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Fetal cardiac circumference derived by spatiotemporal image correlation as a predictor of fetal hemoglobin Bart
Woralak Siwawong1, Fuanglada Tongprasert, Kasemsri Srisupundit
1Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Fetal cardiac circumference measured with STIC ultrasound can help predict Hemoglobin Bart disease in fetuses. While useful, the cardiothoracic ratio appears to be a more accurate predictor of this fetal condition.
Area of Science:
- Perinatal Medicine
- Fetal Ultrasound
- Genetics
Background:
- Hemoglobin Bart disease is a severe anemia affecting fetuses.
- Early prediction is crucial for management and counseling.
- Spatiotemporal Image Correlation (STIC) offers advanced fetal cardiac imaging.
Purpose of the Study:
- To assess the effectiveness of fetal cardiac circumference, measured via STIC, in predicting Hemoglobin Bart disease.
- To compare its predictive accuracy with other sonographic markers.
Main Methods:
- 88 high-risk pregnancies (17-22 weeks gestation) were studied.
- STIC ultrasound was used for fetal cardiac dimension measurements.
- Cordocentesis confirmed Hemoglobin Bart disease status and levels.
Main Results:
- Cardiac circumference was significantly higher in fetuses with Hemoglobin Bart disease (1.33 MoM vs. 1.02 MoM).
- Cardiac circumference showed good predictive ability (AUC 0.85), with 86.4% sensitivity and 78.1% specificity at >1.17 MoM.
- Cardiothoracic ratio demonstrated superior accuracy (90.9% sensitivity, 85.9% specificity at >0.50 MoM).
Conclusions:
- Fetal cardiac circumference (>1.17 MoM) is a potential sonographic marker for Hemoglobin Bart disease in mid-pregnancy.
- The cardiothoracic ratio appears to be a more accurate sonographic predictor of Hemoglobin Bart disease.
Objectives:
The purpose of this study was to evaluate the efficacy of the fetal cardiac circumference derived by spatiotemporal image correlation (STIC) for predicting fetal hemoglobin (Hb) Bart disease.
Methods:
Pregnancies at risk of fetal Hb Bart disease at 17 to 22 weeks' gestation were enrolled. All underwent STIC volume acquisition for analysis of fetal cardiac dimensions and cordocentesis for Hb level and Hb typing analysis. Spatiotemporal image correlation volume data sets were subsequently analyzed offline for cardiac circumference measurements, which were used to evaluate the efficacy in predicting fetal anemia and fetal Hb Bart disease.
Results:
A total of 88 pregnancies at risk of fetal Hb Bart disease at 17 to 22 weeks were recruited into the study. The cardiac circumference was significantly higher in fetuses with Hb Bart disease than in unaffected fetuses (1.33 and 1.02 multiples of the median [MoM], respectively; P < .001). The cardiac circumference effectively predicted fetal Hb Bart disease (area under the receiver operating characteristic curve, 0.85; 95% confidence interval [CI], 0.73-0.97), with sensitivity of 86.4% (95% CI, 72.0%-100%) and specificity of 78.1% (95% CI, 68.0%-88.3%) using a cutoff point of greater than 1.17 MoM, whereas the cardiothoracic ratio had better efficacy, with sensitivity of 90.9% (95% CI, 78.9%-100%) and specificity of 85.9% (95% CI, 77.4%-94.5%) using a cutoff point of greater than 0.50.
Conclusions:
At midpregnancy, a cardiac circumference of greater than 1.17 MoM can be used as an alternative sonographic marker for predicting fetal Hb Bart disease, although not perfectly. However, the cardiothoracic ratio seems to be more accurate than the cardiac circumference for such a purpose.
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