Key result
TAPSE demonstrated the highest repeatability for fetal right heart function (inter-observer ICC 0.86), while PWD-MPI and TDI-MPI were highly repeatable for the left heart (ICC 0.80 and 0.86).
Why the study?
Multiple techniques have been proposed for functional fetal cardiology, but their achievability and reproducibility needed comparison to determine clinical utility for each cardiac side.
Which imaging technique (PW-MPI, TDI-MPI, or TAPSE/MAPSE) has the highest achievability and reproducibility for assessing fetal cardiac function in normal pregnancies?
Observational (n=79)
Which imaging technique (PW-MPI, TDI-MPI, or TAPSE/MAPSE) has the highest achievability and reproducibility for assessing fetal cardiac function in normal pregnancies?
TAPSE is the most reliable tool for evaluating fetal right heart function, whereas PWD-MPI is preferred for the left heart in normal pregnancies.
High achievability supports technique standardization efforts; leaves open validation and clinical utility in complicated 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: Seventy-nine 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.
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Avnet et al. (2025) conducted an observational in Normal pregnancies (n=79). Fetal echocardiography techniques (PWD-MPI, TDI-MPI, TAPSE/MAPSE, STIC) vs. Comparison between techniques was evaluated on Achievability and reproducibility (intraclass correlation coefficient) of fetal cardiac function assessment techniques. TAPSE demonstrated the highest repeatability for fetal right heart function (inter-observer ICC 0.86), while PWD-MPI and TDI-MPI were highly repeatable for the left heart (ICC 0.80 and 0.86).
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