Spatio-temporal images of annular plane systolic excursion: a study of manual intra-observer reliability and correlation with automated values.

OBJECTIVES: Longitudinal ventricular function can be assessed by measuring the annular plane systolic excursion at tricuspid (TAPSE), mitral (MAPSE) or septal (SAPSE) level. This information could be useful in obstetrical practice since common maternal-fetal conditions may modify fetal cardiac function. Automation of these parameters could improve repeatability, enhancing applicability in clinical practice. METHODS: Data was prospectively acquired from a mixed cohort of healthy fetuses and those affected by congenital heart disease between 19 + 6 and 36 + 6 gestational weeks. From 90 available STIC volumes, 40 were selected based on a quality scoring system, and TAPSE, MAPSE, and SAPSE were measured by three different operators at different levels of expertise. A recently developed automated tool was applied to calculate TAPSE, MAPSE, and SAPSE from 4D STIC volumes. Intraclass correlation (ICC) was used for analysis. RESULTS: Manual intra-observer repeatability was high for TAPSE, MAPSE, and SAPSE (ICCs 0.92-0.99 (95 % CI 0.86; 0.99), 0.89-0.99 (95 % CI 0.81; 0.94) and 0.89-0.98 (95 % CI 0.83-0.98) respectively). Manual inter-observer repeatability was highest between the operators with the highest and intermediate experience rather than the least experienced. With clear annulus visibility, agreement between automated and manual was excellent for TAPSE and MAPSE (ICCs 0.90 (95 % CI 0.72; 0.97) and 0.97 (95 % CI 0.88; 0.99) respectively) and good for SAPSE (ICC 0.76 (95 % CI -0.56; 0.98)). CONCLUSIONS: Automated annular displacement measurement generates excellent results for the degree of agreement with manual measurement for TAPSE and MAPSE, and good for SAPSE under specific conditions. This validated tool may be beneficial for practitioners less experienced in fetal cardiac function assessment. Our encouraging results suggest that further study of the automated method of annular systolic excursion is appropriate.