基于瓣膜喀喇音使用的改良心肌性能（Tei）指数提高了胎儿左心功能评估的可重复性。

A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment.

作者信息

Hernandez-Andrade E, López-Tenorio J, Figueroa-Diesel H, Sanin-Blair J, Carreras E, Cabero L, Gratacos E

机构信息

Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vall D'Hebron University Hospital, Autonomous University of Barcelona, Spain.

出版信息

Ultrasound Obstet Gynecol. 2005 Sep;26(3):227-32. doi: 10.1002/uog.1959.

DOI:10.1002/uog.1959

PMID:16116562

Abstract

OBJECTIVE

To determine whether a modified myocardial performance index (Mod-MPI) involving assessment of the movements (clicks) of the mitral valve (MV) and aortic valve (AV), improves intra- and interobserver agreement as compared to the previously reported method for MPI estimation.

METHODS

The Mod-MPI was recorded by two experienced operators in the left cardiac chambers of 25 normally grown fetuses using pulsed Doppler ultrasonography. The isovolumetric contraction time (ICT) was measured from the closure of the MV to the opening of the AV, the ejection time (ET) from the opening to the closure of the AV, and the isovolumetric relaxation time (IRT) from the closure of the AV to the opening of the MV. The Mod-MPI was calculated as (ICT + IRT)/ET. In addition, the MPI was estimated without using the valve clicks (F-MPI) as previously described. Intra- and interobserver agreement were then analyzed for both modalities.

RESULTS

There was a significantly lower intra- and inter-observer variability in the estimation of all time periods with the Mod-MPI than with the F-MPI (ICT: intra-observer, 9.9% vs. 13.9%; interobserver 9.9% vs. 15.6%; IRT: intraobserver, 9.9% vs. 14.8%; interobserver 10.4% vs. 18.3%; and ET: intraobserver, 4.5% vs. 6.1%; interobserver 2.8% vs. 5.2%, respectively). Intraclass correlation coefficient (IntraCC) for the Mod-MPI was 0.8 (95% confidence interval (95% CI), 0.56-0.9) and for the F-MPI, the IntraCC was 0.62 (95% CI, 0.26-0.84); P = 0.01. Agreement between observers using the Mod-MPI showed a mean difference of 0.0 with 95% limits of agreement (LA) -0.09 (95% CI, -0.1 to -0.075) to 0.09 (95% CI, 0.075-0.1) and for the F-MPI the mean difference was -0.01 with 95% LA -0.26 (95% CI, -0.3 to -0.22) to 0.25 (95% CI, 0.21-0.29).

CONCLUSION

Calculation of the Mod-MPI based on Doppler echoes of the MV and AV clicks is associated with a lower variation and better inter- and intraobserver agreement than the previously used method for fetal cardiac evaluation.

摘要

目的

确定一种涉及评估二尖瓣（MV）和主动脉瓣（AV）运动（喀喇音）的改良心肌性能指数（Mod-MPI）与先前报道的MPI估计方法相比，是否能提高观察者内和观察者间的一致性。

方法

两名经验丰富的操作人员使用脉冲多普勒超声心动图在25例正常生长胎儿的左心腔内记录Mod-MPI。等容收缩时间（ICT）从MV关闭至AV开放进行测量，射血时间（ET）从AV开放至关闭进行测量，等容舒张时间（IRT）从AV关闭至MV开放进行测量。Mod-MPI计算为（ICT + IRT）/ET。此外，如前所述，不使用瓣膜喀喇音估计MPI（F-MPI）。然后对两种方法的观察者内和观察者间一致性进行分析。

结果

与F-MPI相比，Mod-MPI在所有时间段估计中的观察者内和观察者间变异性显著更低（ICT：观察者内，9.9%对13.9%；观察者间，9.9%对15.6%；IRT：观察者内，9.9%对14.8%；观察者间，10.4%对18.3%；ET：观察者内，4.5%对6.1%；观察者间，2.8%对5.2%）。Mod-MPI的组内相关系数（IntraCC）为0.8（95%置信区间（95%CI），0.56 - 0.9），F-MPI的IntraCC为0.62（95%CI，0.26 - 0.84）；P = 0.01。使用Mod-MPI的观察者间一致性显示平均差异为0.0，95%一致性界限（LA）为-0.09（95%CI，-0.1至-0.075）至0.09（95%CI，0.075 - 0.1），F-MPI的平均差异为-0.01，95%LA为-0.26（95%CI，-0.3至-0.22）至0.25（95%CI，0.21 - 0.29）。