Two-dimensional Fetal Speckle Tracking; a Learning Curve Study for Offline Strain Analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Nov 18

PMID 39556556

Authors

Chantelle M de Vet

Thomas J Nichting

Annemarie F Fransen

Daisy A A van der Woude

Myrthe van der Ven

Richard A J Post

Zoe van Lier

S Guid Oei

Noortje H M van Oostrum

Judith O E H van Laar

Affiliations

Soon will be listed here.

Abstract

Objectives: Two-dimensional speckle tracking (2D-STE) strain analysis holds promise for assessing fetal cardiac function. Understand the learning curve before introducing 2D-STE into obstetrics is crucial. This study examined the learning curve for offline analysis of fetal left (LV) and right ventricular (RV) global longitudinal strain (GLS) using 2D-STE.

Methods: After 2D-STE training, three trainees (Maternal-Fetal Medicine fellow, OBGYN resident and medical student) analyzed 100 fetal heart clips using 2D-STE to calculate LV- and RV-GLS. Intra-class correlation coefficients (ICC) and Bland-Altman plots were compared GLS values across four sets of 25 clips for each trainee against the expert. Repeated measurements analysis compared GLS score differences between expert and trainees over time and among trainees, adjusting p-values with a Bonferroni correction.

Results: LV-GLS consistency evolved from poor-to-moderate during the first 50 measurements to moderate-to-good during the second 50 for all trainees. RV-GLS consistency evolved from poor-to-moderate during the first 75 measurements to moderate-to-good during the final 25 measurements for the fellow and resident. The student's RV-GLS consistency was poor during the first 25 measurements, moderate-to good during the second 25 measurements and again poor-to-moderate during the final 50 measurements. Repeated measurements analysis showed a significant decrease in variability of the LV- and RV-GLS score differences between the expert and trainees over time (padj<0.001), which was not significantly different between trainees. Moreover, the mean of those differences were significantly different for all trainees for LV-GLS (padj<0.001) and RV-GLS (padj = 0.029), and did significantly change over time for RV-GLS (padj<0.001) but not for LV-GLS.

Conclusions: A clear learning effect was observed by the significant decrease in variability of the difference in the score between the expert and trainees over time. The consistency of fetal GLS analysis with 2D-STE was generally found to be moderate to good after 100 measurements in trainees.

References

van Oostrum N, de Vet C, Clur S, van der Woude D, van den Heuvel E, Oei S . Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses. Ultrasound Obstet Gynecol. 2021; 59(5):651-659. PMC: 9321172. DOI: 10.1002/uog.24781. View

Bansal M, Kasliwal R . How do I do it? Speckle-tracking echocardiography. Indian Heart J. 2013; 65(1):117-23. PMC: 3860973. DOI: 10.1016/j.ihj.2012.12.004. View

Koo T, Li M . A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016; 15(2):155-63. PMC: 4913118. DOI: 10.1016/j.jcm.2016.02.012. View

Day T, Charakida M, Simpson J . Using speckle-tracking echocardiography to assess fetal myocardial deformation: are we there yet?. Ultrasound Obstet Gynecol. 2019; 54(5):575-581. DOI: 10.1002/uog.20233. View

Markkanen H, Pihkala J, Salminen J, Saarinen M, Hornberger L, Ojala T . Prenatal diagnosis improves the postnatal cardiac function in a population-based cohort of infants with hypoplastic left heart syndrome. J Am Soc Echocardiogr. 2013; 26(9):1073-9. DOI: 10.1016/j.echo.2013.05.005. View

DeVore G, Jone P, Satou G, Sklansky M, Cuneo B . Aortic Coarctation: A Comprehensive Analysis of Shape, Size, and Contractility of the Fetal Heart. Fetal Diagn Ther. 2019; 47(5):429-439. DOI: 10.1159/000500022. View

van Oostrum N, van der Woude D, Clur S, Oei S, van Laar J . Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses. Prenat Diagn. 2020; 40(12):1525-1531. DOI: 10.1002/pd.5805. View

Yamada A, Luis S, Sathianathan D, Khandheria B, Cafaro J, Hamilton-Craig C . Reproducibility of regional and global longitudinal strains derived from two-dimensional speckle-tracking and doppler tissue imaging between expert and novice readers during quantitative dobutamine stress echocardiography. J Am Soc Echocardiogr. 2014; 27(8):880-7. DOI: 10.1016/j.echo.2014.04.016. View

Semmler J, Day T, Georgiopoulos G, Garcia-Gonzalez C, Aguilera J, Vigneswaran T . Fetal Speckle-Tracking: Impact of Angle of Insonation and Frame Rate on Global Longitudinal Strain. J Am Soc Echocardiogr. 2020; 33(9):1141-1146.e2. DOI: 10.1016/j.echo.2020.03.013. View

10.

Sonaglioni A, Nicolosi G, Rigamonti E, Lombardo M, La Sala L . Molecular Approaches and Echocardiographic Deformation Imaging in Detecting Myocardial Fibrosis. Int J Mol Sci. 2022; 23(18). PMC: 9501415. DOI: 10.3390/ijms231810944. View

11.

DeVore G, Polanco B, Satou G, Sklansky M . Two-Dimensional Speckle Tracking of the Fetal Heart: A Practical Step-by-Step Approach for the Fetal Sonologist. J Ultrasound Med. 2016; 35(8):1765-81. DOI: 10.7863/ultra.15.08060. View

12.

Dashe J, Mcintire D, Twickler D . Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstet Gynecol. 2009; 113(5):1001-1007. DOI: 10.1097/AOG.0b013e3181a1d2f5. View

13.

Taylor-Clarke M, Matsui H, Roughton M, Wimalasundera R, Gardiner H . Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2013; 208(6):462.e1-6. DOI: 10.1016/j.ajog.2013.02.051. View

14.

Voigt J, Pedrizzetti G, Lysyansky P, Marwick T, Houle H, Baumann R . Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2014; 16(1):1-11. DOI: 10.1093/ehjci/jeu184. View

15.

Mahle W, Clancy R, McGaurn S, Goin J, Clark B . Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics. 2001; 107(6):1277-82. DOI: 10.1542/peds.107.6.1277. View

16.

Chan J, Shiino K, Obonyo N, Hanna J, Chamberlain R, Small A . Left Ventricular Global Strain Analysis by Two-Dimensional Speckle-Tracking Echocardiography: The Learning Curve. J Am Soc Echocardiogr. 2017; 30(11):1081-1090. DOI: 10.1016/j.echo.2017.06.010. View

17.

Mirea O, Pagourelias E, Duchenne J, Bogaert J, Thomas J, Badano L . Intervendor Differences in the Accuracy of Detecting Regional Functional Abnormalities: A Report From the EACVI-ASE Strain Standardization Task Force. JACC Cardiovasc Imaging. 2017; 11(1):25-34. DOI: 10.1016/j.jcmg.2017.02.014. View

18.

McGaghie W, Issenberg S, Cohen E, Barsuk J, Wayne D . Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011; 86(6):706-11. PMC: 3102783. DOI: 10.1097/ACM.0b013e318217e119. View

19.

McGaghie W, Siddall V, Mazmanian P, Myers J . Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009; 135(3 Suppl):62S-68S. DOI: 10.1378/chest.08-2521. View

20.

Azarmehr N, Ye X, Howes J, Docking B, Howard J, Francis D . An optimisation-based iterative approach for speckle tracking echocardiography. Med Biol Eng Comput. 2020; 58(6):1309-1323. PMC: 7211789. DOI: 10.1007/s11517-020-02142-8. View