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Multicenter Study
. 2021 Jul 7;11(7):e049640.
doi: 10.1136/bmjopen-2021-049640.

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

Lijuan Sun  1 , Jingjing Wang  1 , Xiaoting Su  2 , Xinlin Chen  3 , Yuqing Zhou  4 , Xiaoming Zhang  5 , Hong Lu  6 , Jianmei Niu  7 , Lan Yu  8 , Congxin Sun  9 , Wenjun Zhang  10 , Jijing Han  1 , Lina Zhang  1 , Zhenna Wang  2 , Peiwen Chen  3 , Tiantian Chen  4 , Hua Hong  5 , Lulu Zhou  6 , Baoying Ye  7 , Wei Guo  8 , Wei Zhao  9 , Na Zhang  1 , Zhen Li  1 , Sheng Zhao  3 , Qingqing Wu  11 , Jiawei Tian  12 , Yuxin Jiang  13
Affiliations
Multicenter Study

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

Lijuan Sun et al. BMJ Open. .

Abstract

Objectives: The primary aim of this study was to establish the normal reference ranges of the fetal left ventricular (LV) Modified Myocardial Performance Index (Mod-MPI). A secondary aim was to evaluate the agreement between manual and automatic measurements for fetal Mod-MPI.

Design: A prospective, multicentre, cross-sectional study.

Participants: Normal singleton pregnancies.

Methods: The LV functions of normal singleton pregnancies were assessed in nine centres covering eight provinces in China using unified ultrasound protocols and settings and standardised measurements by pulsed Doppler at 20-24, 28-32 and 34-38 weeks of gestation. The isovolumetric relaxation time (IRT), isovolumetric contraction time, ejection time (ET) and Mod-MPI were measured both automatically and manually.

Results: This cross-sectional study included 2081 fetuses, and there was a linear correlation between gestational age (GA) and Mod-MPI (0.416+0.001×GA (weeks), p<0.001, r2=0.013), IRT (36.201+0.162× GA (weeks), p<0.001, r2=0.021) and ET (171.418-0.078*GA (weeks), p<0.001, r2=0.002). This finding was verified using longitudinal data in a subgroup of 610 women. The agreement between the manual and automated measurements for Mod-MPI was good.

Conclusions: We constructed normal reference values of fetal LV Mod-MPI. Automatic measurement can be considered for ease of measurement in view of the good agreement between the automatic and manual values.

Keywords: cardiology; echocardiography; fetal medicine; heart failure; prenatal diagnosis; ultrasonography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Normal Modified Myocardial Performance Index (Mod-MPI) (Tei index) Doppler image with automatic measurement. MCO=mitral valve closing and open time=ICT + IRT+ET. ET, ejection time; ICT, isovolumetric contraction time; IRT, isovolumetric relaxation time.
Figure 2
Figure 2
Normal Modified Myocardial Performance Index (Mod-MPI) (Tei index) Doppler image with manual measurement. MCO=mitral valve closing and open time=ICT + IRT+ET. ET, ejection time; ICT, isovolumetric contraction time; IRT, isovolumetric relaxation time.
Figure 3
Figure 3
The study flow chart. FGR, fetal growth restriction.
Figure 4
Figure 4
Plots of LV Mod-MPI, IRT and ET based on the cross-sectional data (2081 cases) with advancing gestational age (GA). p5=5 th centile; p50=median; p95=95 th centile. ET, ejection time; IRT, isovolumetric relaxation time; Mod-MPI, Modified Myocardial Performance Index.
Figure 5
Figure 5
The verification of LV Mod-MPI, IRT and ET with advancing gestational age (GA) based on the longitudinal data (610 cases). p5=5 th centile; p50=median; p95=95 th centile. ET, ejection time; IRT, isovolumetric relaxation time; Mod-MPI, Modified Myocardial Performance Index.
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