ABSTRACT Objectives: Two methods have been described to assess fetal cardiac output (CO). It has usually been calculated by using 2D ultrasound to measure the diameter of outflow valves and Doppler ultrasound to measure flow velocity through the valves. Recently CO has been assessed using 3D spatio-temporal image correlation (STIC) to measure stroke volume. We aimed to compare the reproducibility of these techniques. Methods: In 27 women with singleton pregnancies, examinations were performed in three gestational age groups: 13 - 15, 19 - 21 and >30 weeks of gestation. Each mother was scanned once. Using 2D pulsed wave Doppler the duration of flow and average flow velocity in systole were measured through aortic and pulmonary valves. We averaged values from three consecutive Doppler complexes. The outlet valve diameters were measured and the cardiac output was calculated for each valve. The measurements were repeated to assess reproducibility. In the same women, we acquired STIC volumes of the fetal heart. The volume measurements were made using the 3D Slice method by one observer. Using 2 mm slices the circumference of the ventricles was traced at the end of systole and diastole to calculate ventricular volume before and after contractions to calculate stroke volume and hence cardiac output. The measurements were repeated to assess reproducibility. Results: The root mean square difference of log (CO) of repeat measurements ranged between 0.12 and 0.21 using Doppler compared to 0.7 to 1.47 using STIC. The differences in reproducibility reached statistical significance for both sides of the heart at all but one gestation. Conclusions: We found that Doppler assessment of fetal cardiac output was more reproducible than measurement using STIC.
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nullParasuraman, R. , Osmond, C. and Howe, D. (2011) Comparison of the reproducibility of 2D doppler and 3D STIC in the measurement of fetal cardiac output. Open Journal of Obstetrics and Gynecology, 1, 163-167. doi: 10.4236/ojog.2011.14031.
 De Smedt, M.C., Visser, G.H. and Meijboom, E.J. (1987) Fetal cardiac output estimated by Doppler echocardiography during mid and late gestation. American Journal of Cardiology, 60, 338-342.
Mielke, G. and Benda, N. (2001) Cardiac output and central distribution of blood flow in the human fetus. Circulation, 103, 1662-1668.
Rizzo, G., Capponi, A., Cavicchioni, O., Vendola, M. and Arduini, D. (2007) Fetal cardiac stroke volume determination by fourdimensional ultrasound with spatio-temporal image correlation compared with two-dimensional and Doppler ultrasonography. Prenatal Diagnosis, 27, 1147-1150. doi:10.1002/pd.1870
Chaoui, R. and Heling, K.S. (2005) New developments in fetal heart scanning: Three- and four-dimensional fetal echocardiography. Seminars in Fetal and Neonatal Medicine, 10, 567-577. doi:10.1016/j.siny.2005.08.008
Goncalves, L.F., Lee, W., Espinoza, J. and Romero, R. (2006) Examination of the fetal heart by four-dimensional (4D) ultrasound with spatiotemporal image correlation (STIC). Ultrasound in Obstetrics & Gynecology, 27, 336-348. doi:10.1002/uog.2724
Hamill, N., Yeo, L., Romero, R., Hassan, S.S., Myers, S.A., Mittal, P., Kusanovic, J.P., Balasubramaniam, M., Chaiworapongsa, T., Vaisbuch, E., Espinoza, J., Gotsch, F., Goncalves, L.F. and Lee, W. (2011) Fetal cardiac ventricular volume, cardiac out-put, and ejection fraction determined with 4-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis. AJOG Article in press.
Messing, B., Cohen, S.M., Valsky, D.V., Rosenak, D., Hochner-Celnikier, D., Savchev, S. and Yagel, S. (2007) Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode. Ultrasound Obstetrics Gynecology, 30, 142-151. doi:10.1002/uog.4036
Molina, F.S., Faro, C., Sotiriadis, A., Dagklis, T. and Nicolaides, K.H. (2008) Heart stroke volume and cardiac output by four-dimensional ultrasound in normal fetuses. Ultrasound Obstetrics Gynecology, 32, 181-187.
Uittenbogaard, L.B., Haak, M.C., Spreeuwenberg, M.D. and Van Vugt, J.M. (2008) A systematic analysis of the feasibility of four dimensional ultrasound imaging using spatiotemporal image correlation in routine fetal echocardiography. Ultrasound Obstetrics Gynecology, 31, 625-632. doi:10.1002/uog.5351
Uittenbogaard, L.B., Haak, M.C., Spreeuwenberg, M.D. and Van Vugt, J.M. (2009) Fetal cardiac function assessed with four-dimensional ultrasound imaging using spatiotemporal image correlation. Ultrasound Obstetrics Gynecology, 33, 272-281. doi:10.1002/uog.6287
Christiane Simioni, C., Nardozza, L., Rolo, E., Zamith, M., Caetano, A.C. and Moron, A.F. (2011) Heart stroke volume, cardiac output, and ejection fraction in 265 normal fetus in the second half of gestation assessed by 4D ultrasound using spatio-temporal image correlation. Journal of Maternal-Fetal and Neonatal Medicine, Early Online, 1-9.
Simpson, J.M. and Cook, A. (2002) Repeatability of echocardiographic measurements in the human fetus. Ultrasound Obstetrics Gynecology, 20, 332-339.
Parasuraman, R., Osmond, C. and Howe, D.T. (2011) Gestation-specific reference intervals for right and left ventricular ejection force from 12 to 40 weeks of gestation. Journal of Obstetrics Gynecology Research, Early view 28 Sep 2011.
Uittenbogaard, L.B., Haak, M.C., Tromp, C.H.N., Terwee, C.B. and Van Vugt, J.M. (2010) Reliability of fetal cardiac volumetry using spatiotemporal image correlation: Assessment of in-vivo and in-vitro measurements. Ultrasound Obstetrics Gynecology, 36, 308-314.