Speckle tracking echocardiography during pregnancy showed variable reproducibility of strain analysis when performed on a fixed cardiac cycle, with more consistent results in the left ventricle.
Abstract
Fetal speckle tracking echocardiography is an ultrasound-based technique used to assess myocardial velocity and deformation of the fetal heart. Despite its potential, the method has not yet been integrated into routine pregnancy care, partly due to concerns about inconsistent reproducibility. This study aimed to evaluate the intra- and inter-observer reproducibility of global longitudinal strain measurements derived from a fixed fetal cardiac cycle, using speckle tracking echocardiography. Healthy women with singleton pregnancies were enrolled during the second trimester. From enrolment until delivery, four-chamber view clips of the fetal heart were acquired every four weeks. For intra-observer reproducibility, a single observer analyzed the same heart cycle in one DICOM clip twice for global longitudinal strain in the left and right ventricles, with a minimum interval of two weeks between assessments in a blinded manner. For inter-observer reproducibility, two independent observers analyzed the same cardiac cycle within one DICOM clip. A total of 124 women were included, yielding 632 ultrasound clips. Intra-observer reproducibility was poor to moderate for global longitudinal strain for the right and left ventricles. Inter-observer reproducibility demonstrated moderate to good reproducibility for global longitudinal strain in both ventricles. The reproducibility was generally higher in the left ventricle than in the right, and the highest reproducibility was observed before 32 weeks of gestation. In conclusion, speckle tracking echocardiography during pregnancy showed variable reproducibility of strain analysis when performed on a fixed cardiac cycle, with more consistent results in the left ventricle. These findings support the potential utility of fetal speckle tracking echocardiography, while highlighting the need for further refinement of reproducibility before clinical implementation.
BACKGROUND
Fetal Heart Quantification is a technology based on two-dimensional speckle-tracking imaging, which divides the fetal ventricle into 24 segments. It is used to quantitatively analyze and evaluate fetal heart morphology and function.
MATERIALS AND METHODS
A prospective observational study was conducted among 52 healthy pregnant women between 18 and 22 weeks of gestation. The Fetal Heart Quantification technology was used to collect ultrasound images for studying fetal heart structure and function. The images were enhanced to define the boundary between the blood and the endocardium. Four-chamber images were recorded as 3-second clips in Digital Imaging and Communications in Medicine files and stored. Measurements of the right and left ventricles and the differences between the 24 segment measurements were recorded and evaluated. SPSS 26.0 was used to analyze variables. The Kolmogorov-Smirnov test was used to assess the normality of the data distribution. The Bootstrap and Monte Carlo simulation techniques were used to assess the robustness of the findings. Paired-samples T-test and Wilcoxon Signed-Rank test were used to compare dependent quantitative variables as appropriate. Partial correlation tests were conducted to determine the correlation between these variables. The variables were analyzed at a 95% confidence level, and a p-value of less than 0.05 was considered statistically significant.
RESULTS
Significant differences between the right and left ventricles were observed for fractional area change (FAC), ventricle end-diastolic volume (EDV) area, ventricle end-systolic volume (ESV) area and length (p<0.05). There was no noticeable difference in the sphericity index values. Left ventricular 24-segment transverse fractional shortening (FS) was significantly greater than right ventricular FS at segments 1 and 23 (p<0.05). The ESV and cardiac output were positively correlated with estimated fetal weight, while cardiac output was positively correlated with ventricular EDV length (p<0.05). There were no significant relationships between the shape of ventricles, short axis shortening, or EDV and gestational age or Estimated Fetal Weight (p>0.05).
CONCLUSION
Fetal Heart Quantification is a quantitative method for assessing fetal ventricular morphology and function during a healthy pregnancy. More extensive and comprehensive studies, as well as meta-analyses involving different ethnic groups, are needed to standardize fetal HQ analyses for both healthy fetuses and those in complicated pregnancies, and to establish their diagnostic value.
Masum Kayapınar, Zafer Bütün, E. A. Salık· Journal of Gynecology Obstet...· 0 citations
Methodological heterogeneity, as well as limited reproducibility data and the relative scarcity of studies available suggest the need for standardized acquisition protocols and larger, well-designed studies to determine its clinical usefulness.
Nishan Kotian, A. Vasudeva, K. Nayak et al.· BMC Pregnancy and Childbirth· 0 citations
Abstract Objectives This study aimed to evaluate predefined two-dimensional speckle-tracking parameters (2D-STE) to distinguish between growth-restricted fetuses (FGR) and healthy controls (FC) and to identify novel parameters using an exploratory approach. Methods The study comprised 112 fetuses, 56 in the FGR cohort and 56 gestational-age-matched healthy fetuses in the FC cohort. We analyzed global longitudinal strain (GLS), as well as segmental strain, displacement, and velocity using 2D Cardiac Performance Analysis software. Dyssynchrony (DYS) was calculated as the difference in time to peak of GLS or segmental parameters inter- and intraventricular. We also measured changes in ventricular length, diameter and area. Additionally, we tested a prototype software with a tracked M-mode approach, which measured annular displacement. Results Dyssynchrony parameters were generally higher in the FGR cohort than in the FC cohort. Particularly the GLS-DYS was noticeably higher in the FGR cohort than in the FC cohort (median 19.85 vs. 8.40 ms; p<0.001). Also strain-dyssynchrony, displacement- and velocity-dyssynchrony were increased. FGR fetuses showed right ventricular alterations with lower RV-GLS and reduced longitudinal shortening and area change (25.58 vs. 22.06; p=0.040; 0.75 vs. 0.78; p=0.015; 0.58 vs. 0.67; p=0.024), while LV-GLS and LV-geometry did not differ noticeably. The prototype software did not sufficiently discriminate between groups. Conclusions FGR was associated with higher cardiac dyssynchrony and altered right-ventricular function and geometry. GLS-based dyssynchrony may complement Doppler for risk stratification and monitoring in suspected placental insufficiency. These results should be considered in the context of the limited sample size. Prospective studies with larger cohorts should validate these parameters and establish standardized reference values.
Jana Rarbach, Georg Schummers, A. Burgmair et al.· Journal of Perinatal Medicin...· 0 citations
Routine clinical practice, standard echocardiographic measurements showed overall good reproducibility, with the strongest performance for left ventricular indices.
Raúl Reyes-Toledo, D. G. David-Pardo, G. Lemus-Barrios et al.· Frontiers in Cardiovascular...· 0 citations
INTRODUCTION
Congenital Long QT Syndrome (LQTS) is a common cause of potentially life-threatening ventricular arrhythmias and sudden cardiac death in infants and children. Fetal Magnetocardiography (fMCG) is available in only a few specialized centers worldwide and offers accurate measurements of the QT and PR intervals. The aim of this study was to assess the diagnostic accuracy of PW Doppler echocardiographic measurement of fetal QT and PR intervals compared with the available normative data for fMCG.
METHODS
576 pregnant women with singleton pregnancies (16-38 weeks' gestation) were studied in this cross-sectional study between 2022 and 2023 with detailed fetal echocardiograms. Standardized pulsed-wave Doppler techniques were used to measure the PR and QT intervals. Results were compared with published normative data for fMCG, adjusted for gestational age, and were also compared with contemporaneous fMCG in a subset of 42 fetuses.
RESULTS
Mean QT interval (echo) was 270.0 ± 38.8 and mean PR interval was 119.3 ± 16.2. In the paired subset (n = 42), strong agreement was observed (PR ICC = 0.89 [95% CI: 0.81-0.94]; QT ICC = 0.82 [95% CI: 0.72-0.89]), with mean biases of +2.1 ms and +6.8 ms on Bland-Altman analysis, respectively. Sensitivity and specificity for the full cohort for prolonged intervals (> 95th percentile of GA-adjusted fMCG norms) were 85% and 78% (PPV 68%, NPV 90%). There were no clinically significant differences for PR interval or fetal heart rate, and there was no significant correlation between measured intervals and gestational age (p > 0.05).
DISCUSSION
Pulsed-wave Doppler echocardiography is a reliable method for measuring fetal QT and PR intervals and is in good agreement with fMCG.
CONCLUSION
It is a practical, non-invasive, and easily accessible substitute for fMCG when it is not available for prenatal screening of cardiac repolarization and conduction abnormalities.
F. Rahimpour, L. Jarahi, Hasan Birjandi et al.· Current medical imaging· 0 citations
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