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

Development of Normal Gestational Ranges for the Right Myocardial Performance Index in the Australian Population with Three Alternative Caliper Placements

“…Data were also excluded if on review the images were not considered technically adequate because (1) images with both ‘original' and ‘reflected' clicks were not present, (2) the fetal heart rate for the ‘a' images was >10 beats different from the fetal heart rate for the ‘b' images and (3) three or more analyzable ‘a' and ‘b' time interval images using appropriate machine settings were not obtained. Although there has not been consistent agreement on the level of discrepancy in ‘a' heart rate (HR) and ‘b' HR likely to affect interpretation of MPI [32,35,36], we felt discrepancies of >10 bpm likely represented a change of fetal state and might bias results. The pregnancy was dated from the woman's clinically agreed estimated due date, based on last menstrual period date, or by ultrasound dating if this was unreliable or differed substantially from ultrasound dating (≥5 days from <12 weeks' ultrasound, 7 or more days from 12-20 weeks' ultrasound).…”

“…However, we previously reported similar reproducibility for RMPI and LMPI [19]. Previously published RMPI ranges have widely divergent reported means, from 0.24 to 0.62 in the second and third trimesters of normal singleton fetuses [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Table 1 highlights previously published RMPI reference ranges in normal singleton pregnancies.…”

“…Table 1 highlights previously published RMPI reference ranges in normal singleton pregnancies. Fetal cardiac function using the right MPI has been compared with other cardiovascular modalities [29,30,32,36,38,39,40,41], including tissue versus spectral Doppler [36,38]. Bui et al [36] suggest RMPI tissue Doppler to be more sensitive to pathology than spectral RMPI; however, tissue and spectral values correlate well in uncomplicated pregnancies [36,37].…”

“…Fetal cardiac function using the right MPI has been compared with other cardiovascular modalities [29,30,32,36,38,39,40,41], including tissue versus spectral Doppler [36,38]. Bui et al [36] suggest RMPI tissue Doppler to be more sensitive to pathology than spectral RMPI; however, tissue and spectral values correlate well in uncomplicated pregnancies [36,37]. Use of RMPI has also been studied in pathological pregnancies, including twin-twin transfusion syndrome (TTTS), where RMPI appears to be an early marker of cardiac dysfunction, becoming abnormal prior to either LMPI or other functional echocardiographic markers [41,42].…”

The development of, and future for, fetal functional cardiac imaging techniques

“…The basis of many of the novel indices of fetal cardiac function include techniques familiar to most fetal medicine practitioners and cardiologists such as pulsed wave, 5 M‐mode, 6 and tissue Doppler 7 as well as the relatively new technique of speckle tracking 8 . Traditionally, cardiologists have been trained in, and fetal medicine practitioners have shied away from M‐mode though it is a very sensitive tool for cardiac measurements.…”