Fetal cardiac ventricular volume, cardiac output, and ejection fraction determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis

Abstract

Objective To quantify fetal cardiovascular parameters with Spatio-Temporal Image Correlation (STIC) and Virtual Organ Computed-aided AnaLysis (VOCAL™) utilizing the sub-feature: “Contour Finder: Trace”. Study Design A cross-sectional study was designed consisting of patients with normal pregnancies between 19 and 40 weeks of gestation. After STIC datasets were acquired, analysis was performed offline (4DView) and the following cardiovascular parameters were evaluated: ventricular volume in end systole and end diastole, stroke volume, cardiac output, and ejection fraction. To account for fetal size, cardiac output was also expressed as a function of head circumference, abdominal circumference, or femoral diaphysis length. Regression models were fitted for each cardiovascular parameter to assess the effect of gestational age and paired comparisons were made between the left and right ventricles. Results 1) Two hundred and seventeen patients were retrospectively identified, of whom 184 had adequate STIC datasets (85% acceptance); 2) ventricular volume, stroke volume, cardiac output, and adjusted cardiac output increased with gestational age; whereas, the ejection fraction decreased as gestation advanced; 3) the right ventricle was larger than the left in both systole (Right: 0.50 ml, IQR: 0.2 – 0.9; vs. Left: 0.27 ml, IQR: 0.1 – 0.5; p<0.001) and diastole (Right: 1.20 ml, IQR: 0.7 – 2.2; vs. Left: 1.03 ml, IQR: 0.5 – 1.7; p<0.001); 4) there were no differences between the left and right ventricle with respect to stroke volume, cardiac output, or adjusted cardiac output; and 5) the left ventricular ejection fraction was greater than the right (Left: 72.2%, IQR: 64 – 78; vs. Right: 62.4%, IQR: 56 – 69; p<0.001). Conclusion Fetal echocardiography, utilizing STIC and VOCAL™ with the sub-feature: “Contour Finder: Trace”, allows assessment of fetal cardiovascular parameters. Normal fetal cardiovascular physiology is characterized by ventricular volumes that are larger on the right and ejection fractions that are greater for the left ventricle resulting in similar left and right ventricular stroke volume and cardiac output.

Antenatal architecture and activity of the human heart

“…Ultrasound is the main clinical method for monitoring foetal rsfs.royalsocietypublishing.org Interface Focus 3: 20120065 development, and can provide structural and functional information on the developing heart [31]. If a developmental abnormality is indicated, higher resolution imaging may be obtained by clinical MRI.…”

Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC): comparison between male and female fetuses

“…In comparison with longitudinal study carried out by Uittenbogaard et al [15] who used the technique 3D slice, we observed that in the range 26 to 30 weeks, our values were also underestimated the likely cause is possibly also the inclusion of the endocardium in the volumetric calculations performed in that study. In a recent study by Hamill et al [17], who evaluated 180 cardiac volumes by STIC and VOCAL, we found that DC increased with gestational age and did not differ between the right and left ventricles, whereas EF decreased with gestational age and was higher in the left ventricle . These results are in agreement with those obtained in our study, with 216 fetuses of both sexes.…”

“…With respect to cardiac evaluation at STIC, first study was performed by Messing et al [13], who evaluated the volume of the ventricular chambers in both systole and diastole in 100 fetuses using methods Virtual Organ Computer-aided Analysis (VOCAL) associated with the inversion mode. Later, other authors also evaluated fetal cardiac function and Molina et al [14] who used the STIC associated only with VOCAL, Uittenbogaard et al [15] who used the STIC and 3D slice method and, more recently, Simioni et al [16] and Hamill et al [17], using only the VOCAL associated with STIC. However, no studies comparing cardiac function by means of 3D U.S. with STIC in relation to gender.…”

Ultrasound assessment of fetal cardiac function

“…, 52 , 53 By scrolling through a saved STIC volume, the operator can obtain the 4‐chamber view at end‐diastole and end‐systole and then perform a manual or semi‐automated volume measurement of the cardiac ventricles. Virtual organ computerised analysis (Figure 10) or inversion mode can be applied to obtain the desired volumes.…”