Key result
Fetal myocardial performance assessment (such as the Tei index and speckle-tracking strain) may capture subclinical cardiac stress in preeclampsia not fully reflected by conventional Doppler alone.
Why the study?
Does adding fetal myocardial functional assessment to established fetoplacental Doppler surveillance improve the prediction of clinically meaningful perinatal outcomes in pregnancies complicated by preeclampsia?
Does adding fetal myocardial functional assessment to established fetoplacental Doppler surveillance improve the prediction of clinically meaningful perinatal outcomes in pregnancies complicated by preeclampsia?
This editorial highlights that integrating fetal myocardial functional assessments (such as the Tei index and speckle-tracking echocardiography) with conventional fetoplacental vascular Doppler parameters may offer a more comprehensive evaluation of fetal cardiovascular adaptation in preeclampsia, though prospective validation is needed before routine clinical adoption.
reeclampsia remains a major cause of maternal and perinatal morbidity and mortality and represents a complex disorder of placental and cardiovascular maladaptation.In current clinical practice, fetal surveillance in pregnancies complicated by preeclampsia relies largely on fetal growth assessment, cardiotocography, and Doppler evaluation of the fetoplacental circulation.Umbilical artery (UA) Doppler reflects placental vascular resistance, whereas middle cerebral artery (MCA) Doppler and the cerebroplacental ratio (CPR) provide information about fetal circulatory redistribution.In more advanced cases of placental insufficiency, ductus venosus assessment may provide additional information on fetal hemodynamic deterioration (1).These tools are indispensable in modern perinatal medicine.Nevertheless, an important question remains: do they fully characterize the fetal cardiovascular response to preeclampsia?The distinction between vascular adaptation and myocardial function may be particularly relevant.Increased placental vascular resistance exposes the fetal heart to altered loading conditions and increased afterload.Conventional Doppler can identify changes in downstream vascular resistance and redistribution of cardiac output, but these measurements do not directly quantify myocardial performance.Therefore, fetal myocardial dysfunction could theoretically coexist with relatively preserved conventional Doppler findings, particularly during earlier stages of cardiovascular adaptation.The myocardial performance index (MPI), or Tei index, offers an attractive method for investigating this additional dimension of fetal physiology.By incorporating isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), and ejection time (ET), MPI provides a combined assessment of systolic and diastolic cardiac performance (2).However, evidence regarding its role in preeclampsia has not been entirely consistent.An earlier study reported no significant difference in modified MPI between fetuses of preeclamptic and Fetal Cardiac Function Assessment in Preeclampsia: Are Conventional Doppler Parameters Enough?
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Yılmaz et al. (2026) conducted an editorial in Preeclampsia. Fetal cardiac function assessment (Myocardial Performance Index / Tei index and myocardial deformation imaging) vs. Conventional Doppler parameters (UA, MCA, CPR, ductus venosus) was evaluated. Fetal myocardial performance assessment (such as the Tei index and speckle-tracking strain) may capture subclinical cardiac stress in preeclampsia not fully reflected by conventional Doppler alone.
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