{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T04:06:25Z","timestamp":1773029185452,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>(1) Objectives: In utero functional cardiac assessments using echocardiography have become increasingly important. The myocardial performance index (MPI, Tei index) is currently used to evaluate fetal cardiac anatomy, hemodynamics and function. An ultrasound examination is highly examiner-dependent, and training is of enormous significance in terms of proper application and subsequent interpretation. Future experts will progressively be guided by applications of artificial intelligence, on whose algorithms prenatal diagnostics will rely on increasingly. The objective of this study was to demonstrate the feasibility of whether less experienced operators might benefit from an automated tool of MPI quantification in the clinical routine. (2) Methods: In this study, a total of 85 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by a targeted ultrasound. The modified right ventricular MPI (RV-Mod-MPI) was measured, both by a beginner and an expert. A calculation was performed semiautomatically using a Samsung Hera W10 ultrasound system (MPI+\u2122, Samsung Healthcare, Gangwon-do, South Korea) by taking separate recordings of the right ventricle\u2019s in- and outflow using a conventional pulsed-wave Doppler. The measured RV-Mod-MPI values were assigned to gestational age. The data were compared between the beginner and the expert using a Bland-Altman plot to test the agreement between both operators, and the intraclass correlation was calculated. (3) Results: The mean maternal age was 32 years (19 to 42 years), and the mean maternal pre-pregnancy body mass index was 24.85 kg\/m2 (ranging from 17.11 to 44.08 kg\/m2). The mean gestational age was 24.44 weeks (ranging from 19.29 to 36.43 weeks). The averaged RV-Mod-MPI value of the beginner was 0.513 \u00b1 0.09, and that of the expert was 0.501 \u00b1 0.08. Between the beginner and the expert, the measured RV-Mod-MPI values indicated a similar distribution. The statistical analysis showed a Bland-Altman bias of 0.01136 (95% limits of agreement from \u22120.1674 to 0.1902). The intraclass correlation coefficient was 0.624 (95% confidence interval from 0.423 to 0.755). (4) Conclusions: For experts as well as for beginners, the RV-Mod-MPI is an excellent diagnostic tool for the assessment of fetal cardiac function. It is a time-saving procedure, offers an intuitive user interface and is easy to learn. There is no additional effort required to measure the RV-Mod-MPI. In times of reduced resources, such assisted systems of fast value acquisition represent clear added value. The establishment of the automated measurement of the RV-Mod-MPI in clinical routine should be the next level in cardiac function assessment.<\/jats:p>","DOI":"10.3390\/diagnostics13101705","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T01:05:10Z","timestamp":1683853510000},"page":"1705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+\u2122 for Direct Quantification of the Modified Myocardial Performance Index"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3685-6997","authenticated-orcid":false,"given":"Jann Lennard","family":"Scharf","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, Ratzeburger Allee 160, 23538 L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Dracopoulos","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, Ratzeburger Allee 160, 23538 L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Gembicki","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, Ratzeburger Allee 160, 23538 L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amrei","family":"Welp","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, Ratzeburger Allee 160, 23538 L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0636","authenticated-orcid":false,"given":"Jan","family":"Weichert","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Campus L\u00fcbeck, Ratzeburger Allee 160, 23538 L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"215910","DOI":"10.1155\/2015\/215910","article-title":"The Fetal Modified Myocardial Performance Index: Is Automation the Future?","volume":"2015","author":"Maheshwari","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s00129-021-04889-z","article-title":"Kardiale Funktionsanalyse beim Feten: Schritt f\u00fcr Schritt","volume":"55","author":"Graupner","year":"2022","journal-title":"Gyn\u00e4kologe"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1159\/000338003","article-title":"Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications","volume":"32","author":"Crispi","year":"2012","journal-title":"Fetal Diagn. Ther."},{"key":"ref_4","first-page":"357","article-title":"New index of combined systolic and diastolic myocardial performance: A simple and repro-ducible measure of cardiac function\u2014A study in normals and dilated cardiomyopathy","volume":"26","author":"Tei","year":"1995","journal-title":"J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1046\/j.1442-200x.1999.01155.x","article-title":"Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index","volume":"41","author":"Tsutsumi","year":"1999","journal-title":"Pediatr. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/S0002-9149(01)02056-2","article-title":"Evaluation of systolic and diastolic ventricular performance of the right ventricle in fetuses with ductal constriction using the Doppler Tei index","volume":"88","author":"Mori","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1515\/JPM.2001.055","article-title":"Fetal congestive heart failure: Correlation of Tei-Index and Cardiovascular-Score","volume":"29","author":"Falkensammer","year":"2001","journal-title":"J. Perinat. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1046\/j.1540-8175.2001.t01-1-00009.x","article-title":"Quantitative Assessment of Fetal Ventricular Function: Establishing Normal Values of the Myocardial Performance Index in the Fetus","volume":"18","author":"Eidem","year":"2001","journal-title":"Echocardiography"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.earlhumdev.2004.07.003","article-title":"The Tei index for evaluation of fetal myocardial performance in sick fetuses","volume":"81","author":"Ichizuka","year":"2005","journal-title":"Early Hum. Dev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1055\/s-2005-837739","article-title":"Left Ventricular Myocardial Performance in the Fetus with Severe Tricuspid Valve Disease and Tricuspid Insufficiency","volume":"22","author":"Inamura","year":"2005","journal-title":"Am. J. Perinatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/uog.1959","article-title":"A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment: Reproducibility of a modified fetal myo-cardial performance index","volume":"26","author":"Carreras","year":"2005","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/uog.11","article-title":"Fetal cardiac function assessed by Doppler myocardial performance index (Tei Index): The fetal Tei Index","volume":"21","author":"Friedman","year":"2003","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/S0002-9149(03)00041-9","article-title":"Measuring left ventricular myocardial performance index in fetuses","volume":"91","author":"Raboisson","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/uog.9090","article-title":"Fetal left modified myocardial performance index: Technical refinements in obtaining pulsed-Doppler waveforms: The fetal left MPI: Technical refinements","volume":"39","author":"Meriki","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1007\/s00246-013-0709-1","article-title":"Fetal Left and Right Ventricle Myocardial Performance Index: Defining Normal Values for the Second and Third Trimesters\u2014Single Tertiary Center Experience","volume":"34","author":"Ghawi","year":"2013","journal-title":"Pediatr. Cardiol."},{"key":"ref_16","unstructured":"Lee, M.Y., Kim, S.Y., and Won, H.S. (2022, October 19). White Paper: MPI+, an Automatic Tool for Measurement of Fetal Right Ventricular Myocardial Per-Formance Index. Published online 9 December 2021. Available online: https:\/\/www.samsunghealthcare.com\/en\/products\/UltrasoundSystem."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/ajum.12035","article-title":"Fetal cardiac function: Feasibility in obtaining the right modified myocardial performance index in a single Doppler waveform","volume":"20","author":"Meriki","year":"2017","journal-title":"Australas. J. Ultrasound Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ejogrb.2020.05.011","article-title":"Normal reference ranges for fetal cardiac function: Assessed by modified Doppler myocardial performance index (Mod MPI) in the Egyptian population","volume":"251","author":"Ali","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kim, S.-M., and Ye, S.-Y. (2021). Evaluation of the Fetal Left Ventricular Myocardial Performance Index (MPI) by Using an Automated Measurement of Doppler Signals in Normal Pregnancies. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020358"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000363181","article-title":"The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research","volume":"38","author":"Mahajan","year":"2015","journal-title":"Fetal Diagn. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1080\/14767058.2018.1535588","article-title":"Assessment of fetal left ventricular modified myocardial performance index and its prognostic significance for adverse perinatal outcome in intrahepatic cholestasis of pregnancy","volume":"33","author":"Ozel","year":"2018","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.siny.2010.09.005","article-title":"Techniques for assessing cardiac output and fetal cardiac function","volume":"16","author":"Tutschek","year":"2011","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1002\/jum.15634","article-title":"Novel Technique for the Measurement of Fetal Right Modified Myocardial Performance Index Using Synchronized Images of Right Ventricular Inflow and Outflow and Clinical Application to Twin-to-Twin Transfusion Syndrome","volume":"40","author":"Kang","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.7863\/ultra.16.07079","article-title":"Novel Technique for Measurement of Fetal Right Myocardial Performance Index Using Dual Gate Pulsed-Wave Doppler: Fetal Cardiac Function","volume":"36","author":"Lee","year":"2017","journal-title":"J. Ultrasound Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/S0002-9149(02)02541-9","article-title":"Comparison of the right ventricular Tei index by tissue Doppler imaging to that obtained by pulsed Doppler in children without heart disease","volume":"90","author":"Harada","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e049640","DOI":"10.1136\/bmjopen-2021-049640","article-title":"Reference ranges of fetal heart function using a Modified Myocardial Performance Index: A prospective multicentre, cross-sectional study","volume":"11","author":"Sun","year":"2021","journal-title":"BMJ Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/uog.8870","article-title":"Gestational age- and estimated fetal weight-adjusted reference ranges for myocardial tissue Doppler indices at 24\u201341 weeks\u2019 gestation","volume":"37","author":"Comas","year":"2010","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000330798","article-title":"Normal Reference Ranges from 11 to 41 Weeks\u2019 Gestation of Fetal Left Modified Myocardial Performance Index by Conventional Doppler with the Use of Stringent Criteria for Delimitation of the Time Periods","volume":"32","author":"Figueras","year":"2012","journal-title":"Fetal Diagn. Ther."},{"key":"ref_29","first-page":"108","article-title":"Quantitative assessment of the right and the left ventricular function using pulsed Doppler myocardial performance index in normal fetuses at 18 to 40 weeks of gestation","volume":"82","year":"2011","journal-title":"Ginekol. Pol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1002\/pd.4798","article-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: Mod-MPI reference values","volume":"36","author":"Lee","year":"2016","journal-title":"Prenat. Diagn."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4236\/ojog.2013.31019","article-title":"Gestation-specific reference intervals for fetal cardiac Doppler indices from 12 to 40 weeks of gestation","volume":"3","author":"Parasuraman","year":"2013","journal-title":"Open J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1002\/pd.4414","article-title":"Gestational age-adjusted trends and reference intervals of the Modified Myocardial Performance Index (Mod-MPI) and its components, with its interpretation in the context of established cardiac physiological principles: Reference intervals of the Mod-MPI and its components in pregnanc","volume":"34","author":"Bhorat","year":"2014","journal-title":"Prenat. Diagn."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1159\/000362388","article-title":"Development of Normal Gestational Ranges for the Right Myocardial Performance Index in the Australian Population with Three Alternative Caliper Placements","volume":"36","author":"Meriki","year":"2014","journal-title":"Fetal Diagn. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/uog.7765","article-title":"Learning curve for Doppler measurement of fetal modified myocardial performance index","volume":"37","author":"Figueras","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/uog.2804","article-title":"The examiner\u2019s ultrasound experience has a significant impact on the detection rate of congenital heart defects at the second-trimester fetal examination","volume":"28","author":"Tegnander","year":"2006","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1080\/14767058.2020.1786519","article-title":"Optical ultrasound simulation-based training in obstetric sonography","volume":"35","author":"Yeo","year":"2020","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s00129-021-04890-6","article-title":"K\u00fcnstliche Intelligenz in der pr\u00e4natalen kardialen Diagnostik","volume":"55","author":"Weichert","year":"2021","journal-title":"Gyn\u00e4kologe"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5468\/ogs.21234","article-title":"Artificial intelligence in obstetrics","volume":"65","author":"Ahn","year":"2022","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"733468","DOI":"10.3389\/fmed.2021.733468","article-title":"Artificial Intelligence in Obstetric Ultrasound: An Update and Future Applications","volume":"8","author":"Chen","year":"2021","journal-title":"Front. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1177\/1742271X211072473","article-title":"The application of artificial intelligence in the sonography profession: Professional and educational considerations","volume":"30","author":"Edwards","year":"2022","journal-title":"Ultrasound"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1007\/s00129-022-04996-5","article-title":"K\u00fcnstliche Intelligenz und Simulation in der Pr\u00e4natalmedizin\u2013was wir von Maschinen lernen k\u00f6nnen","volume":"55","author":"Steinhard","year":"2022","journal-title":"Gyn\u00e4kologie"},{"key":"ref_42","first-page":"90401E","article-title":"Automated measurement of fetal myocardial performance index in ultrasound Doppler waveforms","volume":"9040","author":"Yoon","year":"2014","journal-title":"Proc. SPIE"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1002\/uog.13247","article-title":"Feasibility of using Auto Mod-MPI system, a novel technique for automated measurement of fetal modified myocardial performance index","volume":"43","author":"Lee","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_44","unstructured":"Hahn, H.K., and Mori, K. (2019). Medical Imaging 2019: Computer-Aided Diagnosis, SPIE."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1002\/uog.13365","article-title":"Influence of equipment and settings on myocardial performance index repeatability and definition of settings to achieve optimal reproducibility","volume":"43","author":"Lobmaier","year":"2014","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1111\/chd.12648","article-title":"Prenatal detection of critical cardiac outflow tract anomalies remains suboptimal despite revised obstetrical imaging guidelines","volume":"13","author":"Sun","year":"2018","journal-title":"Congenit. Heart Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1002\/uog.12403","article-title":"ISUOG Practice Guidelines (updated): Sonographic screening examination of the fetal heart: ISUOG Guidelines","volume":"41","author":"Carvalho","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.7863\/jum.2013.32.6.1083","article-title":"AIUM Practice Guideline for the Performance of Obstetric Ultrasound Examinations","volume":"32","author":"Crino","year":"2013","journal-title":"J. Ultrasound Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/10\/1705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:33:07Z","timestamp":1760124787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/10\/1705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,11]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["diagnostics13101705"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13101705","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,11]]}}}