EP09.90: Applicability of two‐dimensional speckle tracking echocardiography for comprehensive analysis of cardiac deformation using fetalHQ in clinical routine

Prenatal 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. The aim 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. A 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, USA). 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. The 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% ± 5.63pp for the left ventricle, that of the expert -14.33% ± 4.88pp and -16.37% ± 5.42pp. The statistical analysis for endoGLS showed a Bland-Altman-Bias of -4.24pp ± 8.06pp for the right and -3.21pp ± 7.11pp for the left ventricle. The Bland-Altman-Bias of the ED in both ventricles in all analysed segments ranged from -0.49mm ± 1.54mm to -0.10mm ± 1.28mm, that for FS from -0.33pp ± 11.82pp to 3.91pp ± 15.56pp and that for SI from -0.38 ± 0.68 to -0.15 ± 0.45. Due to its complexity, the application of fetal 2D-STE 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.