Fetal Growth



Heart Function

Newest Technology to Evaluate Function of the Fetal Heart in Fetuses Who are Have Growth Restriction


Approximately 10% of fetuses may be classified as growth restricted in the last 13 weeks of pregnancy. This simply means that they are undergrown, or their weights estimated by ultrasound measurements are less than the 10th percentile. For example, if we were to classify people by their height it would range between 0 t0 100, with the 50th percentile being average.  If an individual were at the 10th percentile this would mean that 90 percent of the population would be taller than the person who is at the 10th percentile.


Studies evaluating growth of the fetus have reported that those fetuses who have an estimated ultrasound weight less than the 10th percentile are at increased risk for adverse outcome that includes fetal death, as well as complications following birth such as heart disease, diabetes, and learning disabilities.  When such fetuses are identified, further evaluation of blood flow to the placenta and to the fetal brain assist in identifying a subgroup of fetuses who have increased risk for adverse outcome.


Until recently, it was thought that if a fetus had an estimated weight less than the 10th percentile but had NORMAL blood flow studies of the umbilical artery and brain, then the fetus was simply small, with no risk for adverse outcome. However, in recent studies by Dr. DeVore, in conjunction with investigators at the University of Colorado, they demonstrated that these fetuses also had abnormal cardiac findings that altered the size and shape of the fetal heart as well as function of the ventricles.


The above findings were identified using a new technology to assess fetal heart function that was created by Dr. DeVore in conjunction with TomTec and General Electric Ultrasound. This technology was introduced to the ultrasound world in October 2019, at an international meeting of ultrasound specialists in Singapore.  This new technology is called fetalHQ, in which HQ represents “Heart Quantification.”


If you are interested, you may click on the references listed below to review the abstracts and studies written by Dr. DeVore that were used in the creation of this sophisticated program that will revolutionize evaluation of the fetus.  In addition, there is a link to an interview in which Dr. DeVore describes how this technology was developed. Of importance, Dr. DeVore has received no compensation from GE Ultrasound or TomTec for developing this technology and therefore, has no conflict of interest when discussing this technology.


Dr. DeVore's Interview with GE Ultrasound Regarding the Development of fetalHQ

Medical Publications by Dr. DeVore

That Provided the Basis for


1: DeVore GR, Afshar Y, Harake D, Satou G, Sklansky M. Speckle-Tracking Analysis in Fetuses With Tetralogy of Fallot: Evaluation of Right and Left Ventricular Contractility and Left Ventricular Function. J Ultrasound Med. 2022 Dec;41(12):2955-2964. doi: 10.1002/jum.15987. Epub 2022 Apr 9. PMID: 35397130.



2: DeVore GR, Klas B, Satou G, Sklansky M. Measuring the Area of the Interventricular Septum in the 4-Chamber View: A New Technique to Evaluate the Fetus at Risk for Septal Hypertrophy. J Ultrasound Med. 2022 Dec;41(12):2939-2953. doi: 10.1002/jum.15980. Epub 2022 Mar 19. PMID: 35305032.



3: DeVore GR, Klas B, Satou G, Sklansky M. Speckle Tracking Analysis to Evaluate the Size, Shape, and Function of the Atrial Chambers in Normal Fetuses at 20-40 Weeks of Gestation. J Ultrasound Med. 2022 Aug;41(8):2041-2057. doi: 10.1002/jum.15888. Epub 2021 Nov 26. PMID: 34825711.



4: DeVore GR, Cuneo B, Sklansky M, Satou G. Abnormalities of the Width of the Four-Chamber View and the Area, Length, and Width of the Ventricles to Identify Fetuses at High-Risk for D-Transposition of the Great Arteries and Tetralogy of Fallot. J Ultrasound Med. 2022 Jul 13. doi: 10.1002/jum.16060. Epub ahead of print. PMID: 35822424.



5: DeVore GR, Satou GM, Afshar Y, Harake D, Sklansky M. Evaluation of Fetal Cardiac Size and Shape: A New Screening Tool to Identify Fetuses at Risk for Tetralogy of Fallot. J Ultrasound Med. 2021 Dec;40(12):2537-2548. doi: 10.1002/jum.15639. Epub 2021 Jan 27. PMID: 33502041.



6: DeVore GR, Satou G, Sklansky M. Comparing the Non-Quiver and Quiver Techniques for Identification of the Endocardial Borders Used for Speckle- Tracking Analysis of the Ventricles of the Fetal Heart. J Ultrasound Med. 2021 Sep;40(9):1955-1961. doi: 10.1002/jum.15561. Epub 2020 Nov 11. PMID: 33174649.



7: DeVore GR, Portella PP, Andrade EH, Yeo L, Romero R. Cardiac Measurements of Size and Shape in Fetuses With Absent or Reversed End-Diastolic Velocity of the Umbilical Artery and Perinatal Survival and Severe Growth Restriction Before 34 Weeks' Gestation. J Ultrasound Med. 2021 Aug;40(8):1543-1554. doi: 10.1002/jum.15532. Epub 2020 Oct 30. PMID: 33124711; PMCID: PMC8532524.



8: DeVore GR, Haxel C, Satou G, Sklansky M, Pelka MJ, Jone PN, Cuneo BF. Improved detection of coarctation of the aorta using speckle-tracking analysis of fetal heart on last examination prior to delivery. Ultrasound Obstet Gynecol. 2021 Feb;57(2):282-291. doi: 10.1002/uog.21989. PMID: 32022339.



9: DeVore GR, Jone PN, Satou G, Sklansky M, Cuneo BF. Aortic Coarctation: A Comprehensive Analysis of Shape, Size, and Contractility of the Fetal Heart. Fetal Diagn Ther. 2020;47(5):429-439. doi: 10.1159/000500022. Epub 2019 May 27. PMID: 31132773.



10: DeVore GR, Satou G, Sklansky M. Using speckle-tracking echocardiography to assess fetal myocardial deformation: are we there yet? Yes we are! Ultrasound Obstet Gynecol. 2019 Nov;54(5):703-704. doi: 10.1002/uog.21876. PMID: 31688995.



11: DeVore GR, Gumina DL, Hobbins JC. Assessment of ventricular contractility in fetuses with an estimated fetal weight less than the tenth centile. Am J Obstet Gynecol. 2019 Nov;221(5):498.e1-498.e22. doi: 10.1016/j.ajog.2019.05.042. Epub 2019 May 30. PMID: 31153929.



12: DeVore GR, Klas B, Satou G, Sklansky M. Evaluation of Fetal Left Ventricular Size and Function Using Speckle-Tracking and the Simpson Rule. J Ultrasound Med. 2019 May;38(5):1209-1221. doi: 10.1002/jum.14799. Epub 2018 Sep 23. PMID: 30244474.



13: DeVore GR, Klas B, Satou G, Sklansky M. Speckle Tracking of the Basal Lateral and Septal Wall Annular Plane Systolic Excursion of the Right and Left Ventricles of the Fetal Heart. J Ultrasound Med. 2019 May;38(5):1309-1318. doi: 10.1002/jum.14811. Epub 2018 Sep 12. PMID: 30208238.



14: DeVore GR, Cuneo B, Klas B, Satou G, Sklansky M. Comprehensive Evaluation of Fetal Cardiac Ventricular Widths and Ratios Using a 24-Segment Speckle Tracking Technique. J Ultrasound Med. 2019 Apr;38(4):1039-1047. doi: 10.1002/jum.14792. Epub 2018 Oct 2. PMID: 30280404.



15: DeVore GR. Equations for the Right-to-Left Ventricular Ratio and Right and Left Ventricular Widths Do Not Match the Corresponding Tables. J Ultrasound Med. 2019 Feb;38(2):553-554. doi: 10.1002/jum.14702. Epub 2018 Jul 19. PMID: 30027619.



16: DeVore GR, Klas B, Satou G, Sklansky M. Quantitative evaluation of fetal right and left ventricular fractional area change using speckle-tracking technology. Ultrasound Obstet Gynecol. 2019 Feb;53(2):219-228. doi: 10.1002/uog.19048. PMID: 29536575.



17: DeVore GR, Zaretsky M, Gumina DL, Hobbins JC. Right and left ventricular 24-segment sphericity index is abnormal in small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2018 Aug;52(2):243-249. doi: 10.1002/uog.18820. PMID: 28745414.



18: DeVore GR, Klas B, Satou G, Sklansky M. Longitudinal Annular Systolic Displacement Compared to Global Strain in Normal Fetal Hearts and Those With Cardiac Abnormalities. J Ultrasound Med. 2018 May;37(5):1159-1171. doi: 10.1002/jum.14454. Epub 2017 Oct 31. PMID: 29086430.



19: DeVore GR, Klas B, Satou G, Sklansky M. Twenty-four Segment Transverse Ventricular Fractional Shortening: A New Technique to Evaluate Fetal Cardiac Function. J Ultrasound Med. 2018 May;37(5):1129-1141. doi: 10.1002/jum.14455. Epub 2017 Oct 25. PMID: 29068072.



20: DeVore GR, Klas B, Satou G, Sklansky M. 24-segment sphericity index: a new technique to evaluate fetal cardiac diastolic shape. Ultrasound Obstet Gynecol. 2018 May;51(5):650-658. doi: 10.1002/uog.17505. PMID: 28437575.



21: DeVore GR, Klas B, Satou G, Sklansky M. Evaluation of the right and left ventricles: An integrated approach measuring the area, length, and width of the chambers in normal fetuses. Prenat Diagn. 2017 Dec;37(12):1203-1212. doi: 10.1002/pd.5166. Epub 2017 Nov 10. PMID: 29023931.



22: DeVore GR, Satou G, Sklansky M. Abnormal Fetal Findings Associated With a Global Sphericity Index of the 4-Chamber View Below the 5th Centile. J Ultrasound Med. 2017 Nov;36(11):2309-2318. doi: 10.1002/jum.14261. Epub 2017 May 30. PMID: 28556937.



23: DeVore GR, Satou G, Sklansky M. Area of the fetal heart's four-chamber view: a practical screening tool to improve detection of cardiac abnormalities in a low-risk population. Prenat Diagn. 2017 Feb;37(2):151-155. doi: 10.1002/pd.4980. Epub 2017 Jan 24. PMID: 27943393.



24: DeVore GR, Tabsh K, Polanco B, Satou G, Sklansky M. Fetal Heart Size: A Comparison Between the Point-to-Point Trace and Automated Ellipse Methods Between 20 and 40 Weeks' Gestation. J Ultrasound Med. 2016 Dec;35(12):2543-2562. doi: 10.7863/ultra.16.02019. Epub 2016 Oct 13. PMID: 27738291.



25: DeVore GR, Polanco B, Satou G, Sklansky M. Two-Dimensional Speckle Tracking of the Fetal Heart: A Practical Step-by-Step Approach for the Fetal Sonologist. J Ultrasound Med. 2016 Aug;35(8):1765-81. doi: 10.7863/ultra.15.08060. Epub 2016 Jun 27. PMID: 27353066.



26: Lee W, Mack LM, Miremadi R, Furtun BY, Sangi-Haghpeykar H, DeVore GR. Cardiac Size, Shape, and Ventricular Contractility in Fetuses at Sea Level With an Estimated Weight Less-than 10th Centile. J Ultrasound Med. 2022 Nov;41(11):2703-2714. doi: 10.1002/jum.15954. Epub 2022 Feb 10. PMID: 35142391; PMCID: PMC9363529.



27: Anuwutnavin S, Russameecharoen K, Ruangvutilert P, Viboonchard S, Sklansky M, DeVore GR. Assessment of the Size and Shape of the 4-Chamber View and the Right and Left Ventricles Using Fetal Speckle Tracking in Normal Fetuses at 17-24 Gestational Weeks. Fetal Diagn Ther. 2022;49(1-2):41-51. doi: 10.1159/000521378. Epub 2021 Dec 10. PMID: 34915477.



28: Harbison AL, Pruetz JD, Ma S, Sklansky MS, Chmait RH, DeVore GR. Evaluation of cardiac function in the recipient twin in successfully treated twin-to-twin transfusion syndrome using a novel fetal speckle-tracking analysis. Prenat Diagn. 2021 Jan;41(1):136-144. doi: 10.1002/pd.5835. Epub 2020 Nov 23. PMID: 33015877.



29: Hobbins JC, Gumina DL, Zaretsky MV, Driver C, Wilcox A, DeVore GR. Size and shape of the four-chamber view of the fetal heart in fetuses with an estimated fetal weight less than the tenth centile. Am J Obstet Gynecol. 2019 Nov;221(5):495.e1-495.e9. doi: 10.1016/j.ajog.2019.06.008. Epub 2019 Jun 14. PMID: 31207236.


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