Reproducibility of the assessment of myocardial function through tissue Doppler imaging in very low birth weight infants

Abstract

Abstracts Objectives This study aims to analyze the variability between two trained neonatologists when performing consecutive echocardiograms using tissue Doppler imaging (TDI) and conventional methods in very low birth weight infant (VLBWI). Methods Two serial echocardiograms were performed in 30 VLBWI infants. The echocardiographic parameters analyzed were tricuspid annular plane systolic excursion (TAPSE), A′, E′, and S′ waves, and myocardial performance index acquired by TDI (MPI‐TDI) of both ventricles and shortening fraction (SF). The intra‐observer and inter‐observer agreements and the intra‐operator agreement were analyzed using quantitative and qualitative statistical methods. Results The intra‐observer agreement was very good, TAPSE, and TDI‐derived parameters had an intra‐class correlation (ICC) > 0.8. TDI‐derived velocities had a coefficient of variation (COV) < 11%, while MPI‐TDI had a COV between 20%–28%. The inter‐observer agreement was excellent. There was greater variability when analyzing intra‐operator agreement, with the least variable parameter being TAPSE. According to PABAK, the variability presented moderately substantial agreement. Conclusions Tricuspid annular plane systolic excursion is very reproducible between observers and operators. Measurements of TDI wave velocities are more reproducible than MPI‐TDI. TDI is sufficiently reproducible in the VLBWI if adequate training is performed, and guidelines are followed to obtain standardized echocardiographic images.

Myocardial Function Maturation in Very-Low-Birth-Weight Infants and Development of Bronchopulmonary Dysplasia

“…Nevertheless, other exclusion criteria could be suggested, such as ventilatory support. A detailed description of the ventilatory parameters that each patient had while performing the TnEcho is lacking in our study but TnEcho was always performed on good respiratory condition with no major events happening as previously reported (27). However, ventilatory support has not been found to be correlated with TAPSE (46).…”

“…This approach might help develop new therapeutic/prophylactic strategies in this high risk population. NTproBNP levels are easy to obtain from a routine blood sample and are available in a short period of time and, on the other hand, TnEcho could be performed in most NICUs, it is safe (44) and reproducible (27). This makes both techniques widely available and ready to use in routine clinical practice.…”

“…We have explored different predictive models with very close diagnostic accuracy indices. We suggest including TAPSE since it is an easy measurement in TnEcho and has good interobserver and intraobserver reproducibility and reliability (27). Acquiring TAPSE is easy and fast and can be measured in non-collaborating patients and even with suboptimal images, making it perfect for use in VLBWIs.…”

“…Two neonatologists with specific training in neonatal echocardiography performed the studies using a Philips iE33 with an 8-3 Hz transducer according to the recommendations of the American Society of Echocardiography (5). The interobserver and intraobserver reproducibility was previously analyzed and reported by our group (27). Electrocardiographic records were taken simultaneously.…”