Novel Speckle Tracking Analysis Showed Excellent Reproducibility for Size and Shape of the Fetal Heart and Good Reproducibility for Strain and Fractional Shortening

Abstract

<b><i>Introduction:</i></b> This study aimed to evaluate reproducibility and agreement of fetal cardiac shape and deformation using <i>FetalHQ</i>. <b><i>Methods:</i></b> Fifty normal fetuses at 20–38 weeks of gestation were evaluated. Two operators independently selected an optimal cardiac cycle using <i>FetalHQ</i><sup>®™</sup>software for speckle tracking analysis. Intra- and interobserver correlation coefficient and limits of agreement for cardiac shape and deformation were estimated. <b><i>Results:</i></b> Global cardiac markers: high correlation (<i>r</i> = 0.98) and agreement (mean difference, standard deviation [MD, SD] 5.07, 75.8) for ventricular area; moderate correlation (<i>r</i> = 0.78) and agreement (MD, SD: 0.016, 0.08) for global sphericity index (SI) and for left ventricle (LV) global strain (<i>r</i> = 0.65; MD, SD: −4.48, 11.9); and low but still significant correlation (<i>r</i> = 0.58) and agreement (MD, SD: −3.77, 12.27) for right ventricle (RV) global strain. For individual ventricular parameters: high correlation for LV ([median <i>r</i>; range] 0.98; 0.93–0.99) and RV (<i>r</i> = 0.98; 0.97–1.0) SI, and for LV (<i>r</i> = 0.92: 0.56–0.99) and RV (<i>r</i> = 0.96; 0.67–0.99) end diastolic diameters; moderate correlation for LV fractional shortening (<i>r</i> = 0.53; 0.87–0.98); and no significant correlation for RV fractional shortening (<i>r</i> = 0.36; 0.32–0.97). Inter- and intraobserver correlation and agreement were similar for all evaluated parameters. <b><i>Conclusion:</i></b> Speckle tracking analysis of the fetal heart provides reliable estimations of global and LV shape and deformation. Low correlation in the RV can be related to anatomical structures such as the moderator band.

Feasibility of 4D-Spatio Temporal Image Correlation (STIC) in the Comprehensive Assessment of the Fetal Heart Using FetalHQ®

“…Regarding LV systolic parameters (LV volumes, EF and CO), we also report good reproducibility. CO ICC was the lowest regarding LV systolic function, but we only included 24 cases to assess the reproducibility of this parameter, since evaluation of the estimated fetal weight in the same exploration is necessary to calculate CO. On the other hand, biventricular SF showed a poor reproducibility, a finding that has also been reported by other groups [ 55 , 56 ] and that correlates with the poorer reproducibility that we also found for the SI of the different segments of both ventricles. Again, differences in four-chamber-view orientation, methodology and manual tracking could explain our poorer reproducibility results.…”

“…On the contrary, the available studies on 2D STE reproducibility for segmental cardiac morphometric evaluation show discrepant data. While some recent studies [ 55 ] have reported a good reproducibility for biventricular SI (ICC > 0.758), other studies such as ours have shown poorer results, especially for assessing the shape of the basal segments of both ventricles [ 57 ]. We hypothesize that manual adjustment applied for improving the delineation of both ventricles, especially the RV, led to differences in the endocardial delineation, in particular variations of transverse diameters that compute for the SI and FS segmental analysis.…”

“…In fact, more recent studies, which have incorporated the latest technological advances, point to the need to better evaluate STE reproducibility and its correlation with other morphometric and functional echocardiographic parameters before introducing STE into clinical practice. In recent years, FetalHQ ® has shown excellent reproducibility for the analysis of morphometric and functional cardiac parameters [ 26 , 27 , 30 , 32 , 55 , 56 , 57 , 58 ]. FetalHQ ® automatically defines 24 segments of the ventricles and provides information of the shape (SI) and radial systolic function (SF) by the calculation of the longitudinal and transverse diameter of each segment.…”

“…FetalHQ ® automatically defines 24 segments of the ventricles and provides information of the shape (SI) and radial systolic function (SF) by the calculation of the longitudinal and transverse diameter of each segment. Although the reproducibility of this segmental analysis was initially reported to be very good [ 26 , 27 ], more recent studies have reported worse data [ 55 , 57 ]. Additionally, none of the previous studies have reported results on the reproducibility conducting a comprehensive study of global and regional cardiac morphometric and functional data.…”

Cardiac Size, Shape, and Ventricular Contractility in Fetuses at Sea Level With an Estimated Weight Less‐than 10th Centile

“…For this Houston study, the same experienced examiner (GRD) performed all ventricular contractility measurements for both the fetuses with EFW <10th centile and for the published normal reference ranges. Measurement variability results for these cardiac measurements have been previously reported 8,34 although the dA/dt method for identifying cardiac systole has not been previously described for fetalHQ software.…”