Fetal left modified myocardial performance index: technical refinements in obtaining pulsed‐Doppler waveforms

Meriki, Neama; Izurieta, A.; Welsh, Alec

doi:10.1002/uog.9090

Cited by 48 publications

(68 citation statements)

References 46 publications

(56 reference statements)

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“…In the study conducted by Cruz-Martinez et al [18], the learning curve to achieve competence in the Mod-MPI measurement was evaluated; the maximum disagreement between examiners was 10% and 65 measurements on an average were required to attain significant competence. Meriki et al [26] propose refinement adjustments in the apparatus where the MPI measurements will be performed, because these adjustments can influence the inter-observer repeatability as well as the opening and closing clicks valve.…”

Section: Discussionmentioning

confidence: 99%

Assessment of modified myocardial performance index in foetuses with growth restriction

et al. 2016

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Aim: To evaluate the modified myocardial performance index (Mod-MPI) in foetuses with growth restriction and compare this index with appropriate for gestational age foetuses. Material and methods: A prospective cross-sectional case-control study was conducted involving 76 singleton foetuses between 24 and 34 weeks of gestation divided into three groups (24 appropriate growth foetuses, 30 foetuses with estimated weight between the 3 rd and 10 th percentiles and 22 foetuses with estimated weight < 3 rd percentile, according to the Hadlock table). The Mod-MPI was obtained in the plane of the four chamber view, and the spectral Doppler sample volume was placed in the lateral wall of the aorta, close to the mitral valve. Doppler of umbilical artery was normal in all cases. Analysis of variance (ANOVA) was used to compare the groups and the intra-class correlation coefficient (ICC) was used to assess intra-and inter-observer reproducibility. Results: The mean Mod-MPI in the groups of appropriate for gestational age, estimated weight between the 3 rd and 10 th percentiles, and estimated weight < 3 rd percentile was 0.32 ± 0.05, 0.35 ± 0.05 and 0.36 ± 0.06, respectively; there was no statistical difference between the groups (p = 0.072). There was good intra-and inter-observer reproducibility (ICC = 0.726 and 0.760, respectively). Conclusion: Mod-MPI was not significantly different between foetuses appropriate for gestational age and those with growth restriction. Mod-MPI proved to be a feasible and reproducible technique.

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Section: Discussionmentioning

confidence: 99%

Assessment of modified myocardial performance index in foetuses with growth restriction

et al. 2016

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“…There has therefore been limited translation from research groups to clinical practice. Our group has recently published a paper that includes a summary of the published fetal MPI literature and highlights the influence of variation of machine settings on the normal range [13]. …”

Section: Introductionmentioning

confidence: 99%

“…The primary aim of this study was to construct gestational age-based reference ranges for the Mod-MPI in our local population and compare them with previously published gestational ranges [13]. Only one of these previously published ranges has fully described the measurement parameters for the time intervals and the effect of the heart rate and the gestational age [14].…”

Section: Introductionmentioning

confidence: 99%

Development of Australian Reference Ranges for the Left Fetal Modified Myocardial Performance Index and the Influence of Caliper Location on Time Interval Measurement

Meriki

Welsh

2012

Fetal Diagn Ther

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Objectives: To construct gestational age-adjusted reference ranges of the left fetal modified myocardial performance index (Mod-MPI) in the Australian population and assess the influence of valve click caliper position on constituent time intervals and the Mod-MPI. Methods: This is a prospective longitudinal study of 117 normal singleton fetuses undergoing 318 ultrasound scans at 4–6 weekly intervals between 18 and 38 weeks of gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were measured at 3 different caliper positions in each fetus: beginning of the original valve clicks (‘original’), beginning of the reflected valve clicks (‘reflected’), and peak of valve clicks (‘peak’). The Mod-MPI was calculated as (ICT + IRT)/ET. Results: The Mod-MPI increased throughout gestation with means ± SD of 0.42 ± 0.05 ‘reflected’ and ‘peak’ versus 0.49 ± 0.03 ‘original’ at 19 weeks, and means of 0.46 ± 0.05 ‘reflected and peak’ versus 0.51 ± 0.08 ‘original’ at 36 weeks. Throughout gestation, ICT remained fairly constant and IRT increased, while ET decreased with ‘original’ click and remained constant for ‘reflected’ and ‘peak’ clicks. A modest increase in Mod-MPI was seen with increasing fetal heart rate. Analysis of repeatability for the 3 methods showed the following ICCs: ‘original’, 0.797 (95% CI 0.762–0.829); ‘reflected’, 0.809 (95% CI 0.775–0.839), and ‘peak’, 0.799 (95% CI 0.764–0.831). Conclusions: Detailed exploration of the morphology of mitral and aortic valve closure and opening clicks shows how selection of different phases of these clicks may significantly influence the Mod-MPI. We recommend that the peak of the valve clicks be standardized between research groups.

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“…Soon, the enthusiastic ‘first adopters’ realised that they were generating differing normal ranges, so moved on to new fields. When we evaluated this carefully we realised that the published literature at that stage showed huge variation in normal mean MPIs from different research groups 17 . Subsequent evaluation of these studies showed widely differing techniques that would result in over‐ or under‐estimation of true Mod‐MPI.…”

Section: Pitfalls and Limitations Of Fetal Cardiac Functional Evaluationmentioning

confidence: 99%

The development of, and future for, fetal functional cardiac imaging techniques

Welsh

2014

Australas J Ultrason Med

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Fetal left modified myocardial performance index: technical refinements in obtaining pulsed‐Doppler waveforms

Abstract: Objective To assess the influence of machine settings (wall motion filter (WMF), angle of insonation, Doppler aliasing) and phase of valve clicks on repeatability of measurement of the fetal left modified myocardial performance index (Mod-MPI). Methods

Cited by 48 publications

References 46 publications

Assessment of modified myocardial performance index in foetuses with growth restriction

Assessment of modified myocardial performance index in foetuses with growth restriction

Development of Australian Reference Ranges for the Left Fetal Modified Myocardial Performance Index and the Influence of Caliper Location on Time Interval Measurement

The development of, and future for, fetal functional cardiac imaging techniques

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