Measurement of left ventricular systolic to diastolic time index in normal fetuses in the second and third trimesters using both spectral and tissue Doppler echocardiography

doi:10.3877/cma.j.issn.1672-6448.2023.09.010

Abstract

Abstract:

Objective

To establish the normal reference range of left ventricular systolic to diastolic time index (SDI) in normal fetuses in the second and third trimesters by using both spectral and tissue Doppler echocardiography, to assess the effect of fetal gestational age (GA) and fetal heart rate (FHR) on SDI, and to explore the feasibility of using SDI to evaluate fetal left ventricular function.

Methods

The left ventricular time intervals were obtained in 408 singleton fetuses between 18 to 38 weeks of gestation by using pulse wave Doppler (PD) and tissue Doppler imaging (TDI) at the Department of Ultrasonography of Run Run Shaw Hospital, Zhejiang University School of Medicine. SDI and SDI' were then calculated. Isovolumetric contraction time (ICT/ICT'), isovolumetric relaxation time (IRT/IRT'), filling time (FT/FT'), and ejection time (ET/ET') of the fetal left ventricle were obtained by PD and TDI, respectively. Left ventricular SDI, SDI', and myocardial performance index (MPI/MPI') were calculated subsequently. Normal reference range values of SDI and SDI' were obtained, and paired t-test was used to analyze the differences between the SDI and SDI' values measured by PD and TDI, respectively. The correlation between SDI/SDI' and the independent variables GA and FHR was analyzed by linear correlation (Pearson) analysis, and multivariate linear regression was used to analyze the effects of SDI and SDI' on diastolic function indexes (E/A, E'/A', and E/E') and the indicator of overall cardiac function (MPI/MPI'). Intra- and inter-measurement reproducibility was assessed using the intra-group correlation coefficient (ICC).

Results

The normal reference range of SDI was 1.380±0.141 and that of SDI' was 1.499±0.167; paired t-test analysis showed a statistical difference between the SDI and SDI' values measured by PD and TDI, respectively (t=-13.55, P<0.001). Line correlation analysis showed a negative correlation between SDI and GA (r=-0.267, P<0.001), and SDI' decreased with the increase of GA (r=-0.179, P<0.001). SDI was positively correlated with FHR (r=0.324, P<0.001), and SDI' was also positively correlated with FHR (r=0.290, P<0.001). Multivariate linear regression analysis demonstrated that the values of E/A, E/E', and MPI had influence on SDI, and the values of E'/A' and MPI' had influence on SDI'. The results of the repeatability test showed that the values of the correlation coefficient were all greater than 0.75, indicating good reliability and high repeatability.

Conclusion

The normal reference range of left ventricular SDI and SDI' has been established in normal fetuses in the second and third trimesters by using PD and TDI quantification, which provides a reference basis for clinical monitoring of normal fetal ventricular time interval index. Fetal left ventricular SDI/SDI' may have new potential for the clinical evaluation of fetal heart function.

Key words: Fetal, Echocardiography, Systolic to diastolic time index, Time interval, Cardiac function

Hongjuan Zhao, Bowen Zhao, Mei Pan, Yuanyuan Ji, Xiaohui Peng, Ran Chen. Measurement of left ventricular systolic to diastolic time index in normal fetuses in the second and third trimesters using both spectral and tissue Doppler echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 951-958.

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Figures/Tables 11

References 16

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参数	18~22周	23~27周	28~32周	33~38周	18~38周
SDI	1.407±0.136	1.406±0.135	1.359±0.138	1.305±0.101	1.380±0.141
SDI'	1.558±0.137	1.503±0.162	1.501±0.168	1.398±0.186	1.499±0.167
t值	-4.153	-5.987	-8.645	-2.304	-13.554
P值	<0.001	<0.001	<0.001	0.025	<0.001

参数	18~22周	23~27周	28~32周	33~38周	18~38周
SDI	1.407±0.136	1.406±0.135	1.359±0.138	1.305±0.101	1.380±0.141
SDI'	1.558±0.137	1.503±0.162	1.501±0.168	1.398±0.186	1.499±0.167
t值	-4.153	-5.987	-8.645	-2.304	-13.554
P值	<0.001	<0.001	<0.001	0.025	<0.001

变量	b值	b值标准误	t值	P值
E/A	-0.460	0.067	-6.890	<0.001
E/E'	0.016	0.004	4.344	<0.001
MPI	0.602	0.113	5.310	<0.001

变量	b值	b值标准误	t值	P值
E/A	-0.460	0.067	-6.890	<0.001
E/E'	0.016	0.004	4.344	<0.001
MPI	0.602	0.113	5.310	<0.001

变量	b值	b值标准误	t值	P值
E'/A'	-0.338	0.083	-4.079	<0.001
E/E'	-0.004	-0.839	-0.839	0.402
MPI'	0.882	0.123	7.157	<0.001

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