title: Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome.
abstract: OBJECTIVE
  To establish normal reference ranges for the fetal left modified myocardial performance index (Mod-MPI) measured by the Auto Mod-MPI system and evaluate Mod-MPI changes in recipients of twin-to-twin transfusion syndrome (TTTS) before and after fetoscopic laser coagulation.
  
  
  METHODS
  This was a prospective longitudinal study of normal singleton fetuses from 12.0 to 40.0 weeks of gestation. TTTS cases treated by laser coagulation were reviewed for Mod-MPI measurements of recipients. All measurements were performed using the Auto Mod-MPI system by a single experienced operator.
  
  
  RESULTS
  Among a total 447 examinations from 222 fetuses, we were unable to measure the Mod-MPI in two cases, and therefore, 445 examinations were analyzed. The median Mod-MPI consistently increased from 0.44 to 0.56 throughout gestation. The median isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) also increased with advancing gestational age. The ejection time (ET) increased until 27 weeks of gestation and decreased thereafter. In the 30 recipients, Mod-MPI, ICT, and IRT increased before laser coagulation and significantly decreased after laser coagulation.
  
  
  CONCLUSIONS
  Normal reference values for left Mod-MPI were established using the Auto Mod-MPI system, and these might be useful for assessing cardiac function in TTTS. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Hye-Sung
authors.initials: HS
authors.lastname: Won
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jae-Yoon
authors.initials: JY
authors.lastname: Shim
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Pil-Ryang
authors.initials: PR
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ahm
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
mesh_terms: D015150:Echocardiography, Doppler; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation; D008137:Longitudinal Studies; D009200:Myocardial Contraction; D011247:Pregnancy; D011446:Prospective Studies; D012016:Reference Values; D016216:Ultrasonography, Prenatal