Comparing achievability and reproducibility of pulsed wave doppler and tissue doppler myocardial performance index and spatiotemporal image correlation annular plane systolic excursion in the cardiac function assessment of normal pregnancies.

Objectives: Multiple techniques have been proposed for functional fetal cardiology, including pulsed-wave (PW) and tissue Doppler imaging (TDI), Myocardial Performance Index (MPI), annular plane systolic excursion (TAPSE/MAPSE) and spatiotemporal image correlation (STIC). We aimed to compare these techniques' achievability and reproducibility to determine their clinical utility for each cardiac side.

Methods: Uncomplicated pregnancies from 22 to 39 weeks were recruited and images and volumes stored for offline analysis. PWD-MPI values were calculated using previously demonstrated automation algorithms, and the remaining volumes were evaluated by two experienced operators.

Results: 79 women were scanned generating 222 volumes, with high achievability (>86 %) for all three modalities on both cardiac sides; highest for TAPSE/MAPSE (94 %). Repeatability (ICC) on the right side of the heart was highest for TAPSE (inter-observer 0.86; intraobserver 0.73), compared to PWD-MPI (0.69) and TDI-MPI (0.83). For the left side, repeatability was high for both PWD-MPI (0.80) and TDI-MPI (0.86) though low for MAPSE (inter-observer 0.7, intra-observer 0.69). There was poor correlation between PWD-MPI and TDI-MPI values.

Conclusions: TAPSE appears most reliable for evaluation of right heart function, compared to PWD-MPI for the left. As TDI-MPI correlates poorly with PWD-MPI, the latter appears to be the functional tool of choice.