title: The Fetal Modified Myocardial Performance Index: Is Automation the Future?
abstract: The fetal modified myocardial performance index (Mod-MPI) is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1) a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3) ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.
authors.affiliation: Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Priya
authors.initials: P
authors.lastname: Maheshwari
authors.affiliation: Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia ; Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia ; Women's and Children's Health, St George Hospital, Kogarah, NSW 2217, Australia ; Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Henry
authors.affiliation: Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia ; Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia ; Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Alec W
authors.initials: AW
authors.lastname: Welsh
mesh_terms: D018619:Echocardiography, Doppler, Pulsed / Q000639:trends*; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005544:Forecasting; D006334:Heart Function Tests / Q000639:trends*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016216:Ultrasonography, Prenatal / Q000639:trends*