Vol.:(0123456789) 1 3 Pediatric Cardiology https://doi.org/10.1007/s00246-020-02362-7 ORIGINAL ARTICLE Fetal Cardiac Function and Ventricular Volumes Determined by Three‑Dimensional Ultrasound Using STIC and VOCAL Methods in Fetuses from Pre‑gestational Diabetic Women Nathalie Jeanne Bravo‑Valenzuela 1  · Alberto Borges Peixoto 2,3  · Rosiane Mattar 1  · José Francisco Melo Júnior 1  · David Baptista da Silva Pares 1  · Edward Araujo Júnior 1 Received: 6 January 2020 / Accepted: 23 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract To assess the fetal cardiac function and ventricular volumes by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods in fetuses from pre-gestational diabetic women. This was a prospective and cross-sectional study that evaluated 53 fetuses from pre-gestational diabetic women and 53 fetuses from healthy mothers between 20 and 34 weeks of gestation. Only fetuses with no structural or genetic abnormalities and singleton pregnant women were included in this study. The fetal cardiac volumes were assessed by STIC and VOCAL methods. The ejection fraction, stroke volume, and cardiac output were calculated from these measurements to evaluate fetal cardiac function. The Mann–Whitney U test was performed to compare the two groups. For calculation of intra- and interobserver reproducibility’s, we used concordance correlation coefcients. The mean diferences in the right atrial volumes between the diabetic and normal groups ranged from 0.05 mL to 0.1 mL (p = 0.917 and 0.355, respectively). The median of left atrium (LA) volume measurement in pre-gestational diabetic group was signifcantly lower than healthy mothers (LA: 0.62 vs. 0.68 mL; p < 0.001). The fetal right and left ventricular volumes were similar in both groups. No signifcant diferences in ejection fraction, stroke volume and cardiac output were observed (p value range 0.086–0.815). The majority of fetal atrial/ventricular volumes showed good intra- and interobserver reliabilities. Conversely, the majority cardiac function parameters showed poor intra- and interobserver agreements. STIC and VOCAL methods gave reproducible quantitative results for fetal atrial and ventricular volumes. Signifcant diferences in fetal left atrial volumes were observed between the two groups, which be related to LA atrial dysfunction and /or left ventricle (LV) compliance, refecting earlier stages of cardiac dysfunction. Keywords Fetal cardiac function · Diabetes mellitus · Three-dimensional ultrasound · Spatio-temporal image correlation · Virtual organ computer-aided analysis Introduction Classically, assessment of cardiac function by echocardi- ography was routinely performed in fetuses with structural congenital heart diseases (CHD). Currently, fetal echocardi- ography has been used to evaluate cardiac function, even in fetuses without anatomical heart defects who present extra- cardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, congenital infections, or maternal diseases that can include diabetes mellitus (DM) and chronic hypertension, among others [1–3]. A detailed analysis of the cardiac function can pro- vide important information on hemodynamic status and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00246-020-02362-7) contains supplementary material, which is available to authorized users. * Edward Araujo Júnior araujojred@terra.com.br 1 Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP CEP 05089-030, Brazil 2 Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil 3 Department of Obstetrics and Gynecology, University of Uberaba, Uberaba, MG, Brazil