The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

Mahajan, Aditi; Henry, Amanda; Meriki, Neama; Hernández‐Andrade, Edgar; Crispi, F.; Wu, Linda; Welsh, Alec

doi:10.1159/000363181

Cited by 40 publications

(63 citation statements)

References 135 publications

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“…Measurement of the RV‐MPI is further complicated because the right ventricular inflow and outflow cannot be visualized in one plane and thus not in the same trace. Published normal ranges for different gestational ages demonstrate a wide variation, probably because a standardized method has not been established. While automation of these measurements will remove the human factor on measurement error, experience is still required to be able to acquire the correct Doppler waveform successfully .…”

Section: Discussionmentioning

confidence: 99%

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

et al. 2019

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This study aimed to investigate the value of echocardiography and Doppler before fetoscopic laser coagulation for twin‐twin transfusion syndrome (TTTS) in the prediction of intrauterine fetal demise (IUFD). We performed a systematic review and meta‐analysis to compare preoperative parameters between fetuses with and without demise after laser surgery. Eighteen studies were included. Recipient twins have an increased risk of demise in case of preoperative absent/reversed flow (A/REDF) in the umbilical artery (odds ratio [OR] 2.76, 95% confidence interval [CI], 1.78‐4.28), absent or reversed a‐wave in the ductus venosus (OR 2.32, 95% CI, 1.70‐3.16), or a middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) (OR 7.59, 95% CI, 2.56‐22.46). In donors, only A/REDF in the umbilical artery (OR 3.40, 95% CI, 2.68‐4.32) and absent or reversed a‐wave in the ductus venosus (OR 1.66, 95% CI, 1.12‐2.47) were associated with IUFD. No association was found between donor‐IUFD and preoperative myocardial performance index (MPI). Two studies found an association between abnormal MPI and recipient demise. With this study, we have identified a set of preoperative Doppler parameters predictive of fetal demise after laser surgery. More research is needed to assess the utility of preoperative echocardiographic parameters such as the MPI in predicting IUFD.

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Section: Discussionmentioning

confidence: 99%

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

et al. 2019

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“…Maternal diabetes can cause hypertrophy of fetal interventricular septum, resulting in impaired ventricular compliance and diastolic dysfunction reflected by prolongation of IRT [30,31]. IRT is the main LMPI parameter to become abnormal in preliminary stages of dysfunction [13,32,33], and so it warrants further exploration as an early cardiac marker for DFM fetuses.…”

Section: Discussionmentioning

confidence: 99%

“…It has been established as a reliable marker of fetal cardiac dysfunction in reflecting early cardiac adaptation to perinatal insults [12]. Its use has been investigated in various fetal pathologies [13], but its utility in DFM remains unknown.…”

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confidence: 99%

Use of the Myocardial Performance Index in Decreased Fetal Movement Assessment: A Case-Control Study

Wang

Homann

et al. 2017

Fetal Diagn Ther

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Objectives: To determine whether there are any fetal cardiac function changes, as measured by the myocardial performance index (MPI), in pregnancies complicated by decreased fetal movement (DFM). Methods: We performed a prospective cross-sectional case-control study of 50 DFM and 50 uncomplicated third-trimester pregnancies matched within 2 gestational weeks. Routine ultrasound growth and well-being parameters as well as MPI were measured. Average MPI measurements and its component values were compared between the DFM and the control group, as were demographics, other ultrasound data, and perinatal outcomes. Results: Average left MPI (LMPI) and right MPI (RMPI) was similar between groups (LMPI: 0.54 ± 0.08 [DFM], 0.53 ± 0.08 [controls], p = 0.76; RMPI: 0.60 ± 0.12 (DFM), 0.59 ± 0.11 [controls], p = 0.79). However, subgroup analysis of DFM fetuses with (n = 20) or without (n = 30) any adverse perinatal outcome demonstrated modestly higher average RMPI and LMPI in the adverse perinatal outcome group (RMPI: 0.64 ± 0.08 vs. 0.57 ± 0.13, p = 0.02; LMPI: 0.56 ± 0.07 vs. 0.52 ± 0.07, p = 0.052). Conclusion: The MPI did not demonstrate clinically usable differences between the overall DFM population and controls. However, higher LMPI and RMPI values in the exploratory subgroup of DFM fetuses with adverse perinatal outcomes may warrant further exploration of the MPI in DFM.

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“…This concept is particularly relevant when applying these measurements to clinical practice in the assessment of fetal cardiac function for different pathologies [10,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Different Ultrasound Systems for the Evaluation of Tissue Doppler Velocities in Fetuses

et al. 2015

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Introduction: Recent studies have reported variations of up to 30% between different ultrasound machines for tissue Doppler imaging (TDI), a problem that can significantly impact clinical diagnosis, patient management and research studies. The objective of this study was to assess repeatability and agreement between fetal myocardial peak velocities evaluated by TDI with two different ultrasound systems. Materials and Methods: Systolic (S'), early (E') and late (A') diastolic myocardial peak velocities at mitral and tricuspid annuli as well as at the basal septum were evaluated by spectral TDI in 150 fetuses using two different ultrasound systems: Siemens Antares (Siemens Medical Systems, Malvern, Pa., USA) and Vivid Q (General Electric Healthcare, Horten, Norway). A method comparison study was performed, calculating intraclass correlation coefficients (ICC), and agreement was assessed by Bland-Altman plots. Results: Annular peak velocities showed lower values when measured by Vivid Q compared to values measured by Siemens Antares. ICC ranged from 0.07 (septal S') to 0.33 (right A'), showing very poor repeatability for clinical application. Agreement between the two systems was also poor, with high coefficients of variation for all measurements. Conclusions: Fetal annular peak velocities obtained with different ultrasound systems are not directly comparable. This is consistent with previous data in adults and warrants the need of system-specific reference values, suggesting that the same ultrasound machine should be used for longitudinal follow-up.

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The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

Cited by 40 publications

References 135 publications

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

Use of the Myocardial Performance Index in Decreased Fetal Movement Assessment: A Case-Control Study

Comparison of Two Different Ultrasound Systems for the Evaluation of Tissue Doppler Velocities in Fetuses

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