Fetuses with an abdominal circumference below the 10th percentile exhibited significantly increased modified myocardial performance index values compared to those above the 10th percentile (p<0.001).
Observational (n=157)
No
Does fetal growth restriction alter the modified myocardial performance index in singleton pregnancies at ≥ 32 weeks of gestation compared to normal growth fetuses?
The modified myocardial performance index can detect subclinical fetal cardiac dysfunction in growth-restricted fetuses, including those in the borderline 3rd-10th percentile range who have normal conventional Doppler findings.
Absolute Event Rate: 0.67% vs 0.39%
p-value: p=<0.001
Accurate differentiation between constitutionally small fetuses and those affected by true fetal growth restriction (FGR) remains a major clinical challenge, particularly in fetuses with estimated fetal weight between the 3rd and 10th percentiles. Conventional Doppler parameters may remain normal until late stages of placental insufficiency. The modified myocardial performance index (M-MPI) has been proposed as a sensitive marker of early fetal cardiac dysfunction. This prospective observational study included 157 singleton pregnancies at ≥ 32 weeks of gestation. Fetuses were classified into three groups according to abdominal circumference (AC) percentiles ( 10th percentile), using a classification framework informed by the Delphi consensus definition of fetal growth restriction. Fetal biometry, amniotic fluid index, umbilical artery and middle cerebral artery Doppler measurements were obtained. Fetal cardiac function was assessed using the modified myocardial performance index. Delivery outcomes were recorded. Comparisons among groups were performed using appropriate statistical tests. Maternal demographic and obstetric characteristics were similar among groups. Umbilical artery Doppler, middle cerebral artery Doppler, cerebroplacental ratio, and amniotic fluid index did not differ significantly between groups (all p > 0.05). In contrast, both fetuses below the 3rd percentile and those between the 3rd and 10th percentiles exhibited significantly prolonged isovolumetric contraction and relaxation times, shortened ejection time, and increased M-MPI values compared with fetuses above the 10th percentile ( p < 0.05). No significant differences in M-MPI parameters were observed between the <3rd percentile and 3rd–10th percentile groups. Fetuses with abdominal circumference below the 10th percentile, including those within the borderline 3rd–10th percentile range, demonstrate subclinical cardiac dysfunction despite normal conventional Doppler findings. Assessment of the modified myocardial performance index may provide valuable additional information in the evaluation of suspected fetal growth restriction.
Ateş et al. (2026) conducted an observational in Fetal growth restriction (n=157). Abdominal circumference <10th percentile vs. Abdominal circumference >10th percentile was evaluated on Modified myocardial performance index (M-MPI) (p=<0.001). Fetuses with an abdominal circumference below the 10th percentile exhibited significantly increased modified myocardial performance index values compared to those above the 10th percentile (p<0.001).