ORCID

0000-0002-2752-4061 (Horgan), 0000-0003-0658-138X (Kalafat), 0000-0001-7925-5302 (Saade)

Document Type

Article

Publication Date

2025

DOI

10.1002/uog.70110

Publication Title

Ultrasound in Obstetrics & Gynecology

Volume

66

Issue

6

Pages

781-785

Abstract

Objective

Although spectral tissue Doppler imaging is recognized as the optimal method for assessing the fetal myocardial performance index (MPI), longitudinal reference ranges for fetal MPI measured using spectral tissue Doppler have not been established. Our objective was to use spectral tissue Doppler data to establish gestational-age-specific reference ranges from 12–33 weeks for left and right ventricular fetal MPI.

Methods

This was a prospective longitudinal study of women aged 18–35 years, with a body mass index below 30 kg/m² and a singleton pregnancy conceived spontaneously. Fetal MPI measurements were obtained in the first, second and third trimesters and MPI was determined using spectral tissue Doppler imaging. A generalized additive model for location, scale and shape (GAMLSS) was used to explore the relationship between fetal MPI and gestational age. Model fit was assessed by checking the normality of estimated Z-scores across the fitted range and independency from gestational age.

Results

Median fetal MPI was determined for the right and left ventricles at 12–13 weeks, 20–21 weeks and 32–33 weeks' gestation in 90 fetuses. Using multilevel regression modeling, weekly reference ranges for each gestational age were created to provide a continuous characterization of normal fetal MPI assessed using spectral tissue Doppler throughout pregnancy. Percentile reference ranges (5th, 10th, 25th, 50th, 75th, 90th and 95th) for right and left ventricular fetal MPI were generated from these models, capturing normal variability across gestation.

Conclusion

We have established gestational-age-specific reference ranges for left and right ventricular fetal MPI using spectral tissue Doppler imaging, thus providing clinicians with an important tool for the early detection of fetal cardiac dysfunction in high-risk pregnancies.

Rights

© 2025 The Authors.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Data Availability

Article states: "The data that support the findings of this study are available from the corresponding author upon reasonable request."

Original Publication Citation

Horgan, R., Sinkovskaya, E., Kalafat, E., Saade, G., & Abuhamad, A. (2025). Longitudinal assessment of fetal myocardial performance index in normal pregnancy using spectral tissue Doppler. Ultrasound in Obstetrics & Gynecology, 66(6), 781-785. https://doi.org/10.1002/uog.70110

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