Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study

Sun, Li-Ying; Wang, Jingjing; Su, Xiaoting; Chen, Xinlin; Zhou, Yuqing; Zhang, Xiaoming; Lu, Hong; Niu, Jun; Yu, Li; Sun, Congxin; Zhang, Wenjun; Han, Jianing; Zhang, Lina; Zhen-na, Wang; Chen, Peiwen; Chen, Tiantian; Hua, Hong; Zhou, Lulu; Ye, Baoying; Guo, Wei; Zhao, Wei; Zhang, Na; Li, Zhen; Zhao, Sen; Tian, Jiawei; Jiang, Yuxin

doi:10.1136/bmjopen-2021-049640

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…The increase in mod-MPI over gestation is also consistent with most manuscripts reporting left mod-MPI reference ranges but not meeting our inclusion criteria [21][22][23]. However, a few other studies reported either a negative or no correlation between mod-MPI and gestational age [24,25].…”

Section: Discussionsupporting

confidence: 86%

Reference Ranges for Left Modified Myocardial Performance Index: Systematic Review and Meta-Analysis

Bligard,

Doering,

Porat

et al. 2023

Fetal Diagn Ther

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Introduction: The modified myocardial performance index (mod-MPI) is a noninvasive Doppler-derived metric used to evaluate fetal cardiac function. However, the reference ranges for mod-MPI in normal fetuses are not clearly defined which limits the use of this technology in fetuses with potential cardiac compromise. Thus, we aimed to perform a systematic review and meta-analysis of published mod-MPI reference ranges across gestation. Methods: The published literature was systematically searched, and all published articles in any language that provided values for the left ventricular mod-MPI obtained in low-risk, singleton fetuses were considered eligible for further review. All retrieved titles and abstracts were independently reviewed by two researchers. Mean and standard deviation by gestational week was extracted or calculated from published data. DerSimonian-Laird random effects models were used to estimate pooled means and 95% confidence intervals (CIs). Results: The search resulted in 618 unique citations, of which 583 did not meet inclusion criteria, leaving 35 abstracts selected for full-text review. Review of the references of these 35 articles identified another 5 studies of interest. Of the 40 articles reviewed, six met inclusion criteria. There was significant heterogeneity seen in the mod-MPI results reported. Mod-MPI increased as pregnancy progressed in all studies. The pooled mean mod-MPI at 11 weeks’ gestation was 0.400 (95% CI 0.374- 0.426) and increased to 0.585 (95% CI 0.533-0.637) at 41 weeks’ gestation. The increase was linear in 5 of 6 studies, while in 1 study, the mod-MPI was stable until 27 weeks’ gestation, and then increased throughout the third trimester. Despite all having trends increasing over pregnancy, there was no study in which all the weekly means fell within the pooled 95% CI. Conclusion: While mod-MPI does increase over gestation, the true “reference ranges” for fetuses remain elusive. Future efforts to further optimize calculation of time intervals possibly via automation are desperately needed to allow for reproducibility of this potentially very useful tool to assess fetal cardiac function.

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Section: Discussionsupporting

confidence: 86%

Reference Ranges for Left Modified Myocardial Performance Index: Systematic Review and Meta-Analysis

Bligard,

Doering,

Porat

et al. 2023

Fetal Diagn Ther

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“…As a result of the highly heterogeneous measurement techniques used so far, with priority given to the lack of standard criteria regarding caliper placement, clinicians are currently confronted with a wide variation in the quoted reference values for the MPI to date-which still lack consistency-ranging from 0.35 to 0.60 as the mean values. The values of the RV-Mod-MPI for both operators corresponded with this expected distribution pattern and increased with GA (Figure 3), even though a significant correlation between the MPI and GA has been controversially discussed in the current literature [1,8,15,18,20,23,[26][27][28][29][30][31][32][33]. The present values of the RV-Mod-MPI were very similar to those of Kang et al, who investigated the clinical value of the MPI+™ tool for the assessment of cardiac function in TTTS.…”

Section: Discussionsupporting

confidence: 86%

“…There is a wide variation in the quoted reference values of the MPI to date-which are still inconsistent-ranging from 0.35 to 0.60 as the mean values. Therefore, a significant correlation between the MPI and the gestational age (GA) is controversially debated in the current literature [1,8,15,18,20,23,[26][27][28][29][30][31][32][33]. The Mod-MPI is less dependent on factors that impair image acquisition and quality than the other methods used for assessing fetal cardiac function (e.g., maternal BMI, anterior placenta, oligohydramnios), is less dependent on fetal anatomy and position or precise imaging and, by incorporating only time intervals, is less prone to artifacts such as fetal movements.…”

Section: Introductionmentioning

confidence: 99%

How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index

et al. 2023

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(1) Objectives: In utero functional cardiac assessments using echocardiography have become increasingly important. The myocardial performance index (MPI, Tei index) is currently used to evaluate fetal cardiac anatomy, hemodynamics and function. An ultrasound examination is highly examiner-dependent, and training is of enormous significance in terms of proper application and subsequent interpretation. Future experts will progressively be guided by applications of artificial intelligence, on whose algorithms prenatal diagnostics will rely on increasingly. The objective of this study was to demonstrate the feasibility of whether less experienced operators might benefit from an automated tool of MPI quantification in the clinical routine. (2) Methods: In this study, a total of 85 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by a targeted ultrasound. The modified right ventricular MPI (RV-Mod-MPI) was measured, both by a beginner and an expert. A calculation was performed semiautomatically using a Samsung Hera W10 ultrasound system (MPI+™, Samsung Healthcare, Gangwon-do, South Korea) by taking separate recordings of the right ventricle’s in- and outflow using a conventional pulsed-wave Doppler. The measured RV-Mod-MPI values were assigned to gestational age. The data were compared between the beginner and the expert using a Bland-Altman plot to test the agreement between both operators, and the intraclass correlation was calculated. (3) Results: The mean maternal age was 32 years (19 to 42 years), and the mean maternal pre-pregnancy body mass index was 24.85 kg/m2 (ranging from 17.11 to 44.08 kg/m2). The mean gestational age was 24.44 weeks (ranging from 19.29 to 36.43 weeks). The averaged RV-Mod-MPI value of the beginner was 0.513 ± 0.09, and that of the expert was 0.501 ± 0.08. Between the beginner and the expert, the measured RV-Mod-MPI values indicated a similar distribution. The statistical analysis showed a Bland-Altman bias of 0.01136 (95% limits of agreement from −0.1674 to 0.1902). The intraclass correlation coefficient was 0.624 (95% confidence interval from 0.423 to 0.755). (4) Conclusions: For experts as well as for beginners, the RV-Mod-MPI is an excellent diagnostic tool for the assessment of fetal cardiac function. It is a time-saving procedure, offers an intuitive user interface and is easy to learn. There is no additional effort required to measure the RV-Mod-MPI. In times of reduced resources, such assisted systems of fast value acquisition represent clear added value. The establishment of the automated measurement of the RV-Mod-MPI in clinical routine should be the next level in cardiac function assessment.

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“…There is no universal reference range and guidelines for normal Mod-MPI values. Normal reference ranges of fetal Mod-MPI still show wide variations in recent studies, 29 - 33 reported due to heterogeneous study populations, possibly other maternal or fetal characteristics, and differences in measurement techniques. Comparable 29 , 31 , 32 or totally different 30 , 33 Mod-MPI values from ours have been cited in the literature.…”

Section: Discussionmentioning

confidence: 98%

Modified Myocardial Performance Index in Fetal Growth Disturbances as Diagnostic and Prognostic Adjunct

Simsek¹

2023

Anatol J Cardiol

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Background: Fetal growth disturbance can be associated with cardiac dysfunction. This study aimed to assess the modified myocardial performance index in growth-restricted and appropriate for gestational age fetuses and evaluate both its prognostic value in perinatal period and also its association with adverse perinatal outcomes. Methods: Totally 131 pregnant women were included in this prospective study. Of these, 56 cases were in study group with a diagnosis of small fetus and 75 cases were in control group with a diagnosis appropriately grown fetus. Fetal echocardiography was performed in all pregnant women to measure modified myocardial performance index. Umbilical, middle cerebral and uterine artery Doppler ultrasound parameters were measured in the study group. Small fetuses were categorized into 2 subgroups of late-onset fetal growth restriction and small for gestational age. Results: Modified myocardial performance index was significantly higher in small fetuses compared to controls (0.45 vs. 0.37, P < .001). Newborn intensive care unit admission rates were significantly higher in small fetuses than in controls (chi-square test, P < .001). The highest mean modified myocardial performance index was recorded in the late-onset fetal growth restriction subgroup (0.45 vs. 0.41 vs. 0.37). The sensitivity and specificity of modified myocardial performance index in predicting adverse outcomes at a cut-off value of 0.41 were 63% and 75%, respectively. There was a significant negative correlation between modified myocardial performance index values and birth weights. Conclusions: We found higher left fetal heart modified myocardial performance index values in small fetuses indicating the presence of prenatal cardiac dysfunction. Fetal myocardial performance deteriorates in concordance with severity of growth restriction. Modified myocardial performance index can also be used to predict adverse perinatal outcomes among growth-restricted fetuses.

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Reference ranges of fetal heart function using a Modified Myocardial Performance Index: a prospective multicentre, cross-sectional study

Cited by 9 publications

References 29 publications

Reference Ranges for Left Modified Myocardial Performance Index: Systematic Review and Meta-Analysis

Reference Ranges for Left Modified Myocardial Performance Index: Systematic Review and Meta-Analysis

How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index

Modified Myocardial Performance Index in Fetal Growth Disturbances as Diagnostic and Prognostic Adjunct

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