Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early‐onset intrauterine growth restriction

Cruz‐Martínez, R.; Figueras, F.; Benavides-Serralde, Andrés; Crispi, F.; Hernández‐Andrade, Edgar; Gratacós, Eduard

doi:10.1002/uog.8903

Cited by 75 publications

(74 citation statements)

References 36 publications

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“…However, it requires training to achieve the necessary competence to perform the exam. 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%

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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%

“…This Mod-MPI improved the inter-observer reproducibility associated with the original coefficient [16]. Cruz-Martinez et al [18] indicated that on an average, the MPI values are above the 95 th percentile three weeks before the pulsatility index (PI) change in the ductus venosus of foetuses with early-onset FGR.…”

Section: Introductionmentioning

confidence: 93%

Assessment of modified myocardial performance index in foetuses with growth restriction

et al. 2016

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“…In addition, progressive changes in AoI Doppler values are strongly correlated with those occurring in the DV [32]. These reasons are proposed as determinants to explain the poor predictiveness of this vessel for perinatal mortality [8,12,13,14,33,34]. On the contrary, AoI has been suggested to have a clear association with postnatal neurological morbidity [15,35] since it is a marker of brain centralization.…”

Section: Discussionmentioning

confidence: 99%

“…The statistical analysis used in the present study was based on a CHAID model that automatically chooses the independently associated parameters for decision making, while our previous analysis was performed manually for each group. A recent longitudinal study on cardiovascular changes in IUGR showed that the MPI becomes altered at an earlier stage than the DV [33], and this may explain a weaker association with perinatal mortality. These results do not preclude the clinical value of MPI but illustrate that larger studies should be conducted in order to refine the assessment of the potential contribution of the MPI to monitoring of early-onset IUGR.…”

Section: Discussionmentioning

confidence: 99%

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

et al. 2012

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Objective: To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses. Methods: A multicenter prospective cohort study including 157 early-onset (<34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates. Results: Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index <5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI <5th centile, and 1.6 for MPI >95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death (<26 weeks, 93% mortality; 26–28 weeks, 29% mortality, and >28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality. Conclusions: Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation.

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“…MPI in IUGR fetuses has been evaluated in a number of different studies by conventional and tissue Doppler [6,11,30,31,32,33,34,83,84,85,86,87,88]. In fetuses followed longitudinally, MPI was identified as one of the earliest Doppler parameters affected and remained elevated throughout the different stages of deterioration with a steeper curve of deterioration compared with other Doppler indices (aortic isthmus and ductus venosus pulsatility indices) [34,87].…”

Section: Clinical Application Of Mpimentioning

confidence: 99%

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

et al. 2015

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Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.

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Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early‐onset intrauterine growth restriction

Abstract: Objective To explore the sequence of changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) flow in fetuses with earlyonset intrauterine growth restriction (IUGR). Methods

Cited by 75 publications

References 36 publications

Assessment of modified myocardial performance index in foetuses with growth restriction

Assessment of modified myocardial performance index in foetuses with growth restriction

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

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

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