Introduction: Both tissue Doppler imaging (TDI) and pulsed wave Doppler (PWD) Myocardial Performance Indices (MPIs) have been proposed as tools for functional fetal cardiology. We wished to determine if there was any correlation between TDI-MPI and PWD-MPI. Methods: A cohort of uncomplicated women with morphologically normal singleton fetuses between 22 and 39 weeks of gestation was recruited. A single sonologist acquired Doppler waveforms for evaluation of both left and right TDI-MPI and PWD-MPI. The PWD-MPI values were calculated using a previously published algorithm and the TDI-MPI time intervals were measured manually by a single operator. Results: Achievability and repeatability were high for both modalities. TDI produced significantly lower right MPI values yet significantly higher left MPI values, potentially reflecting their evaluation of physiologically different events, blood flow versus myocardial contraction. Conclusion: This study demonstrates that MPIs measured from PWD and TDI have a weak correlation and cannot be used interchangeably, even with the exclusion of suboptimal TDI-MPI scans from the analysis. Given the lack of correlation between the two methods, the high variation in TDI waveform, and the lack of unified approach to TDI analysis, we feel further research is needed before adoption of this technique.

1.
Tei
C
.
New non-invasive index for combined systolic and diastolic ventricular function
.
J Cardiol
.
1995 Aug
26
2
135
6
.
2.
Tsutsumi
T
,
Ishii
M
,
Eto
G
,
Hota
M
,
Kato
H
.
Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index
.
Pediatr Int
.
1999 Dec
41
6
722
7
.
3.
Crispi
F
,
Hernandez-Andrade
E
,
Pelsers
MM
,
Plasencia
W
,
Benavides-Serralde
JA
,
Eixarch
E
et al
.
Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses
.
Am J Obstet Gynecol
.
2008 Sep
199
3
254 e1
8
.
4.
Hernandez-Andrade
E
,
Crispi
F
,
Benavides-Serralde
JA
,
Plasencia
W
,
Diesel
HF
,
Eixarch
E
et al
.
Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses
.
Ultrasound Obstet Gynecol
.
2009
;
34
(
4
):
430
6
.
5.
Cruz-Martinez
R
,
Figueras
F
,
Benavides-Serralde
A
,
Crispi
F
,
Hernandez-Andrade
E
,
Gratacos
E
.
Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early-onset intrauterine growth restriction
.
Ultrasound Obstet Gynecol
.
2011 Aug
38
2
179
84
.
6.
Van Mieghem
T
,
DeKoninck
P
,
Steenhaut
P
,
Deprest
J
.
Methods for prenatal assessment of fetal cardiac function
.
Prenat Diagn
.
2009 Dec
29
13
1193
203
.
7.
Stirnemann
JJ
,
Mougeot
M
,
Proulx
F
,
Nasr
B
,
Essaoui
M
,
Fouron
JC
et al
.
Profiling fetal cardiac function in twin-twin transfusion syndrome
.
Ultrasound Obstet Gynecol
.
2010 Jan
35
1
19
27
.
8.
Papanna
R
,
Mann
LK
,
Molina
S
,
Johnson
A
,
Moise
KJ
.
Changes in the recipient fetal Tei index in the peri-operative period after laser photocoagulation of placental anastomoses for twin-twin transfusion syndrome
.
Prenat Diagn
.
2011 Feb
31
2
176
80
.
9.
Wong
M
,
Wong
W
,
Cheung
Y
.
Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance
.
Ultrasound Obstet Gynecol
.
2007
;
29
(
4
):
395
400
.
10.
Russell
NE
,
Foley
M
,
Kinsley
BT
,
Firth
RG
,
Coffey
M
,
McAuliffe
FM
.
Effect of pregestational diabetes mellitus on fetal cardiac function and structure
.
Am J Obstet Gynecol
.
2008 Sep
199
3
312.e1
7
.
11.
Garcia-Flores
J
,
Janez
M
,
Gonzalez
MC
,
Martinez
N
,
Espada
M
,
Gonzalez
A
.
Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes
.
Eur J Obstet Gynecol Reprod Biol
.
2011 Jan
154
1
24
6
.
12.
Api
O
,
Emeksiz
MB
,
Api
M
,
Ugurel
V
,
Unal
O
.
Modified myocardial performance index for evaluation of fetal cardiac function in pre-eclampsia
.
Ultrasound Obstet Gynecol
.
2009 Jan
33
1
51
7
.
13.
Henry
A
,
Welsh
AW
.
Monitoring intrahepatic cholestasis of pregnancy using the fetal myocardial performance index: a cohort study
.
Ultrasound Obstet Gynecol
.
2015 Nov
46
5
571
8
.
14.
Ho
D
,
Wang
J
,
Homann
Y
,
Alphonse
J
,
Beirne
G
,
Welsh
AW
et al
.
Use of the myocardial performance index in decreased fetal movement assessment: a case-control study
.
Fetal Diagn Ther
.
2018
;
43
:
208
17
.
15.
Mielke
G
,
Benda
N
.
Cardiac output and central distribution of blood flow in the human fetus
.
Circulation
.
2001 Mar 27
103
12
1662
8
.
16.
Friedman
D
,
Buyon
J
,
Kim
M
,
Glickstein
JS
.
Fetal cardiac function assessed by Doppler myocardial performance index (Tei Index)
.
Ultrasound Obstet Gynecol
.
2003 Jan
21
1
33
6
.
17.
Hernandez-Andrade
E
,
Benavides-Serralde
JA
,
Cruz-Martinez
R
,
Welsh
A
,
Mancilla-Ramirez
J
.
Evaluation of conventional Doppler fetal cardiac function parameters: E/A ratios, outflow tracts, and myocardial performance index
.
Fetal Diagn Ther
.
2012
32
1–2
22
9
.
18.
Acharya
G
,
Pavlovic
M
,
Ewing
L
,
Nollmann
D
,
Leshko
J
,
Huhta
JC
.
Comparison between pulsed-wave Doppler- and tissue Doppler-derived Tei indices in fetuses with and without congenital heart disease
.
Ultrasound Obstet Gynecol
.
2008
;
31
(
4
):
406
11
.
19.
Mahajan
A
,
Henry
A
,
Meriki
N
,
Hernandez-Andrade
E
,
Crispi
F
,
Wu
L
et al
.
The (Pulsed-Wave) Doppler fetal myocardial performance index: technical challenges, clinical applications and future research
.
Fetal Diagn Ther
.
2015 Apr 28
38
1
13
.
20.
Gaibazzi
N
,
Petrucci
N
,
Ziacchi
V
.
Left ventricle myocardial performance index derived either by conventional method or mitral annulus tissue-Doppler: a comparison study in healthy subjects and subjects with heart failure
.
J Am Soc Echocardiogr
.
2005
;
18
(
12
):
1270
6
.
21.
Harada
K
,
Tamura
M
,
Toyono
M
,
Yasuoka
K
.
Comparison of the right ventricular Tei index by tissue Doppler imaging to that obtained by pulsed Doppler in children without heart disease
.
Am J Cardiol
.
2002
;
90
(
5
):
566
9
.
22.
Cui
W
,
Roberson
DA
.
Left ventricular Tei index in children: comparison of tissue Doppler imaging, pulsed wave Doppler, and M-mode echocardiography normal values
.
J Am Soc Echocardiogr
.
2006
;
19
(
12
):
1438
45
.
23.
Duan
Y
,
Harada
K
,
Wu
W
,
Ishii
H
,
Takada
G
.
Correlation between right ventricular Tei index by tissue Doppler imaging and pulsed Doppler imaging in fetuses
.
Pediatr Cardiol
.
2008 Jul
29
4
739
43
.
24.
Amoozgar
H
,
Soltani
M
,
Borzoee
M
,
Ajami
G
,
Cheriki
S
.
Evaluation of pulsed Doppler-versus tissue Doppler-derived Tei index of right and left ventricle in fetuses
.
Int Cardiovasc Res J
.
2011
;
5
(
4
):
134
8
.
25.
Balli
S
,
Pac
FA
,
Ece
İ
,
Oflaz
MB
,
Kibar
AE
,
Kandemir
O
.
Assessment of cardiac functions in fetuses of gestational diabetic mothers
.
Pediatr Cardiol
.
2014 Jan
35
1
30
7
.
26.
Meriki
N
,
Izurieta
A
,
Welsh
AW
.
Fetal left modified myocardial performance index: technical refinements in obtaining pulsed-Doppler waveforms
.
Ultrasound Obstet Gynecol
.
2012 Apr
39
4
421
9
.
27.
Hernandez-Andrade
E
,
Lopez-Tenorio
J
,
Figueroa-Diesel
H
,
Sanin-Blair
J
,
Carreras
E
,
Cabero
L
et al
.
A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment
.
Ultrasound Obstet Gynecol
.
2005 Sep
26
3
227
32
.
28.
Lee
MY
,
Won
HS
,
Jeon
EJ
,
Yoon
HC
,
Choi
JY
,
Hong
SJ
et al
.
Feasibility of using auto Mod-MPI system, a novel technique for automated measurement of fetal modified myocardial performance index
.
Ultrasound Obstet Gynecol
.
2014 Jun
43
6
640
5
.
29.
Meriki
N
,
Izurieta
A
,
Welsh
A
.
Reproducibility of constituent time intervals of right and left fetal modified myocardial performance indices on pulsed Doppler echocardiography: a short report
.
Ultrasound Obstet Gynecol
.
2012 Jun
39
6
654
8
.
30.
Comas
M
,
Crispi
F
.
Assessment of fetal cardiac function using tissue Doppler techniques
.
Fetal Diagn Ther
.
2012
32
1–2
30
8
.
31.
Maheshwari
P
,
Henry
A
,
Welsh
AW
.
The fetal modified myocardial performance index: is automation the future
.
Biomed Res Int
.
2015
;
2015
:
215910
.
32.
Meriki
N
,
Welsh
AW
.
Development of Australian reference ranges for the left fetal modified myocardial performance index and the influence of caliper location on time interval measurement
.
Fetal Diagn Ther
.
2012
32
1–2
87
95
.
33.
Meriki
N
,
Henry
A
,
Sanderson
J
,
Majajan
A
,
Wu
L
,
Welsh
AW
.
Development of normal gestational ranges for the right myocardial performance index in the Australian population with three alternative caliper placements
.
Fetal Diagn Ther
.
2014
;
36
(
4
):
272
81
.
34.
Leung
V
,
Avnet
H
,
Henry
A
,
Wang
J
,
Redmond
S
,
Welsh
AW
.
Automation of the fetal right myocardial performance index to optimise repeatability
.
Fetal Diagn Ther
.
2017 Sep 27
44
1
28
35
.
35.
Wang
J
,
Henry
A
,
Welsh
AW
,
Redmond
SJ
.
Automated fetal cardiac valve movement detection for modified myocardial performance index calculation
.
Annu Int Conf IEEE Eng Med Biol Soc
.
2014 Aug
2014
1063
6
.
36.
Aoki
M
,
Harada
K
,
Ogawa
M
,
Tanaka
T
.
Quantitative assessment of right ventricular function using Doppler tissue imaging in fetuses with and without heart failure
.
J Am Soc Echocardiogr
.
2004
;
17
:
28
35
.
37.
Comas
M
,
Crispi
F
,
Gomez
O
,
Puerto
B
,
Figueras
F
,
Gratacos
E
.
Gestational age- and estimated fetal weight-adjusted reference ranges for myocardial tissue Doppler indices at 24-41 weeks’ gestation
.
Ultrasound Obstet Gynecol
.
2011 Jan
37
1
57
64
.
38.
Bui
YK
,
Kipps
AK
,
Brook
MM
,
Moon-Grady
AJ
.
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
.
J Am Soc Echocardiogr
.
2013 May
26
5
507
14
.
39.
Kurtulmuş
S
,
Meşe
T
,
Taner
CE
,
Oztekin
DC
,
Okyay
D
,
Uysal
A
et al
.
Evaluation of tissue Doppler-derived myocardial performance index in fetuses with intracardiac echogenic focus
.
J Matern Fetal Neonatal Med
.
2013 Nov
26
16
1662
6
.
40.
McGraw
KO
,
Wong
SP
.
Forming inferences about some intraclass correlations coefficients: correction
.
Psychol Methods
.
1996 Dec
1
4
390
0
.
41.
Paladini
D
,
Lamberti
A
,
Teodoro
A
,
Arienzo
M
,
Tartaglione
A
,
Martinelli
P
.
Tissue Doppler imaging of the fetal heart
.
Ultrasound Obstet Gynecol
.
2000 Nov
16
6
530
5
.
42.
Sengupta
PP
,
Tajik
AJ
,
Chandrasekaran
K
,
Khandheria
BK
.
Twist mechanics of the left ventricle: principles and application
.
JACC Cardiovasc Imaging
.
2008 May
1
3
366
76
.
43.
Welsh
AW
,
Maheshwari
P
,
Wang
J
,
Henry
A
,
Chang
D
,
Crispi
F
et al
.
Evaluation of an automated fetal myocardial performance index
.
Ultrasound Obstet Gynecol
.
2016 Oct
48
4
496
503
.
44.
Bartlett
JW
,
Frost
C
.
Reliability, repeatability and reproducibility: analysis of measurement errors in continuous variables
.
Ultrasound Obstet Gynecol
.
2008 Apr
31
4
466
75
.
45.
Overholser
BR
,
Sowinski
KM
.
Biostatistics primer: part 2
.
Nutr Clin Pract
.
2008 Feb
23
1
76
84
.
46.
Zanardini
C
,
Prefumo
F
,
Fichera
A
,
Botteri
E
,
Frusca
T
.
Fetal cardiac parameters for prediction of twin-to-twin transfusion syndrome
.
Ultrasound Obstet Gynecol
.
2014 Oct
44
4
434
40
.
47.
Comas
M
,
Crispi
F
,
Cruz-Martinez
R
,
Martinez
JM
,
Figueras
F
,
Gratacos
E
.
Usefulness of myocardial tissue Doppler vs conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction
.
Am J Obstet Gynecol
.
2010 Jul
203
1
45 e1
7
.
48.
Lobmaier
SM
,
Cruz-Lemini
M
,
Valenzuela-Alcaraz
B
,
Ortiz
JU
,
Martinez
JM
,
Gratacos
E
et al
.
Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility
.
Ultrasound Obstet Gynecol
.
2014 Jun
43
6
632
9
.
49.
Harada
K
,
Tamura
M
,
Toyono
M
,
Oyama
K
,
Takada
G
.
Assessment of global left ventricular function by tissue Doppler imaging
.
Am J Cardiol
.
2001 Oct 15
88
8
927
32
.
50.
Royston
P
,
Wright
EM
.
How to construct ‘normal ranges’ for fetal variables
.
Ultrasound Obstet Gynecol
.
1998 Jan
11
1
30
8
.
51.
Meriki
NWA
,
Welsh
AW
.
Fetal cardiac function: feasibility in obtaining the right modified myocardial performance index in a single Doppler waveform
.
Australas J Ultrasound Med
.
2017 February
20
1
18
25
.
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