Tissue Doppler Is More Sensitive and Reproducible than Spectral Pulsed-Wave Doppler for Fetal Right Ventricle Myocardial Performance Index Determination in Normal and Diabetic Pregnancies

• Published in: Journal of the American Society of Echocardiography Vol. 26; no. 5; pp. 507 - 514
• Main Authors: Bui, Yen K., MD, PhD, Kipps, Alaina K., MD, Brook, Michael M., MD, FASE, Moon-Grady, Anita J., MD, FASE
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2013
• Subjects: Cardiac function; Cardiovascular; Doppler tissue imaging; Echocardiography, Doppler; Echocardiography, Doppler, Pulsed; Female; Fetal echocardiography; Fetal Heart - diagnostic imaging; Heart Ventricles - diagnostic imaging; Humans; Myocardial performance index; Pregestational diabetes; Pregnancy; Pregnancy in Diabetics - diagnostic imaging; Reproducibility of Results; Fetal echocardiography; RV; Cardiac function; Diabetes mellitus; MPI; DTI; Right ventricular; DM; Doppler tissue imaging; Myocardial performance index; Pregestational diabetes
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2013.02.006

Background The aim of this study was to compare the reproducibility, agreement, and sensitivity of pulsed-wave Doppler tissue imaging (DTI) versus spectral Doppler assessment of right ventricular (RV) myocardial performance index (MPI) in midgestation fetuses in both a normal and a disease state. Methods RV MPI was calculated using pulsed-wave DTI and spectral Doppler in normal pregnancies ( n  = 69) and in women with pregestational diabetes ( n  = 51). Intraobserver and interobserver variability and agreement were evaluated using Bland-Altman analysis. Student's t tests were used for comparisons of differences. Results In normal fetuses, RV MPI derived by the two methods showed no statistical difference, were interchangeable (DTI, 0.51 ± 0.10; spectral Doppler, 0.50 ± 0.12; P  = .686), and were in agreement by Bland-Altman analysis. However, in fetuses of mothers with diabetes, the two methods produced different RV MPI measurements (DTI, 0.56 ± 0.10; spectral Doppler, 0.51 ± 0.12; P < .001). Intraobserver and interobserver bias was lower for DTI. Conclusions The DTI method of measuring fetal RV MPI is more sensitive, has less variability and more precision, and is better able to demonstrate subtle abnormalities in cardiac function than the spectral Doppler method in diabetic versus normal pregnancies.