Comparison of Left Ventricular Stroke Volume in 2nd- and 3rd Trimester Fetuses Measured by the Product of VTI and Aortic Annular Area With That Assessed by Simpson's Single-Plane Rule Using the STE Technique

Krzysztof Serafin; Agnieszka A Nocun; Katarzyna Zawisza; Magdalena M Dudzik; Marcin T Wiechec

doi:10.1002/jum.16456

Comparison of Left Ventricular Stroke Volume in 2nd- and 3rd Trimester Fetuses Measured by the Product of VTI and Aortic Annular Area With That Assessed by Simpson's Single-Plane Rule Using the STE Technique

J Ultrasound Med. 2024 Apr 3. doi: 10.1002/jum.16456. Online ahead of print.

Authors

Krzysztof Serafin^{1

2}, Agnieszka A Nocun³, Katarzyna Zawisza⁴, Magdalena M Dudzik³, Marcin T Wiechec^{1

3}

Affiliations

¹ Chair of Gynecology and Obstetrics, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
² Ultrasound Laboratory, ARS MEDICA Specialist Gynecology and Obstetrics Clinic, Tarnow, Poland.
³ Ultrasound Laboratory, MWU DOBRE USG Center of Ultrasound Diagnostics, Cracow, Poland.
⁴ Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Cracow, Poland.

PMID: 38567690
DOI: 10.1002/jum.16456

Abstract

Objectives: The aim of the study was to compare left ventricle stroke volume in healthy, eutrophic fetuses in the 2nd and 3rd trimesters evaluated using the velocity time integral and aortic annulus area with left ventricular stroke volume measured using Simpson's single-plane rule and to determine the discrepancy equation.

Methods: The study included 354 fetuses. In each fetus, during the same examination, simultaneous assessment of stroke volume was performed by pulsed-wave Doppler using the product of the velocity time integral and aortic annulus area and by the fetalHQ® software using Simpson's single-plane rule. The Mann-Whitney U test was used to compare the "product-derived" stroke volume and stroke volume using fetalHQ® software values in the 2nd and 3rd trimesters separately. The agreement between the two methods were verified using Bland-Altman analysis. A linear regression model was used to obtain the discrepancy equation.

Results: In the 2nd trimester, the mean percentage difference between both the techniques showed that the stroke volume values determined using pulsed-wave Doppler were, on average, 88% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 146% and the lower limit of agreement was equal to 29.6%. In the 3rd trimester, the results indicated that the stroke volume values determined using pulsed-wave Doppler were, on average, 76% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 129% and the lower limit of agreement was 23%. Based on the results of the linear regression models, discrepancy formulas of the stroke volume values were obtained. The equations to calculate the predicted mean and standard deviations were used to compute the reference intervals for the mean, 5th and 95th centiles.

Conclusion: The calculation of left ventricular stroke volume using pulsed Doppler has higher result in relation to stroke volume determined using Simpson's rule significantly. The aortic annulus area showed a higher correlation regarding stroke volume than the velocity time integral in both the 2nd and 3rd trimesters. Stroke volume increased with the increase in aortic annulus area, whereas the velocity time integral remained relatively constant. The retrospective analysis of the collected material enabled the determination of the discrepancy equation.

Keywords: cardiac output; fetal cardiac function; fetal echocardiography; fetalHQ®; speckle tracking; stroke volume; velocity time integral.