIC ultrasound is feasible and reproducible in well newborn infants. With further evaluation, this technique may provide valuable information about haemodynamic status in newborn infants requiring intensive care.
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Affiliation(s)
- Lisha Lobo
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Gordon Stevenson
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Jennifer Alphonse
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,Department of Maternal-Foetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Ju Lee Oei
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Timothy Schindler
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia, .,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia,
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7
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Abstract
With the introduction of the electronic 4-dimensional and spatial-temporal image Correlation (e-STIC), it is now possible to obtain large volume datasets of the fetal heart that are virtually free of artifact. This allows the examiner to use a number of imaging modalities when recording the volumes that include two-dimensional real time, power and color Doppler, and B-flow images. Once the volumes are obtained, manipulation of the volume dataset allows the examiner to recreate views of the fetal heart that enable examination of cardiac anatomy. The value of this technology is that a volume of the fetal heart can be obtained, irrespective of the position of the fetus in utero, and manipulated to render images for interpretation and diagnosis. This article presents a summary of the various imaging techniques and provides clinical examples of its application used for prenatal diagnosis of congenital heart defects and abnormal cardiac function.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, CA, USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Chen R, Zhu M, Amacher K, Wu X, Sahn DJ, Ashraf M. Non-invasive Evaluation of Right Ventricular Function with Real-Time 3-D Echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2247-2255. [PMID: 28716430 DOI: 10.1016/j.ultrasmedbio.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/22/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to evaluate the accuracy and feasibility of real-time 3-D echocardiography (3-DE) in assessing right ventricular (RV) systolic function. A latex balloon was inserted into the right ventricle of 20 freshly harvested pig hearts which were then passively driven by a pulsatile pump apparatus. The RV global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and RV ejection fraction (RVEF), derived from 3-DE, as well as the RVEF obtained from 2-D echocardiography (2-DE) were quantified at different stroke volumes (30-70 mL) and compared with sonomicrometry data. In all comparisons, 3-D GLS, GCS, GAS, 2-D RVEF and 3-D RVEF exhibited strong correlations with sonomicrometry data (r = 0.89, 0.79, 0.74, 0.80, and 0.93, respectively; all p values < 0.001). Bland-Altman analyses revealed slight overestimations of echo-derived GLS, GCS, 2-DE RVEF and 3-DE RVEF compared with sonomicrometry values (bias = 1.55, 2.72, 3.59 and 2.21, respectively). Furthermore, there is better agreement among GLS, 3-D RVEF and the sonomicrometry values than between GCS and 2-D RVEF. Real-time 3-DE is more feasible and accurate for assessing RV function than 2-DE. GLS is a potential alternative parameter for quantifying RV systolic function.
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Affiliation(s)
- Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Zhejiang, China; Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA.
| | - Meihua Zhu
- Center for Regenerative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kacie Amacher
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Zhejiang, China
| | - David J Sahn
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammad Ashraf
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
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9
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Yeo L, Romero R. How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart: Part 2. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1043-66. [PMID: 27091912 PMCID: PMC8475629 DOI: 10.7863/ultra.16.01082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/13/2016] [Indexed: 05/04/2023]
Abstract
The effective performance of fetal cardiac examination using spatiotemporal image correlation (STIC) technology requires 2 essential steps: volume acquisition and postprocessing. An important prerequisite is training sonologists to acquire high-quality volume data sets so that when analyzed, such volumes are informative. This article is part 2 of a series on 4-dimensional sonography with STIC. Part 1 focused on STIC technology and its features, the importance of operator training/experience and acquisition of high-quality STIC volumes, factors that affect STIC volume acquisition rates, and general recommendations on performing 4D sonography with STIC. In part 2, we discuss a detailed and practical stepwise approach for STIC volume acquisition, along with methods 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
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
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10
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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: 13] [Impact Index Per Article: 1.6] [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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Zhang J, Zhou Q, Zhao Y, Peng Q, Gong Z, Long X. Evaluation of right ventricular function in fetal hypoplastic left heart syndrome using spatio-temporal image correlation (STIC). Cardiovasc Ultrasound 2016; 14:12. [PMID: 27066831 PMCID: PMC4827237 DOI: 10.1186/s12947-016-0056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/02/2016] [Indexed: 02/06/2023] Open
Abstract
Background Postnatal outcome of fetuses with hypoplastic left heart syndrome (HLHS) is mainly determined by right ventricular function. In the present study we used spatio-temporal image correlation (STIC) to assess right ventricular function of fetuses with HLHS. Methods Three-dimensional ultrasound with STIC technique was used to acquire heart images from fetuses that had HLHS and the normal controls, between 24+0 and 37+6 weeks of gestation. Right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were determined using the virtual organ computer-aided analysis software, and the parameters of right ventricular function were calculated. Results Both RVEDV and RVESV were found to be significantly higher in fetuses with HLHS as compared to that in normal controls (P < 0.001). There were no significant differences in the parameters between fetuses with and without a visible left ventricular cavity (P > 0.05). Compared to fetuses with HLHS plus mild tricuspid regurgitation (TR), fetuses with HLHS plus severe TR exhibited lower right ventricular stroke volume (RVSV), right ventricular cardiac output (RVCO) and standardized RVCO (P < 0.05). The right ventricular ejection fraction (RVEF) was significantly lower in HLHS fetuses that had severe TR (P < 0.001). Conclusion As the right ventricle is solely responsible for maintenance of circulation, the right ventricular systolic function undergoes compensatory enhancement in fetuses with HLHS and mild TR, compared to that in normal controls. Size of the left ventricle does not significantly affect the right ventricular function in HLHS. However, right ventricular systolic function may be impaired prenatally in HLHS fetuses that have severe TR.
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Affiliation(s)
- Jing Zhang
- Department of Ultrasound, Second Xiangya Hospital of Central South University, 139 Middle Renmin Rd, 410011, Changsha, Hunan, China
| | - Qichang Zhou
- Department of Ultrasound, Second Xiangya Hospital of Central South University, 139 Middle Renmin Rd, 410011, Changsha, Hunan, China
| | - Yili Zhao
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, 23507, VA, USA
| | - Qinghai Peng
- Department of Ultrasound, Second Xiangya Hospital of Central South University, 139 Middle Renmin Rd, 410011, Changsha, Hunan, China.
| | - Zheli Gong
- Department of Ultrasound, Second Xiangya Hospital of Central South University, 139 Middle Renmin Rd, 410011, Changsha, Hunan, China
| | - Xiangdang Long
- Department of Ultrasound, Second Xiangya Hospital of Central South University, 139 Middle Renmin Rd, 410011, Changsha, Hunan, China
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12
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Coelho Neto MA, Roncato P, Nastri CO, Martins WP. True Reproducibility of UltraSound Techniques (TRUST): systematic review of reliability studies in obstetrics and gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:14-20. [PMID: 25175693 DOI: 10.1002/uog.14654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the quality of methods used and the accuracy of the interpretation of agreement in existing studies that examine the reliability of ultrasound measurements and judgments in obstetrics and gynecology. METHODS A systematic search of MEDLINE was performed on 25 March 2014, looking for studies that examined the reliability of ultrasound measurements and judgments in obstetrics and gynecology with evaluation of concordance (CCC) or intraclass (ICC) correlation coefficients or kappa as a main objective. RESULTS Seven hundred and thirty-three records were examined on the basis of their title and abstract, of which 141 full-text articles were examined completely for eligibility. We excluded 29 studies because they did not report CCC/ICC/kappa, leaving 112 studies that were included in our analysis. Two studies reported both ICC and kappa and were counted twice, therefore, the number used as the denominator in the analyses was 114. Only 16/114 (14.0%) studies were considered to be well designed (independent acquisition and blinded analysis) and to have interpreted the results properly. Most errors occurring in the studies are likely to overestimate the reliability of the method examined. CONCLUSIONS The vast majority of published studies examined had important flaws in design, interpretation and/or reporting. Such limitations are important to identify as they might create false confidence in the existing measurements and judgments, jeopardizing clinical practice and future research. Specific guidelines aimed at improving the quality of reproducibility studies that examine ultrasound methods should be encouraged.
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Affiliation(s)
- M A Coelho Neto
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - P Roncato
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
- School of Health Technology - Ultrasonography School of Ribeirao Preto (FATESA-EURP), Ribeirao Preto, Brazil
| | - C O Nastri
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
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Zhu M, Ashraf M, Zhang Z, Streiff C, Shimada E, Kimura S, Schaller T, Song X, Sahn DJ. Real Time Three-Dimensional Echocardiographic Evaluations of Fetal Left Ventricular Stroke Volume, Mass, and Myocardial Strain: In Vitro and In Vivo Experimental Study. Echocardiography 2015; 32:1697-706. [PMID: 25865121 DOI: 10.1111/echo.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Left ventricular stroke volume, mass, and myocardial strain are valuable indicators of fetal heart function. This study investigated the feasibility of nongated real time three-dimensional echocardiography (RT3DE) to determine fetal stroke volume (SV), left ventricular mass (LVM), and myocardial strain under different conditions. METHODS To evaluate fetal hearts, fetal-sized rabbit hearts were used in this study. The in vitro portion of this study was carried out using a balloon inserted into the LV of eight fresh rabbit hearts and driven by a calibrated pulsatile pump. RT3DE volumes were obtained at various pump-set SVs. The in vivo experiments in this study were performed on open-chest rabbits. RT3DE volumes were acquired at the following conditions: baseline, simulated hypervolemia, inferior vena cava (IVC) ligation, and ascending aorta (AAO) ligation. Displacement values and sonomicrometry data were used as references for RT3DE-derived SV, LVM, longitudinal strain (LS), and circumferential strain (CS). RESULTS Excellent correlations between RT3DE-derived values and reference values were demonstrated and accompanied by high coefficients of determination (R(2) ) for both in vitro and in vivo studies for SV, LVM, LS, and CS (in vitro: SV: R(2) = 0.98; LVM: R(2) = 0.97; LS: R(2) = 0.87, CS: R(2) = 0.80; in vivo: SV: R(2) = 0.92; LVM: R(2) = 0.98; LS: in vivo: R(2) = 0.84; CS: in vivo: R(2) = 0.76; all P < 0.05). CONCLUSIONS RT3DE is capable of quantifying the SV, LVM, and myocardial strain of fetal-sized hearts under different conditions. This nongated RT3DE may aid the evaluation of fetal cardiac function, providing a superior understanding of the progress of fetal heart disorders.
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Affiliation(s)
- Meihua Zhu
- Oregon Health & Science University, Portland, Oregon
| | | | - Zhijun Zhang
- Oregon Health & Science University, Portland, Oregon
| | - Cole Streiff
- Oregon Health & Science University, Portland, Oregon
| | - Eriko Shimada
- Oregon Health & Science University, Portland, Oregon
| | - Sumito Kimura
- Oregon Health & Science University, Portland, Oregon
| | | | - Xubo Song
- Oregon Health & Science University, Portland, Oregon
| | - David J Sahn
- Oregon Health & Science University, Portland, Oregon
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Zhu M, Streiff C, Panosian J, Roundhill D, Lapin M, Tutschek B, Ashraf M, Sahn DJ. Evaluation of Stroke Volume and Ventricular Mass in a Fetal Heart Model: A Novel Four-Dimensional Echocardiographic Analysis. Echocardiography 2014; 31:1138-1145. [DOI: 10.1111/echo.12520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Meihua Zhu
- Department of Medical Ultrasound; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Oregon Health & Science University; Portland Oregon
| | - Cole Streiff
- Oregon Health & Science University; Portland Oregon
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15
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Real-time 3-dimensional echocardiographic assessment of ventricular volume, mass, and function in human fetuses. PLoS One 2013; 8:e58494. [PMID: 23516490 PMCID: PMC3597738 DOI: 10.1371/journal.pone.0058494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 02/05/2013] [Indexed: 12/26/2022] Open
Abstract
Objectives We sought to determine the feasibility and reproducibility of real-time 3-dimensional echocardiography (RT3DE) for evaluation of cardiac volume, mass, and function and to characterize maturational changes of these measurements in human fetuses. Methods Eighty pregnant women in the 2nd and 3rd trimesters (59 with normal fetuses and 21 with fetuses with congenital heart disease [CHD]) were enrolled. We acquired RT3DE images using a matrix-array transducer. RT3DE measurements of volume, mass, stroke volume (SV), combined cardiac output (CCO), and ejection fraction (EF) were obtained. Images were scored and analyzed by two blinded independent observers. Inter- and intraobserver variabilities and correlations between fetal cardiac indices and gestational age were determined. Results Fifty-two of 59 normal data sets (88%) and 9 of 21 CHD data sets (43%) were feasible for analysis. In normal fetuses, the right ventricle (RV) is larger than the left ventricle (LV) (P<0.05), but no difference exists between the LV and RV in mass, SV, CO, and CO/CCO. The EFs for the LV and RV were diminished; the RVSV/LVSV was reduced in CHD fetuses compared with normal fetuses (P<0.05). Fetal ventricular volumes, mass, SV, and CCO fit best into exponential curves with gestational age, but LVEF, RVEF, and RVSV/LVSV remain relatively constant. Conclusions RT3DE is feasible and reproducible for assessment of LV and RV volume, mass, and function, especially in normal fetuses. Gestational growth of these measures, except for EF, is exponential in normal and CHD fetuses. CHD fetuses exhibit diminished LV and RV EFs.
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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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Hodges RJ, Wallace EM. Mending a growth-restricted fetal heart: should we use glucocorticoids? J Matern Fetal Neonatal Med 2012; 25:2149-53. [DOI: 10.3109/14767058.2012.697940] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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DeKoninck P, Steenhaut P, Van Mieghem T, Mhallem M, Richter J, Bernard P, De Catte L, Deprest J. Comparison of Doppler-based and three-dimensional methods for fetal cardiac output measurement. Fetal Diagn Ther 2012; 32:72-8. [PMID: 22613961 DOI: 10.1159/000336128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/28/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Fetal cardiac output is conventionally measured using two-dimensional (2D) and Doppler ultrasound (Doppler). New methods based on 3D measurements of ventricular size in systole and diastole have been proposed. Our aim was to validate these tools against the conventional Doppler-based methods. METHODS Fetal combined cardiac output was prospectively measured at 16, 20, and 24 weeks of gestation in 15 uncomplicated pregnancies using Doppler and three different 3D algorithms [virtual organ computer-aided analysis (VOCAL), sonographic automatic volume calculation (SonoAVC), and inversion mode]. We determined the inter- and intraobserver variability of the 3D techniques and assessed the correlation between Doppler and 3D. RESULTS The 3D techniques showed adequate inter- and intraobserver reproducibility (intraclass correlation coefficient 0.69-0.98), with the best reproducibility for SonoAVC and inversion mode. Bland-Altman analysis revealed low bias and relatively good correlations when comparing the 3D methods among each other, albeit with wide 95% confidence intervals. Doppler measurement of fetal weight-adjusted combined cardiac output (349.0 ml·min⁻¹·kg⁻¹) yielded significantly higher results than 3D CO measurements (177.2, 160.7, and 174.0 ml·min⁻¹·kg⁻¹ for VOCAL, SonoAVC, and inversion mode, respectively; p < 0.0001) and correlated poorly with the 3D methods. CONCLUSIONS Although 3D volume-based cardiac output measurements are reproducible, results obtained with different methods are not interchangeable. SonoAVC and inversion have the highest intra- and interobserver reproducibility. Results of cardiac output measurement by 3D and Doppler cannot be interchanged.
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Affiliation(s)
- Philip DeKoninck
- Fetal Medicine Unit, Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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Godfrey ME, Messing B, Cohen SM, Valsky DV, Yagel S. Functional assessment of the fetal heart: a review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:131-144. [PMID: 21611999 DOI: 10.1002/uog.9064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 05/30/2023]
Abstract
The purpose of this review is to evaluate the current modalities available for the assessment of fetal cardiac function. The unique anatomy and physiology of the fetal circulation are described, with reference to the difference between in-utero and ex-utero life. M-mode, early/atrial ratio, myocardial performance index, three-dimensional and four-dimensional ultrasound, tissue Doppler including strain and strain rate, speckle tracking, magnetic resonance imaging and venous flow assessment are described. The modalities are analyzed from the perspective of the clinician and certain questions are posed. Does the modality assess systolic function, diastolic function or both? Is it applicable to both ventricles? Does it require extensive post-processing or additional hardware, or does it make use of technology already available to the average practitioner? The reproducibility and reliability of the techniques are evaluated, with reference to their utility in clinical decision-making. Finally, directions for future research are proposed.
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Affiliation(s)
- M E Godfrey
- Department of Pediatric Cardiology, Schneider Children's Medical Center Israel, Petach Tikva, Israel
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20
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Godfrey M, Messing B, Valsky D, Cohen S, Yagel S. Fetal Cardiac Function: M-Mode and 4D Spatiotemporal Image Correlation. Fetal Diagn Ther 2012; 32:17-21. [DOI: 10.1159/000335357] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 11/26/2011] [Indexed: 11/19/2022]
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21
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Schoonderwaldt EM, Groenenberg IAL, Hop WCJ, Wladimiroff JW, Steegers EAP. Reproducibility of echocardiographic measurements of human fetal left ventricular volumes and ejection fractions using four-dimensional ultrasound with the spatio-temporal image correlation modality. Eur J Obstet Gynecol Reprod Biol 2011; 160:22-9. [PMID: 22018832 DOI: 10.1016/j.ejogrb.2011.09.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 08/04/2011] [Accepted: 09/16/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To determine the reproducibility, both reliability and agreement, of measurements of fetal left ventricular parameters from volumes obtained by spatio-temporal image correlation (STIC) acquisition applying virtual organ computer-aided analysis (VOCAL) and Simpson's rule (method of discs). Furthermore the success rate of STIC acquisition was determined. STUDY DESIGN In 84 pregnancies between 20 and 34 weeks of gestation the fetal heart was scanned using the STIC modality. An optimal four-chamber view in end-diastole and end-systole was obtained. Left ventricular end-diastolic volume, left ventricular end-systolic volume, stroke volume and ejection fraction were determined. For calculations based on Simpson's rule only one plane was traced, whereas for VOCAL six planes were traced. To quantify the reliability intraclass correlation coefficients were calculated for both intra- and inter-observer measurements. Agreement of measurements was evaluated by Bland-Altman plots. RESULTS The STIC volumes of 54 women (64%) were excluded from the study because of poor quality, leaving 30 volumes for further analysis. Intraclass correlation coefficients for intra-observer reliability for VOCAL and Simpson were 0.99 and 0.99 for left ventricular end-diastolic volume, 0.95 and 0.92 for left ventricular end-systolic volume, 0.98 and 0.97 for stroke volume, 0.76 and 0.77 for ejection fraction, respectively. Intraclass correlation coefficients for inter-observer reliability for VOCAL and Simpson were 0.97 and 0.86 for left ventricular end-diastolic volume, 0.97 and 0.86 for left ventricular end-systolic volume, 0.95 and 0.81 for stroke volume, 0.68 and 0.63 for ejection fraction, respectively. According to Bland-Altman plots, the mean percentage difference and 95% limits of intra- and inter-observer agreement for left ventricular stroke volume measurements using VOCAL were -0.2 (-25.1, 24.7)% and 2.8 (-34.2, 39.8)%, respectively. For left ventricular stroke volume measured with Simpson versus VOCAL the mean percentage difference and 95% limits of agreement were -1.8 (-22.1, 18.5)%. CONCLUSIONS 4D STIC enables reproducible measurements of left ventricular volumes. Reliability of the VOCAL mode is not essentially different from the single-plane method used in Simpson's rule. The large percentage of poor quality STIC volumes and the wide limits of inter-observer agreement would create obstacles for the clinical applicability of this technique.
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Affiliation(s)
- Ernst M Schoonderwaldt
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Messing B, Cohen SM, Valsky DV, Shen O, Rosenak D, Lipschuetz M, Yagel S. Fetal heart ventricular mass obtained by STIC acquisition combined with inversion mode and VOCAL. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:191-197. [PMID: 21370304 DOI: 10.1002/uog.8980] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Estimation of fetal heart ventricular mass is important for fetal cardiac evaluation in cases of structural or functional cardiac disorders or extracardiac factors. It may be used with other cardiac parameters to ascertain the severity and prognosis of such disorders, or the nature and timing of intervention. We applied a novel technique combining spatiotemporal image correlation (STIC) with three-dimensional inversion mode and Virtual Organ Computer-aided AnaLysis (VOCAL™) for fetal cardiac mass assessment in healthy fetuses in the second and third trimesters. METHODS STIC acquisition was performed during fetal quiescence with the abdomen uppermost, at an angle of 30-50°, without color Doppler mapping. Myocardial volume measurements were performed in postprocessing using VOCAL mode, set to 15°. Beginning with the heart in four-chamber view at end diastole, a trace was drawn manually including the myocardium and interventricular septum. Inversion mode colors the intraventricular (anechoic, fluid-filled) voxels; this intraventricular volume was subtracted automatically from the total. Mass was determined by multiplying the result by the estimated fetal myocardial density (1.050 g/cm(3) ). The process was repeated for right and left ventricles. RESULTS Data from 106 fetuses at 21-38 weeks' gestation were obtained and scatterplots of fetal cardiac ventricular mass distribution were created. Several cases of fetuses with disordered cardiac ventricle (supraventricular tachycardia, hypoplastic left heart syndrome, dilated cardiomyopathy, twin-to-twin transfusion syndrome, Ebstein anomaly, non-immune hydrops fetalis, septate right atrium and diaphragmatic hernia) were examined. Ventricular mass parameters were markedly affected as compared with normal cases of similar gestational age. CONCLUSIONS STIC acquisition combined with inversion mode and VOCAL is a feasible method of cardiac ventricular mass quantification. This methodology may have added value in fetal cardiac evaluation in cases of anatomic malformation or cardiac dysfunction, or in cases of maternal diabetes.
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Affiliation(s)
- B Messing
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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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: 55] [Impact Index Per Article: 4.2] [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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Simioni C, Nardozza LMM, Araujo Júnior E, Rolo LC, Zamith M, Caetano AC, Moron AF. Heart stroke volume, cardiac output, and ejection fraction in 265 normal fetus in the second half of gestation assessed by 4D ultrasound using spatio-temporal image correlation. J Matern Fetal Neonatal Med 2011; 24:1159-67. [PMID: 21250911 DOI: 10.3109/14767058.2010.545921] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to establish nomograms for fetal stroke volume (SV), cardiac output (CO), and ejection fraction (EF) using four-dimensional ultrasound with spatio-temporal image correlation (STIC) modality. METHODS The fetal heart was scanned using STIC modality, starting with classic four-chamber view plane, during fetal quiescence with abdomen uppermost, at an angle of 20-30°, without color Doppler flow mapping. In post-processing virtual organ, computer-aided analysis technique was used to obtain a sequence of six sections of each ventricular volume in end-systolic volume (ESV) and end-diastolic volume (EDV). The SV (SV = EDV-ESV), CO (CO = SV × fetal heart rate), and EF (EF = SV/EDV) for each ventricle were then calculated. Intra- and interobserver agreement were then calculated. RESULTS Two hundred sixty-five fetuses, ranging in gestational age (GA) from 20 to 34(+6) weeks, were included in the study. The left and right SV and CO increased exponentially with gestation and EF remained fairly stable through gestational. Mean left and right SV increased from 0.211 ml and 0.220 ml at 20 weeks to 1.925 ml and 2.043 ml, respectively, at 34 weeks. Mean left and right CO increased from 30.25 ml/min and 31.52 ml/min at 20 weeks to 268.49 ml/min and 287.80 ml/min, respectively, at 34 weeks. Both left and right mean EF remained constant at around 0.63 with advancing GA. Nomograms were created for LSV, RSV, LCO, RCO, LEF, and REF vs. gestational age. Intra- and interobserver agreement reached 95%. CONCLUSIONS Four-dimensional ultrasound using STIC represents a simple and reproducible method for estimating fetal cardiac function. 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)
- Christiane Simioni
- Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo, Brazil
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Fetal cardiac function assessed by spatio-temporal image correlation. Arch Gynecol Obstet 2010; 284:253-60. [PMID: 21188403 DOI: 10.1007/s00404-010-1813-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 12/08/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Three-dimensional (3D) and four-dimensional (4D) ultrasound have been proposed to be valuable tools for the examination of fetal heart. Spatio-temporal image correlation (STIC) is a technique that adds a time component to 3D ultrasound imaging of the fetal heart, so we can evaluate cardiac structures as a 4D cine sequence containing information of one full cardiac cycle. STIC gives the investigator the opportunity to freeze the displayed cardiac loop in end-diastolic and end-systolic phases. By STIC, 3D measurements of both the left and right ventricle can be used to calculate fetal heart stroke volume, cardiac output and ejection fraction, and expressions of cardiac function. The ultimate goal of STIC technique is to improve fetal cardiac function analysis by decreasing the dependency on operator skills required by two-dimensional ultrasound. CONTEXT In this article, we describe literature practical approach for the examination of the fetal heart function using 4D ultrasound by STIC technique.
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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: 22] [Impact Index Per Article: 1.6] [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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Van Mieghem T, DeKoninck P, Steenhaut P, Deprest J. Methods for prenatal assessment of fetal cardiac function. Prenat Diagn 2009; 29:1193-203. [DOI: 10.1002/pd.2379] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hamill N, Romero R, Hassan SS, Lee W, Myers SA, Mittal P, Kusanovic JP, Chaiworapongsa T, Vaisbuch E, Espinoza J, Gotsch F, Carletti A, Goncalves LF, Yeo L. Repeatability and reproducibility of fetal cardiac ventricular volume calculations using spatiotemporal image correlation and virtual organ computer-aided analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1301-11. [PMID: 19778875 PMCID: PMC3071609 DOI: 10.7863/jum.2009.28.10.1301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The objective of this study was to quantify the repeatability and reproducibility of fetal cardiac ventricular volumes obtained using spatiotemporal image correlation (STIC) and Virtual Organ Computer-Aided Analysis (VOCAL; GE Healthcare, Kretztechnik, Zipf, Austria). METHODS A technique was developed to compute ventricular volumes using the subfeature Contour Finder: Trace. Twenty-five normal pregnancies were evaluated for the following: (1) to compare the coefficient of variation (CV) of ventricular volumes obtained using 15 degrees and 30 degrees rotation; (2) to compare the CV between 3 methods of quantifying ventricular volumes: (a) Manual Trace, (b) Inversion Mode, and (c) Contour Finder: Trace; and (3) to determine repeatability by calculating agreement and reliability of ventricular volumes when each STIC was measured twice by 3 observers. Reproducibility was assessed by obtaining 2 STICs from each of 44 normal pregnancies. For each STIC, 2 ventricular volume calculations were performed, and agreement and reliability were evaluated. Additionally, measurement error was examined. RESULTS (1) Agreement was better with 15 degrees rotation than 30 degrees (15 degrees: 3.6%; 95% confidence interval [CI], 3.0%-4.2%; versus 30 degrees: 7.1%; 95% CI, 5.8%-8.6%; P < .001); (2) ventricular volumes obtained with Contour Finder: Trace had better agreement than those obtained using either Inversion Mode (Contour Finder: Trace: 3.6%; 95% CI, 3.0%-4.2%; versus Inversion Mode: 6.0%; 95% CI, 4.9%-7.2%; P < .001) or Manual Trace (10.5%; 95% CI, 8.7%-12.5%; P < .001); (3) ventricular volumes were repeatable with good agreement and excellent reliability for both intraobserver and interobserver measurements; and (4) ventricular volumes were reproducible with negligible differences in agreement and good reliability. In addition, bias between STIC acquisitions was minimal (<1%; mean percent difference, -0.4%; 95% limits of agreement, -5.4%-5.9%). CONCLUSIONS Fetal echocardiography using STIC and VOCAL allows repeatable and reproducible calculation of ventricular volumes with the subfeature Contour Finder: Trace.
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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
| | - 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
| | - Wesley Lee
- William Beaumont Hospital, Royal Oak, 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
| | - Angela Carletti
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 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
| | - 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
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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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Shaw SW, Hsieh TT, Hsu JJ, Lee CL, Cheng PJ. Measurement of nuchal volume in the first trimester Down screening using three-dimensional ultrasound. Prenat Diagn 2008; 29:69-73. [DOI: 10.1002/pd.2120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Rizzo G, Capponi A, Cavicchioni O, Vendola M, Arduini D. Low cardiac output to the placenta: an early hemodynamic adaptive mechanism in intrauterine growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:155-9. [PMID: 18663767 DOI: 10.1002/uog.5389] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A low combined cardiac output (CCO) to the placenta (placenta/CCO fraction) has been reported in growth-restricted (IUGR) fetuses, but the temporal sequence of these modifications in relation to other changes in the fetal circulation is unknown. The aim of this study was to evaluate the placenta/CCO fraction in relation to other hemodynamic changes in fetuses at risk of developing IUGR. METHODS We studied 340 singleton nulliparous pregnancies characterized at 20-24 weeks by abnormal uterine artery pulsatility index (PI) values (> 95(th) centile). At this gestational age we measured fetal biometry and Doppler waveforms from the umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), umbilical vein (UV) and outflow tracts of both ventricles. The diameters of the semilunar valves and UV were measured and CCO (left cardiac + right cardiac outputs) and UV blood flow were calculated. The placenta/CCO fraction was calculated as UV flow as a percentage of CCO. RESULTS There were 283 pregnancies with birth weight >or= 10(th) centile and normal UA-PI throughout gestation (Group A), 34 with birth weight < 10(th) centile and normal UA-PI throughout gestation (Group B) and 23 with birth weight < 10(th) centile and abnormal UA-PI developing later in gestation (Group C). At 20-24 weeks there were no differences among the three groups in fetal biometric parameters, PI values from the UA, MCA and DV, and CCO. UV flow and placenta/CCO fraction were significantly lower in Group C compared with Group A (UV flow delta value = - 1.439, P < 0.0001; placenta/CCO fraction delta value = - 1.74, P < 0.0001) but not in Group B. CONCLUSIONS Our data suggest that, in fetuses developing IUGR secondary to placental compromise, UV flow and placental/CCO fraction are already reduced by 20-24 weeks, and that this reduction occurs earlier than do modifications in fetal size and arterial and venous PI values.
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Affiliation(s)
- G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Ospedale GB Grassi Roma, Rome, Italy.
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Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Role of tomographic ultrasound imaging with spatiotemporal image correlation for identifying fetal ventricular septal defects. JOURNAL OF ULTRASOUND IN MEDICINE 2008; 27:1071-5. [PMID: 18577671 DOI: 10.7863/jum.2008.27.7.1071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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 test the possibility of diagnosing ventricular septal defects (VSDs) by using tomographic ultrasound imaging (TUI) on 4-dimensional volumes of the fetal chest obtained with spatiotemporal image correlation and the color Doppler function. METHODS We retrospectively evaluated the 4-dimensional spatiotemporal image correlation volumes of 8 fetuses with VSDs (single in 7 and double in 1) between 20 and 33 weeks' gestation. The data were analyzed to determine whether VSDs were correctly identified in at least 1 of 7 automatically generated TUI displays. RESULTS All of the included VSDs were correctly identified with the use of an interslice distance in the TUI function ranging from 0.8 to 2 mm without the need to further manipulate the volume. CONCLUSIONS This automatic approach shows good retrieval of diagnostic cardiac planes in fetuses with VSDs, which may improve the diagnostic accuracy for this disease.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Arduini D. Sonographic automated volume count (SonoAVC) in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:111-2. [PMID: 18536064 DOI: 10.1002/uog.5387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Rizzo G, Capponi A, Cavicchioni O, Vendola M, Pietrolucci ME, Arduini D. Application of automated sonography on 4-dimensional volumes of fetuses with transposition of the great arteries. JOURNAL OF ULTRASOUND IN MEDICINE 2008; 27:771-6; quiz 777. [PMID: 18424653 DOI: 10.7863/jum.2008.27.5.771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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 assess, in second-trimester fetuses with transposition of the great arteries (TGA), the performance of software (sonographically based volume computer-aided analysis) that automatically retrieves diagnostic cardiac planes from a 4-dimensional volume of the fetal chest obtained with spatiotemporal image correlation. METHODS We retrospectively evaluated the 4-dimensional spatiotemporal image correlation volumes of 12 fetuses with TGA (complete TGA, 10 cases; correct TGA, 2 cases). The data were analyzed to determine whether the target diagnostic planes, that is, cardiac plane 1 (left ventricle outflow tract) and cardiac plane 2 (right ventricle outflow tract), were correctly identified in at least 1 of the 7 automatically generated tomographic sonographic image displays and whether they allowed diagnosis of TGA. RESULTS In 9 of 10 fetuses with complete TGA, target diagnostic cardiac plane 1 showed a branching arterial vessel (pulmonary artery) arising from the left ventricle, whereas in 7 of 10 fetuses, the aorta arising from the right ventricle was shown. In both cases with correct TGA, the pulmonary artery starting from the morphologic left ventricle was shown, whereas in 1 of 2, the connection of the aorta with the morphologic right ventricle was found. In all of the fetuses with TGA, a ventricular arterial connection anomaly was shown in either cardiac plane 1 or 2. CONCLUSIONS This automatic approach shows good retrieval of diagnostic cardiac planes in fetuses with TGA, which may improve diagnostic efficacy for this disease.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Ospedale Fatebenefratelli S. Giovanni Calabita, Isola Tiberina 89, 00186 Rome, Italy.
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