{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:03:31Z","timestamp":1788174211496,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centre of Postgraduate Medical Education","award":["501-1-157-81-24"],"award-info":[{"award-number":["501-1-157-81-24"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: This review aims to investigate the clinical implications of using the myocardial performance index (MPI), obtained through tissue Doppler imaging (TDI) and spectral Doppler, in assessing fetal cardiac function in growth-restricted fetuses. It explores the MPI\u2019s potential in predicting adverse perinatal outcomes and its utility when combined with conventional pulsed-wave Doppler assessments for enhanced fetal well-being evaluations. Material and Methods: A systematic search of PubMed and Google Scholar databases spanning from 2004 to 2023 was conducted to identify pertinent articles on the MPI\u2019s clinical application in managing growth-restricted fetuses. Inclusion criteria followed the Fetal Medicine Barcelona definition of fetal growth restriction (FGR) to mitigate study group heterogeneity. The research sources were PubMed and Google Scholar databases, and the review was conducted without any specific clinical or laboratory setting. Only articles meeting the inclusion criteria for FGR, as per the Fetal Medicine Barcelona definition, were considered. Six studies meeting these criteria were included in the review. The review analyzed the correlation between MPI values and conventional Doppler parameters, investigating the progression of myocardial function impairment and its association with the risk of fetal demise. The primary outcome measures included the relationship between MPI values, fetal well-being, and the potential for prenatal cardiac dysfunction in growth-restricted fetuses. Results: The findings indicate that as conventional Doppler parameters deteriorate, MPI values increase, suggesting progressive myocardial dysfunction. The MPI may cross the 95th percentile before abnormal flow in the ductus venosus and aortic isthmus, highlighting the potential for diastolic dysfunction preceding hypoxia in growth-restricted fetuses. Elevated MPI levels were observed in both growth-restricted and small-for-gestational-age (SGA) fetuses, indicating prenatal cardiac impairment. The strong association between an abnormal MPI and perinatal mortality has been shown for early FGR. Conclusions: MPI alterations appear to precede abnormal Doppler parameters in early- and late- onset FGR, potentially indicating diastolic dysfunction preceding hypoxia. Additionally, the MPI correlates with the risk of fetal demise. However, larger studies are needed to establish its sensitivity and specificity. Furthermore, the significance of prenatal cardiac impairment in some SGA fetuses raises questions about its potential impact on perinatal outcomes and cardiovascular programming.<\/jats:p>","DOI":"10.3390\/jcm13216469","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T11:52:47Z","timestamp":1730116367000},"page":"6469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Significance of the Myocardial Performance Index and Fetal Doppler Abnormalities in Growth-Restricted Fetuses: A Systematic Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3198-3102","authenticated-orcid":false,"given":"Agnieszka Helena","family":"Czapska","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Ceg\u0142owska St. 80, 01-809 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5461-273X","authenticated-orcid":false,"given":"Katarzyna","family":"Kosi\u0144ska-Kaczy\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Ceg\u0142owska St. 80, 01-809 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/S0140-6736(06)68074-4","article-title":"Controversies in ventricular remodelling","volume":"367","author":"Opie","year":"2006","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1111\/aogs.14466","article-title":"Current practice in the diagnosis and management of fetal growth restriction: An international survey","volume":"101","author":"Fantasia","year":"2022","journal-title":"Acta Obs. Gynecol. Scand."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/uog.18815","article-title":"Severe fetal growth restriction at 26\u201332 weeks: Key messages from the TRUFFLE study","volume":"50","author":"Bilardo","year":"2017","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0301-2115(03)00123-4","article-title":"Cardiac function monitoring of fetuses with growth restriction","volume":"110","author":"Figueras","year":"2003","journal-title":"Eur. J. Obs. Gynecol. Reprod. Biol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1111\/echo.14364","article-title":"Assessment of fetal modified myocardial performance index in early-onset and late-onset fetal growth restriction","volume":"36","author":"Zhang","year":"2019","journal-title":"Echocardiography"},{"key":"ref_6","first-page":"135","article-title":"New non-invasive index for combined systolic and diastolic ventricular function","volume":"26","author":"Tei","year":"1995","journal-title":"J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/0974-2069.177516","article-title":"Fetal left ventricular myocardial performance index: Defining normal values for Indian population and a review of literature","volume":"9","author":"Nair","year":"2016","journal-title":"Ann. Pediatr. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1002\/uog.3947","article-title":"Gestational-age-adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac function","volume":"29","author":"Kottman","year":"2007","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/uog.14930","article-title":"Fetal cardiac function in late-onset intrauterine growth restriction vs. small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler","volume":"46","author":"Fernandez","year":"2015","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_10","first-page":"170","article-title":"Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venous Doppler in fetuses with early-onset intrauterine growth restriction","volume":"38","author":"Figueras","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"195","DOI":"10.5603\/GP.a2020.0175","article-title":"Investigation of fetal cardiac function using tissue doppler imaging in fetuses compromised by growth restriction","volume":"92","author":"Palalioglu","year":"2021","journal-title":"Ginekol. Pol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1159\/000357592","article-title":"Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol","volume":"36","author":"Figueras","year":"2014","journal-title":"Fetal Diagn. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1515\/jpm-2019-0206","article-title":"Comparison of fetal cardiac functions between small-for-gestational age fetuses and late-onset growth-restricted fetuses","volume":"47","author":"Kaya","year":"2019","journal-title":"J. Perinat. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1159\/000333001","article-title":"Risk of perinatal death in early-onset intrauterine growth restriction according to gestational age and cardiovascular Doppler indices: A multicenter study","volume":"32","author":"Crispi","year":"2012","journal-title":"Fetal Diagn. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1002\/uog.7347","article-title":"Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses","volume":"34","author":"Crispi","year":"2009","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1002\/pd.4537","article-title":"Determination of the myocardial performance index in deteriorating grades of intrauterine growth restriction and its link to adverse outcomes","volume":"35","author":"Bhorat","year":"2015","journal-title":"Prenat. Diagn."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/uog.15884","article-title":"Consensus definition of fetal growth restriction: A Delphi procedure","volume":"48","author":"Gordijn","year":"2016","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_19","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)","volume":"21","author":"Friedman","year":"2003","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_20","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_21","doi-asserted-by":"crossref","first-page":"45.E1","DOI":"10.1016\/j.ajog.2010.02.044","article-title":"Usefulness of myocardial tissue Doppler vs. conventional echocardiography in the evaluation of cardiac dysfunction in early-onset intrauterine growth restriction","volume":"203","author":"Comas","year":"2010","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1159\/000535602","article-title":"Reference Ranges for Left Modified Myocardial Performance Index: Systematic Review and Meta-Analysis","volume":"51","author":"Bligard","year":"2024","journal-title":"Fetal Diagn. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"34","DOI":"10.14744\/AnatolJCardiol.2022.2577","article-title":"Modified Myocardial Performance Index in Fetal Growth Disturbances as Diagnostic and Prognostic Adjunct","volume":"27","year":"2023","journal-title":"Anatol. J. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6469\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:22:32Z","timestamp":1760113352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":23,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13216469"],"URL":"https:\/\/doi.org\/10.3390\/jcm13216469","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,28]]}}}