Effect of pregestational diabetes mellitus on fetal cardiac function and structure

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

“…Our study began with an a priori assumption that our study population of fetuses of mothers with DM would show subtle differences, as previously suggested, and was powered to detect the expected difference in MPI. 18,25,26,29 We further provide additional characterization of our study groups by demonstrating the expected differences in peak velocities and ratios of E/E 0 between groups that have been previously shown by others and that suggest that diastolic function abnormalities can exist in this population even in the absence of myocardial hypertorphy. 20 Of note, our study also confirmed a trend toward increases in E 0 and A 0 , though it was not adequately powered to detect statistically significant difference in these values for peak myocardial velocities (which have been shown in prior studies to be increased in fetuses of mothers with DM).…”

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

“…Subsequent studies, for example, have placed the cursor within the echo of the valve clicks (at the beginning) [29], from the end to the beginning of the valve clicks (corresponding to physiological time intervals) [68], at the peak (a clearer landmark used to overcome the variation in width of valve clicks) [62], or the method has not been defined [14,79,80]. The peak method has shown good intra- and interobserver variability and high repeatability compared with the original method [61].…”

“…An increased IRT is generally accompanied by a reduced ET, with the ICT the most stable MPI parameter [4]. The MPI has been used to demonstrate fetal cardiac dysfunction in a number of pathologies including maternal diabetes [11,12,13,14,15,16], TTTS [7,17,18,19,20,21,22], congenital heart malformations [23,24,25,26,27,28], pre-eclampsia [29], IUGR [11,30,31,32,33,34], and other fetal conditions [35,36,37,38]. Several studies have proposed methods to improve the repeatability of fetal MPI by defining fixed machine settings [39] and using the clicks of the aortic and mitral valves as landmarks to delineate the constituent time intervals [9,40,41].…”

Automation of the Fetal Right Myocardial Performance Index to Optimise Repeatability

“…Results: Successful automation was performed on 63 cases (97%) showing repeatability ICCs of: 0.83 manual intraobserver; 0.77 manual interobserver; 1.00 automated. The degree of absolute agreement between manual and automated values was: inexperienced observer ICC 0.43 (95% CI 0.21-growth restriction [4][5][6], twin-twin transfusion syndrome (TTTS) [7][8][9], maternal diabetes [10][11][12], preeclampsia [13], and cholestasis [14].…”