title: Fetal myocardial performance index in assessment and management of small-for-gestational-age fetus: a cohort and nested case-control study.
abstract: To assess the clinical utility of the fetal myocardial performance index (MPI) in assessment and management of the small-for-gestational-age (SGA) fetus/growth-restricted fetus (FGR).
  
  
  
  This was a prospective cohort study in metropolitan Australia of patients referred in the period June 2012 to March 2015 to fetal medicine services at 24-38 weeks' gestation for suspected singleton SGA/FGR (estimated fetal weight (EFW) < 10thcentile with or without abnormal umbilical artery (UA) Doppler) pregnancy. Patients had MPI assessed in addition to routine measures, and were followed through to birth. We compared MPI values against those of a local reference population and gestational age-matched controls, and assessed the correlation with perinatal outcome and other Doppler measures.
  
  
  
  Fifty-two cases were included, 38 diagnosed < 32 weeks and 14 diagnosed ≥ 32 weeks. None demonstrated significantly elevated left, right or delta MPI compared with the reference population or with gestational age-matched controls at the time of first MPI evaluation. There were no consistent longitudinal patterns in MPI that would suggest its clinical utility. The mean ± SD gestational age at delivery was 34.6 ± 3.8 weeks and birth weight was 1.7 ± 0.6 kg, and the median neonatal hospital admission time was 27 days, confirming a pathological cohort. There were no significant correlations between left, right or delta-MPI and perinatal outcome, although there were significant correlations between UA, middle cerebral artery (MCA) and ductus venosus (DV) Doppler and perinatal outcome (birth weight, gestational age at birth and length of neonatal hospital stay). Exploratory subgroup comparisons (EFW < 3rdvs 3rd-10thcentile; early- vs late-onset; abnormal vs normal UA Doppler) found only minor differences in MPI, reaching statistical, but not clinical, significance, only in the EFW < 3rdvs 3rd-10thcentile comparison.
  
  
  
  MPI did not demonstrate clinical utility in either triage or longitudinal follow-up of an SGA/FGR cohort presenting to fetal medicine services. Given that prior research suggesting its utility originates from single-center cohorts, while multicenter, large cohorts have suggested little utility or no additional utility if routine UA/MCA/DV Doppler is performed, publication bias may have affected previous reports. It seems unlikely that MPI has clinical utility in assessment and management of SGA/FGR fetuses. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia.|Department of Women's and Children's Health, St George Hospital, Sydney, Australia.
authors.forename: A
authors.identifier: 0000-0002-7351-8922
authors.initials: A
authors.lastname: Henry
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Alphonse
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Tynan
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia.
authors.forename: A W
authors.initials: AW
authors.lastname: Welsh
mesh_terms: D000328:Adult; D001315:Australia; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007236:Infant, Small for Gestational Age / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000196:embryology
keywords: Doppler ultrasound; MPI; SGA; Tei index; fetal growth restriction