5D Heart Research Articles

Evolution of Fetal Cardiac Imaging over the Last 20 Years

The purpose of this article is to describe the evaluation of a variety of congenital heart diseases (CHDs) using three-dimensional (3D) ultrasound with different software, such as Cristal Vue, Realistic Vue, LumiFlow, and Spatiotemporal Image Correlation (STIC), with HDlive and HDlive Flow Silhouette modes. These technologies provide realistic images of the fetal heart and cardiac vessels using a fixed virtual light source that allows the operator to freely select a better light source position to enhance the cardiovascular anatomical details. In addition, Fetal Intelligent Navigation Echocardiography (FINE) technology, also known as “5D Heart” or “5D”, is a technology that enables the automatic reconstruction of the nine standard fetal echocardiographic views and can alert non-specialists to suspected CHD. Through the use of artificial intelligence, an ultrasound machine is able to perform automatic anatomical and functional measurements. In addition, hese technologies enable the reconstruction of fetal cardiac structures in realistic images, improving the depth perception and resolution of anatomic cardiac details and blood vessels compared to those of standard two-dimensional (2D) ultrasound.

Progenitor cells offer great hope for heart failure patients

The 5D Heart Patch Project has identified human ventricular progenitor (HVP) cells that can create self-assembling heart grafts in vivo, offering hope to people suffering from heart failure.

Physical performance of patients with chronic kidney disease stage 5D and coronary heart disease

BACKGROUND. Assessment of physical performance in patients is usually based on the results of the 6-minute walk test, which is primarily associated with heart or respiratory failure. THE AIM: to analyze the results of the 6-minute walk test with clinical and laboratory parameters of patients with CKD 5D, including criteria for protein-energy malnutrition. PATIENTS AND METHODS. 67 people with CKD 5D were examined, including 42 men and 25 women, mean age 49.0 ± 14.9 and 57.2 ± 15.5 years, respectively, p = 0.036. The duration of RRT in men was 96.1 ± 80.3 months, in women 100.7 ± 66.1 months, p = 0.810. The diagnosis of coronary heart disease was established in 22 people, 7 of them had AMI. The muscle strength of the skeletal muscles was assessed using a hand dynamometer, the performance of the skeletal muscles – during a test with a 6-minute walk. All patients filled out food diaries, where they indicated the qualitative and quantitative composition of the food which they consumed for 3 days. RESULTS. Walking load was most easily tolerated by patients without clinical manifestations of CAD. Between patients with and without AMI in history, the number of points on the Borg scale was comparable and reached the maximum values. The highest concentration of C-reactive protein and the lowest concentration of serum albumin were observed in patients who had had AMI. Relationships were found between serum albumin with C-reactive protein and the results of the 6-minute walk test, as well as between the mass index of the left ventricular myocardium with the results of the 6-minute walk test. CONCLUSION. Left ventricular hypertrophy masks the clinical signs of reduced physical performance, but increases the risk of cardiovascular complications. The results of the 6-minute walk test in patients with CAD should be evaluated in more detail. A number of studies are needed to clarify how dietary recommendations should be modified depending on the level of systemic inflammation in CKD.

New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D heart

Congenital heart disease (CHD) is the leading organ-specific birth defect, as well as the leading cause of infant morbidity and mortality from congenital malformations. Therefore, a comprehensive screening examination of the fetal heart should be performed in all women to maximize the detection of CHD. Four-dimensional sonography with spatiotemporal image correlation (STIC) technology displays a cine loop of a complete single cardiac cycle in motion. A novel method known as Fetal Intelligent Navigation Echocardiography (or FINE) was previously developed to interrogate STIC volume datasets using “intelligent navigation” technology. Such method allows the automatic display of nine standard fetal echocardiography views required to diagnose most cardiac defects. FINE considerably simplifies fetal cardiac examinations and reduces operator dependency. It has both high sensitivity and specificity for the detection of CHD. Indeed, FINE has been integrated into several commercially available ultrasound platforms. Recently, eight novel and advanced features have been developed for the FINE method and they will be described herein. Such features can be categorized based upon their broad goals. The first goal is to simplify FINE further, and consists of the following features: (1) Auto fetal positioning (or FINE align); (2) Skip points; (3) Predictive cursor; (4) Static mode volume; and (5) Breech sweep. The second goal is to allow quantitative measurements to be performed on the cardiac views generated by FINE: (6) Automatic cardiac axis; and (7) Cardiac biometry. Finally, the last goal is to improve the success of obtaining fetal echocardiography view(s); and consists of (8) Maestro planar navigation.

Novel foetal echocardiographic image processing software (5D Heart) improves the display of key diagnostic elements in foetal echocardiography

BackgroundTo evaluate the clinical value of foetal intelligent navigation echocardiography (5D Heart) for the display of key diagnostic elements in basic sections.Methods3D volume datasets of 182 normal singleton foetuses were acquired with a four chamber view by using a volume probe. After processing the datasets by using 5D Heart, eight cardiac diagnostic planes were demonstrated, and the image qualities of the key diagnostic elements were graded by 3 doctors with different experiences in performing foetal echocardiography.ResultsA total of 231 volume datasets acquired from the 182 normal foetuses were used for 5D Heart analysis and display. The success rate of 8 standard diagnostic views was 88.2%, and the success rate of each diagnostic view was 55.8–99.2% and 70.7–99.0% for the random four chamber view as the initial section and for the apical four chamber view as the initial section, respectively. The success rate of each diagnostic element in the 8 diagnostic sections obtained by 5D Heart was 58.9%~ 100%. Excellent agreement was found between experienced sonographers and less-experienced sonographers (kappa> 0.769). Inter- and intra-observer agreement were substantial to near-perfect, kappa values ranging from 0.612 to 1.000 (Cohen’s kappa).Conclusions5D Heart can significantly improve the image quality of key diagnostic elements in foetal echocardiography with low operator dependency and good reproducibility.

Study on diagnostic performance of fetal intelligent navigation echocardiography for congenital heart defect

Objective To explore the sensitivity and specificity of fetal intelligent navigation echocardiography(FINE, 5D Heart) in the prenatal detection of congenital heart defect(CHD), and to compare its diagnostic performance with spatiotemporal image correlation(STIC) loop (STICloop). Methods A total of 250 pregnant women having a singleton pregnancy in the second and third trimesters from April 2018 to May 2019 in Sir Run Run Shaw Hospital, Zhejiang University College of Medicine were enrolled in this prospective study. 2D ultrasound diagnosis has been made before acquiring STIC volume data set. After the appropriateness of each volume data set was preliminarily determined, all identifying informations were concealed and the appropriate volumes were randomly distributed to less experienced sonographer for analysis using 5D Heart software. The sensitivity and specificity, positive and negative likelihood ratios, as well as area under the receiver operating characteristic curve (AUC) of the two methods were determined respectively, and the differences between the two methods were statistically analyzed. Results The diagnostic performance of 5D Heart for the prenatal detection of CHD was: sensitivity of 95.45% (105/110), specificity of 94.29% (132/140), positive likelihood ratio of 16.72, negative likelihood ratio of 0.05, and AUC of 0.95, respectively. Among cases with confirmed CHD, the 5D Heart diagnosis completely matched the final diagnosis in 77.27% (85/110). The diagnostic performance of STICloop for the prenatal detection of CHD was: sensitivity of 90.91% (100/110), specificity of 92.86% (130/140), positive likelihood ratio of 12.73, negative likelihood ratio of 0.10, and AUC of 0.92. The sensitivity and secificity of 5D Heart in diagnosing CHD were both higher than 90%, and it could successfully detect a broad spectrum of severe fetal CHD. Among cases with confirmed CHD, even the STICloop diagnosis completely matched the final diagnosis in 61.81%(68/110), its diagnostic accuracy was relatively lower than 5D Heart (P=0.013). However, there were no statistical differences between the two methods in sensitivity and specificity(all P>0.05). Conclusions The sesitivity and specifity of 5D Heart in diagnosis CHD were both higher than 90%, and it could successfully detect a broad spectrum of severe fetal CHD. STICloop could be used for preliminary screening of CHD, as it has the same high sensitivity and specificity as 5D Heart. Further examination may be recommended when fetal heart abnormalities are suspected. Key words: Echocardiography; Congenital heart defect; Fetal intelligent navigation echocardiography; Spatiotemporal image correlation

986: The utility of Fetal Intelligent Navigation Echocardiography in obtaining fetal echocardiography views

Prenatal identification of congenital heart defects can be difficult due to the complex anatomy, size and motion of the fetal heart. Newer evidence suggests that 3D and 4D sonographic imaging using a dynamic volume dataset may improve identification of fetal heart anomalies. We aimed to evaluate the performance of Fetal Intelligent Navigation Echocardiography (FINE) when applied to volume datasets of the normal fetal heart. Prospective cohort study from a single academic institution of low risk women presenting for fetal anatomic evaluation between 18 and 23 weeks gestation. During sonographic evaluation, one or more dynamic volume acquisitions were obtained by a qualified, trained sonographer of the apical 4 chamber view of the heart. Each dynamic volume dataset was assessed for quality of anatomical views and the presence of motion or shadow artifact by a trained sonographer and physician prior to application of FINE (5D) software. The rates (95% CI) for visualization of the various heart views using diagnostic 2D planes and the 5D heart method were calculated using the Wald method, and compared between the two groups using χ2 test. One or more dynamic volumes (160 in total) were obtained from 60 women. Non-manipulated 2D view rates of visualization for individual fetal echocardiographic views ranged from 50-95%. Applying the FINE method resulted in rates of visualization of individual fetal echocardiographic views ranging between 80-98% (Table 1). The completeness of cardiac views for basic, detailed, and fetal echocardiography surveys was improved with additional manipulations obtained through diagnostic planes or FINE-Assistance for each normal dynamic volume dataset (Table 2). The FINE (5D) method is superior to traditional 2D diagnostic plane in generating all nine standard fetal echocardiography views in cases studied. Utilization of the 5D heart (FINE) method may enhance fetal cardiac survey during second trimester anatomic ultrasounds.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

EP10.14: Value of fetal intelligent navigation echocardiography (5D heart) and virtual intelligent sonographer assistance (VIS‐assistance) in the display of key diagnostic elements in basic fetal echocardiographic views

EP10.14: Value of fetal intelligent navigation echocardiography (5D heart) and virtual intelligent sonographer assistance (VIS‐assistance) in the display of key diagnostic elements in basic fetal echocardiographic views

P08.06: Value of fetal intelligent navigation echocardiography with colour flow imaging (5D heart colour) in the display of key diagnostic elements in basic fetal echocardiographic views

P08.06: Value of fetal intelligent navigation echocardiography with colour flow imaging (5D heart colour) in the display of key diagnostic elements in basic fetal echocardiographic views

Value of fetal intelligent navigation echocardiography with color flow imaging in the display of key diagnostic elements in basic fetal echocardiographic views

Objective To evaluate the value of fetal intelligent navigation echocardiography with color flow imaging (5D Heart Color) in the display of key diagnostic elements in basic fetal echocardiographic views. Methods The heart volumes datasets of 220 fetuses were collected and the offline analysis was conducted. Pearson correlations was used to compare the detection rate of blood flow element between 5D Heart Color software and color Doppler flow imaging(CDFI) in basic fetal echocardiographic views, and the detection rate of blood flow between normal fetuses (control group) and fetuses with cardiovascular abnormalities(case group). Bland-Altman analysis was used to prove consistency and reliability of the results. Results Totally 384 fetal heart volume datasets were collected from 220 fetuses, and 317 volume datasets of 200 cases could be used for the analysis, with the acquiring success rate of 82.6%. 5D Heart Color software and CDFI showed a close correlation in displaying key cardiovascular blood flow information in key fetal echocardiographic diagnosis sections (r=0.88, P<0.05); The detection rates of blood flow elements in control group and case group were 91.9% and 87.3%, respectively, with an average of 89.6% (r=0.9, P<0.05). Bland-Altman analysis showed close consistency between inter- and intra-observations in the detection rates of blood flow elements, and their 95% confidence intervals were (-0.1/+ 0.09) and (-0.09/+ 0.1), respectively, and the points outside the 95% confidence interval were 5.4%(17/231) and 5.7%(18/231), respectively. Conclusions 5D Heart Color software shows similar usefulness in the displaying key blood flow elements, comparing with CDFI, demonstrating higher reliability and repeatability in displaying fetal echocardiographic diagnosis views and diagnostic blood flow elements. Key words: Echocardiography; Congenital heart disease; Fetus; Fetal intelligent navigation echocardiography

A preliminary study of fetal intelligent navigation echocardiography in the normal fetuses during second and third trimester

Objective To investigate the value of fetal intelligent navigation echocardiography (FINE, 5D Heart) in displaying the normal fetal heart structure during 20 to 38 weeks′ gestation. Methods Three-dimensional data of fetal heart during 20 to 38 weeks′ gestation were acquired using volume transducer prospectively. The STIC volume images were post-processed with 5D heart software by three physicians with different levels of echocardiographic examination and the quality of the section images were analyzed. The intra- and interobserver repeatability was analyzed for the qualification of section images. The correlation between the quality of image and gestational age, body mass index, the placenta position, fetal initial plane position were evaluated using univariate and multivariable logistic regression analysis. Results Two hundreds and five cases of pregnant women were included, and 9 cases were excluded.Volume data acquisition was completed in 180 pregnant women, and the image acquisition rate was 91.8%. The data were assessed twice by three observers and qualified 9 section images were gotten in 156-180 cases (degree of qualification 86.7%-100%). The screening images were satisfied in 152 cases (84.4%), dissatisfied with 28 cases (15.6%). The intra-observer agreement by three observers was absolute concord in four chamber view and abdomen/stomach view; excellent in three vessel trachea view(3VT), five chamber view, left ventricular outflow tract view and superior and inferior vena cava view; good in right ventricular outflow tract view, ductal arch view and aortic arch view. The inter-observer agreement by each of three observers was absolute concord in four chamber view and abdomen/stomach view; excellent in superior and inferior vena cava view; excellent to good in five chamber view, left ventricular outflow tract view, right ventricular outflow tract view; good in 3VT, ductal arch view and aortic arch view. In a univariate analysis, the quality of the image was associated with obesity (χ2=15.338, P=0.000), gestational age (χ2=23.356, P=0.000). Multivariable analysis showed that the obesity (OR=5.587, P=0.001) and gestational age (OR=8.843, P=0.000) were factors affecting the quality of the image. The average time spent in post-processing the images for first time by three observers was (2.77±1.39)min, and there was no significant difference among observers (P>0.05). Conclusions Fetal intelligent navigation echocardiography (FINE, 5D Heart) based on STIC volumes can successfully generate 9 standard fetal echocardiography views in 86.7%-100% of fetuses in the 2nd and 3rd trimesters. This method can simplify examination of the fetal heart and reduce operator dependency. Key words: Echocardiography; Fetal heart; Spatiotemporal image correlation; Fetal intelligent navigation echocardiography(FINE)

Clinical value of fetal intelligent navigation echocardiography (5D Heart) in the display of key diagnostic elements in basic fetal echocardiographic views

Objective To evaluate the clinical value of fetal intelligent navigation echocardiography (5D Heart) in the display of key diagnostic elements in basic fetal echocardiographic views. Methods Using volume probe, 3D volume datasets of the 209 normal singleton fetuses in the second and third trimesters were acquired from a four-chamber view. After processing the datasets by using 5D Heart, 9 cardiac diagnostic planes were acquired and then the image qualities of key diagnosis elements of the heart and great vessels were graded by 3 doctors with different experiences of performing fetal echocardiography. Results Two hundred and sixty-two volume datasets were acquired from 209 normal fetuses, including 53 volume datasets collected when cardiac apex was in different directions, satisfactory datasets failed to be acquired in 27 fetuses because of the maternal obesity, the artifacts of fetal movement, or other influencing factors. Two hundred and thirty-one volume datasets of 182 fetuses could be used for 5D Heart analyzing and displaying, and the displaying rate of 9 standard diagnostic views was up to 88.2%. No significant difference was found when comparing the grading results of one observer in different periods of time, the grading results between two experienced doctors and the grading results among the experienced doctor and one relatively inexperienced doctor (P>0.05). Conclusions 5D Heart has high reliability and repeatability in obtaining fetal echocardiographic diagnosis views and displaying fetal elemental diagnostic information. Key words: Fetal echocardiography; Congenital heart disease; Fetal intelligent navigation echocardiography; Spatiotemporal image correlation

Value of fetal intelligent navigation echocardiography (5D heart) and Virtual Intelligent Sonographer Assistance (VIS-Assistance®) in the display of key diagnostic elements in basic fetal echocardiographic views

Objective To evaluate the value of fetal intelligent navigation echocardiography (5D Heart) and Virtual Intelligent Sonographer Assistance (VIS-Assistance®) in the display of key diagnostic elements in basic fetal echocardiographic views. Methods The heart volumes data of 209 normal fetuses were collected and then the offline analysis was conducted. Processing of the built-in VIS-Assistance® for each diagnosis plane was optimized. The display success rate and image quality difference of diagnosis images and diagnosis elements before and after the VIS-Assistance® processing as well as the repeatability between observers were analyzed and compared. Results Totally 262 fetal heart volume data were collected from 209 fetuses,and 231 volume data of 182 cases could be used for the analysis,with the acquiring success rate of 88.2%. For the display rate of 8 diagnosis sections of the 231 fetal heart volume data before and after VIS-Assistance® processing,abdominal transverse section at stomach level showed no significant difference,while the other diagnostic sections showed significant differences (all P<0.05),and the display rate after the processing was higher than that before the processing. For the image quality scores of diagnosis sections before and after VIS-Assistance® processing,abdominal transverse section at stomach level showed no significant differences,while other diagnostic sections showed significant differences (all P<0.01),and the image quality scores after the processing were higher than those before the processing. According to Bland-Altman analysis,95% credibility interval of the total scores of 8 sections measured by different observers before and after VIS-Assistance® were (-0.17/+ 0.18) and (-0.17/+ 0.18),respectively,6.06% (14/231) and 3.89% (9/231) of the points were outside the 95% credibility interval,and the rest had high consistency. Conclusions 5D Heart and VIS-Assistance® technology can significantly improve the display rate of diagnostic section and image quality of element structures,and has high reliability and repeatability in obtaining fetal cardiac diagnosis sections and displaying fetal elemental diagnostic information. Key words: Echocardiography; Heart difects,congenital; Fetus; Spatiotemporal image correlation

Performance of Fetal Intelligent Navigation Echocardiography (FINE, 5DHeart ©) in congenital heart defects – experiences from a retrospective single center study

Purpose: Congenital heart defects (CHD) are among the most common malformations as well as the main cause of malformation related childhood mortality. Although ultrasound is nowadays available almost everywhere, the majority of congenital heart defects are diagnosed postnatally. Fetal intelligent navigation echocardiograpy (FINE, 5D Heart©) was developed to assist physicians in the extraction of examinations planes in accordance to national and international guidelines from a STIC (spatiotemporal image correlation) volume data set. Material and methods: In our retrospective study STIC volumes of patients with a fetus affected by congenital heart disease (n = 35) were examined. After seven predefined anatomical structures were labeled, a sort of “map” of the fetal heart was automatically constructed by the algorithm and nine examination planes in accordance with the guidelines of the German Society for Ultrasound in Medicine (DEGUM), International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the American Institute of Ultrasound in Medicine (AIUM) were extracted. The examined heart defects include tetralogy of Fallot, atrioventricular septal defects (AVSD), double outlet right ventricle (DORV), Hypoplastic left heart syndrome and other major structural heart defects. The volume data sets of the affected fetuses were analyzed with the FINE algorithm and the resulting planes have been examined. Results: The results whether the heart defect is detectable will be demonstrated. Conclusions: Preliminary results confirm and expand previously published data that the algorithm in combination with the standard 2D ultrasound could be a valuable tool to identify CHD and moreover to improve prenatal counseling and multidisciplinary management of the delivery.