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BioMed Research International
Volume 2015, Article ID 215910, 9 pages
Review Article

The Fetal Modified Myocardial Performance Index: Is Automation the Future?

1Faculty of Medicine, School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
2Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
3Women’s and Children’s Health, St George Hospital, Kogarah, NSW 2217, Australia
4Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia

Received 15 August 2014; Accepted 28 September 2014

Academic Editor: Marco Francone

Copyright © 2015 Priya Maheshwari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The fetal modified myocardial performance index (Mod-MPI) is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1) a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3) ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.