Kardiale Funktionsanalyse beim Feten: Schritt für Schritt

Graupner, O; Enzensberger, C

doi:10.1007/s00129-021-04889-z

Cited by 4 publications

(18 citation statements)

References 28 publications

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“…It is based on an image-to-image analysis that tracks the movement of so-called “speckles” within the myocardium and allows to assess systolic myocardial deformation (strain) during the cardiac cycle. The analysis is performed using a four-chamber view, usually offline in the form of a post-processing technique 61 ( Fig. 3 ).…”

Section: Fetal Cardiac Functionmentioning

confidence: 99%

“…The technical limitations of the cardiac function analysis due to factors such as fetal heart size, higher heart rates and motion artefacts, however, continue to present barriers to reproducibility. Therefore, the measured results and their clinical interpretation should be viewed critically 61 . Another limitation that must be considered at this point is the variability of strain anomalies: longitudinal strain values from SGA/FGR fetuses with a manifest PD have been measured as similar to, elevated and > 95th percentile when compared to AGA fetuses 62 , 63 .…”

Section: Fetal Cardiac Functionmentioning

confidence: 99%

“…Dadurch kann die systolische Myokarddeformation (Strain) innerhalb des Herzzyklus beurteilt werden. Die Analyse erfolgt auf Basis eines 4-Kammer-Blicks in der Regel offline im Sinne eines Post-Processing-Verfahrens 61 ( Abb. 3 ).…”

Section: Fetale Kardiale Funktionunclassified

“…Allerdings sorgen technische Limitierungen der kardialen Funktionsanalyse durch Faktoren wie beispielsweise der fetalen Herzgröße und höheren Herzfrequenz sowie Bewegungsartefakten nach wie vor für eine eingeschränkte Reproduzierbarkeit. Dies erfordert einen kritischen Blick auf gewonnene Ergebnisse und deren klinische Interpretation 61 . Hier muss auch einschränkend die Variabilität im Vorhandensein einer Strain-„Abnormalität“ berücksichtigt werden: So wurden longitudinale Strain-Werte bei SGA/FGR-Feten mit manifester PD als vergleichbar, erhöht und > 95.…”

Section: Fetale Kardiale Funktionunclassified

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New Markers for Placental Dysfunction at Term – Potential for More

Graupner

Kuschel

Axt-Fliedner

et al. 2022

Geburtshilfe Frauenheilkd

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The remaining placental reserve capacity at term plays a decisive role in the perinatal morbidity of mother and child. Considering advances made in the field of fetal monitoring, the routine examination methods currently used at term or late term may be insufficient to detect subclinical placental dysfunction (PD). The aim of this study is to offer an up-to-date, narrative review of the literature in the context of detecting PD at term using complementary ultrasound markers and biomarkers. Parameters of fetomaternal Doppler ultrasound and fetal cardiac function, as well as (anti-)angiogenic factors in maternal serum are potential PD markers. These may help identify patients that may benefit from an elective, early induction of labor at term, thereby potentially reducing morbidity and mortality. However, their value in terms of the optimal date of delivery must first be determined in randomized controlled trials on a large number of cases.

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Section: Fetal Cardiac Functionmentioning

confidence: 99%

Section: Fetal Cardiac Functionmentioning

confidence: 99%

Section: Fetale Kardiale Funktionunclassified

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New Markers for Placental Dysfunction at Term – Potential for More

Graupner

Kuschel

Axt-Fliedner

et al. 2022

Geburtshilfe Frauenheilkd

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“…A functional cardiac assessment of a fetus using echocardiography has become increasingly important. It allows for the early detection of subclinical cardiac dysfunction and reveals intrauterine functional cardiac remodeling, and can therefore contribute to improving and predicting perinatal outcomes [1][2][3]. The myocardial performance index (MPI, synonym: Tei index) was initially proposed for adult cardiology and can be used to assess the left as well as the right ventricular cardiac function [4].…”

Section: Introductionmentioning

confidence: 99%

How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index

et al. 2023

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(1) Objectives: In utero functional cardiac assessments using echocardiography have become increasingly important. The myocardial performance index (MPI, Tei index) is currently used to evaluate fetal cardiac anatomy, hemodynamics and function. An ultrasound examination is highly examiner-dependent, and training is of enormous significance in terms of proper application and subsequent interpretation. Future experts will progressively be guided by applications of artificial intelligence, on whose algorithms prenatal diagnostics will rely on increasingly. The objective of this study was to demonstrate the feasibility of whether less experienced operators might benefit from an automated tool of MPI quantification in the clinical routine. (2) Methods: In this study, a total of 85 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by a targeted ultrasound. The modified right ventricular MPI (RV-Mod-MPI) was measured, both by a beginner and an expert. A calculation was performed semiautomatically using a Samsung Hera W10 ultrasound system (MPI+™, Samsung Healthcare, Gangwon-do, South Korea) by taking separate recordings of the right ventricle’s in- and outflow using a conventional pulsed-wave Doppler. The measured RV-Mod-MPI values were assigned to gestational age. The data were compared between the beginner and the expert using a Bland-Altman plot to test the agreement between both operators, and the intraclass correlation was calculated. (3) Results: The mean maternal age was 32 years (19 to 42 years), and the mean maternal pre-pregnancy body mass index was 24.85 kg/m2 (ranging from 17.11 to 44.08 kg/m2). The mean gestational age was 24.44 weeks (ranging from 19.29 to 36.43 weeks). The averaged RV-Mod-MPI value of the beginner was 0.513 ± 0.09, and that of the expert was 0.501 ± 0.08. Between the beginner and the expert, the measured RV-Mod-MPI values indicated a similar distribution. The statistical analysis showed a Bland-Altman bias of 0.01136 (95% limits of agreement from −0.1674 to 0.1902). The intraclass correlation coefficient was 0.624 (95% confidence interval from 0.423 to 0.755). (4) Conclusions: For experts as well as for beginners, the RV-Mod-MPI is an excellent diagnostic tool for the assessment of fetal cardiac function. It is a time-saving procedure, offers an intuitive user interface and is easy to learn. There is no additional effort required to measure the RV-Mod-MPI. In times of reduced resources, such assisted systems of fast value acquisition represent clear added value. The establishment of the automated measurement of the RV-Mod-MPI in clinical routine should be the next level in cardiac function assessment.

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How automated techniques ease functional assessment of the fetal heart: Applicability of two‐dimensional speckle‐tracking echocardiography for comprehensive analysis of global and segmental cardiac deformation using fetalHQ®

Scharf,

Dracopoulos,

Gembicki

et al. 2024

Echocardiography

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BackgroundPrenatal echocardiographic assessment of fetal cardiac function has become increasingly important. Fetal two‐dimensional speckle‐tracking echocardiography (2D‐STE) allows the determination of global and segmental functional cardiac parameters. Prenatal diagnostics is relying increasingly on artificial intelligence, whose algorithms transform the way clinicians use ultrasound in their daily workflow. The purpose of this study was to demonstrate the feasibility of whether less experienced operators can handle and might benefit from an automated tool of 2D‐STE in the clinical routine.MethodsA total of 136 unselected, normal, singleton, second‐ and third‐trimester fetuses with normofrequent heart rates were examined by targeted ultrasound. 2D‐STE was performed separately by beginner and expert semiautomatically using a GE Voluson E10 (FetalHQ®, GE Healthcare, Chicago, IL). Several fetal cardiac parameters were calculated (end‐diastolic diameter [ED], sphericity index [SI], global longitudinal strain [EndoGLS], fractional shortening [FS]) and assigned to gestational age (GA). Bland‐Altman plots were used to test agreement between both operators.ResultsThe mean maternal age was 33 years, and the mean maternal body mass index prior to pregnancy was 24.78 kg/m2. The GA ranged from 16.4 to 32.0 weeks (average 22.9 weeks). Averaged endoGLS value of the beginner was ‐18.57% ± 6.59 percentage points (pp) for the right and ‐19.58% ± 5.63 pp for the left ventricle, that of the expert ‐14.33% ± 4.88 pp and ‐16.37% ± 5.42 pp. With increasing GA, right ventricular endoGLS decreased slightly while the left ventricular was almost constant. The statistical analysis for endoGLS showed a Bland‐Altman‐Bias of ‐4.24 pp ± 8.06 pp for the right and ‐3.21 pp ± 7.11 pp for the left ventricle. The Bland‐Altman‐Bias of the ED in both ventricles in all analyzed segments ranged from ‐.49 mm ± 1.54 mm to ‐.10 mm ± 1.28 mm, that for FS from ‐.33 pp ± 11.82 pp to 3.91 pp ± 15.56 pp and that for SI from ‐.38 ± .68 to ‐.15 ± .45.ConclusionsBetween both operators, our data indicated that 2D‐STE analysis showed excellent agreement for cardiac morphometry parameters (ED and SI), and good agreement for cardiac function parameters (EndoGLS and FS). Due to its complexity, the application of fetal 2D‐STE remains the domain of scientific‐academic perinatal ultrasound and should be placed preferably in the hands of skilled operators. At present, from our perspective, an implementation into clinical practice “on‐the‐fly” cannot be recommended.

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Kardiale Funktionsanalyse beim Feten: Schritt für Schritt

Cited by 4 publications

References 28 publications

New Markers for Placental Dysfunction at Term – Potential for More

New Markers for Placental Dysfunction at Term – Potential for More

How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index

How automated techniques ease functional assessment of the fetal heart: Applicability of two‐dimensional speckle‐tracking echocardiography for comprehensive analysis of global and segmental cardiac deformation using fetalHQ®

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