Fetal Cardiac Function: M-Mode and 4D Spatiotemporal Image Correlation

Abstract

Fetal cardiac function has been shown to be a marker of disease severity in many conditions, including intrauterine growth restriction, congenital heart defects or disease (CHD), twin-to-twin transfusion syndrome, idiopathic hydrops, fetal arrhythmias, and others. It is often targeted for evaluation of patient management, for providing complete and accurate diagnoses in CHD, for patient counseling, or in referring for fetal cardiac interventions. In this review we will describe the use of M-mode and 4D spatiotemporal image correlation in fetal cardiac evaluation, the parameters that can be measured, and their application to clinical practice.

Using speckle‐tracking echocardiography to assess fetal myocardial deformation: are we there yet?

“…By measuring the difference in end-systolic and end-diastolic ventricular diameter, the fractional shortening can be calculated 6 . In the longitudinal plane, the excursion of the mitral and tricuspid valve annuli can be measured, 4,6 . Calculation of ejection fraction, as opposed to fractional shortening, makes geometric assumptions about the heart that may not be applicable in smaller hearts, especially in CHD 4 .…”

“…It was the first ultrasound method used to assess the adult heart, and was introduced to fetal cardiology in the early 1980s. By measuring the difference in end‐systolic and end‐diastolic ventricular diameter, the fractional shortening can be calculated. In the longitudinal plane, the excursion of the mitral and tricuspid valve annuli can be measured, allowing an assessment of left‐ventricular (LV) and right‐ventricular (RV) longitudinal function.…”

“…However, there are several limitations to this technique. It is highly angle‐dependent and hence reliant on suitable fetal lie. Calculation of ejection fraction, as opposed to fractional shortening, makes geometric assumptions about the heart that may not be applicable in smaller hearts, especially in CHD.…”

“…Calculation of ejection fraction, as opposed to fractional shortening, makes geometric assumptions about the heart that may not be applicable in smaller hearts, especially in CHD. In fetal life, a fall in ejection fraction may appear only as a late manifestation of cardiac failure, reducing its clinical utility.…”

Translational paradigms in scientific and clinical imaging of cardiac development

“…Spatiotemporal image correlation (STIC) reconstructs a volumetric dataset within an entire cardiac cycle based on a 3D dataset from approximately 1500 B‐mode images slices from five transverse planes acquired during the imaging scan (Godfrey et al, ). STIC processing coupled with 3D/4D ultrasound has emerged as a powerful diagnostic tool for assessing the fetal heart, and has the ability to increase diagnostic accuracy of CHD (DeVore et al, ).…”