Two-dimensional fetal speckle tracking; a learning curve study for offline strain analysis.

Area of Science:

• Cardiology
• Obstetrics
• Medical Imaging

Background:

• Two-dimensional speckle tracking (2D-STE) strain analysis is a promising tool for evaluating fetal cardiac function.
• Understanding the learning curve for 2D-STE is essential before its widespread adoption in obstetrics.

Purpose of the Study:

• To examine the learning curve for offline analysis of fetal left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) using 2D-STE.
• To assess the consistency and learning progression of trainees in fetal cardiac strain analysis.

Main Methods:

• Three trainees (fellow, resident, 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 used to compare trainee GLS values against an expert.
• Repeated measurements analysis assessed GLS score differences over time and between trainees, with Bonferroni correction.

Main Results:

• LV-GLS consistency improved from poor-to-moderate to moderate-to-good within 100 measurements for all trainees.
• RV-GLS consistency showed improvement in the latter half of measurements for the fellow and resident, but varied for the student.
• Variability in GLS score differences between trainees and the expert significantly decreased over time (padj<0.001).

Conclusions:

• A significant learning effect was observed, indicated by reduced variability in GLS scores over time.
• Trainee consistency in fetal GLS analysis using 2D-STE reached moderate-to-good levels after approximately 100 measurements.
• The findings support the feasibility of incorporating 2D-STE into clinical obstetrics practice after adequate training.