Turkish reference ranges for the left fetal modified myocardial performance index

Abstract

Background. This study aimed to assess fetal cardiac left ventricular function in healthy pregnant women by calculating the modified myocardial performance index (Mod-MPI) and to construct reference ranges for the Turkish population.Methods. One-hundred-two randomly selected healthy singleton pregnant women ranging between 25 and 39 gestational weeks were included in the study. Left fetal Mod-MPI was measured for each pregnant woman. Women with chronic systemic diseases or fetuses with chromosomal or structural abnormalities were excluded from the study. Mitral valve (MV) and aortic valve (AoV) clicks were used as landmarks to define the following time periods that were used to calculate the Mod-MPI: isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET).Results. The mean Mod-MPI was 0.42±0.10. The mean IRT, ICT, and ET were 43.5±10.2, 27.27±8.1, and 170.5±16.9, respectively. A significant correlation was found between Mod-MPI and gestational age, umbilical artery systolic/diastolic (UA S/D) ratio and the middle cerebral artery pulsatility index (MCA PI) values (r=0.199, p=0.047, p=0.001, p=0.001, respectively) Conclusions. The current study's results will be a reference for future studies, especially studies investigating pathological conditions that impact fetal cardiac function.

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

“…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.…”

Fetal left ventricular myocardial performance index measured at 11–14 weeks of gestation in fetuses with an increased nuchal translucency

“…However, the right MPI examination needs two planes for right ventricle tricuspid and pulmonary valve measurements, which creates difficulties in assessing the right ventricle. 24 Left MPI measurement is the preferred method in previous investigations since it can be easily determined in the same recording if the Doppler gate is located to examine concurrently the mitral inflow and aortic outflow waveforms. 25 Also, Russell et al demonstrated that the MPI values are similar for the left and right ventricles at 12 to 14 weeks of gestation.…”

“…Although several studies have shown that the mean MPI is a constant value throughout gestation, studies reporting that MPI values increase or decrease in correlation with the gestational week have also been published. 10,24,26,28 The conflicting results could be due to the variations regarding the techniques utilized to assess the MPI, weak reproducibility of Doppler measurements in tiny hearts of the very small fetus, and slight, yet statistically meaningful, alterations in cardiac function which might not be meaningful from a clinical approach. 26 Hernandez-Andrade et al described a modified MPI (Mod-MPI) involving the evaluation of the aortic and mitral valve clicks and advocated that this estimation was related to a better intra-and interobserver agreement and lower variation than the Tei method.…”

“…Thus, systolic dysfunction results in prolonging the MPI values. Also, IRT is the component of MPI value that is initially affected in the event of pregnancy complications 24 . Thus, we selected the left MPI as the primary variable based on its usefulness and capableness to illustrate cardiac function.…”

“…Hypothetically, the right MPI measurement appears to be more prudent because the fetal heart is considered to be right dominant throughout the fetal life. However, the right MPI examination needs two planes for right ventricle tricuspid and pulmonary valve measurements, which creates difficulties in assessing the right ventricle 24 . Left MPI measurement is the preferred method in previous investigations since it can be easily determined in the same recording if the Doppler gate is located to examine concurrently the mitral inflow and aortic outflow waveforms 25 .…”