Assessing the development of fetal myocardial function by a novel Doppler myocardial performance index

Doppler-derived myocardial performance index are used to assess aspects of systolic and diastolic function in adult as well as fetal heart. The Tei Index (TI) is a useful and non-invasive tool. The aim of this study was to determine normal values of fetal left ventricular (LV) TI in early (16-32 weeks) and late trimester (35-41 weeks) fetuses and to develop a new myocardial performance index (K-index; KI) which focuses on fetal diastolic interval when oxygenated blood from the placenta filled in the LV. Simultaneous recordings of Doppler Ultrasound Signal (DUS) of the LV outflow tracts and fetal electrocardiogram signals were obtained in 55 early- and late-trimester fetuses. The LV isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ventricular ejection time (VET) and ventricular filling time (VFT) were measured from amplitudes and peaks of high frequency component of DUS signals by an automated model. The TI and the new index were calculated by using the formula (ICT + IRT)/VET and (ICT + IRT)/VFT respectively. The TI did not show any significant change from early-to late trimester fetuses (0.74± 0.057 vs 0.75±0.07; NS). On the other hand, KI showed significant decline in values (1.00±0.24 vs 0.87±0.23; p<0.05) during this development period. The correlation of KI with gestational ages was found to be negative and significant (r=-0.35; p=0.007). No significant correlation of gestational ages with TI was found. Both TI and KI can be easily obtained in the fetus from DUS recording without the need for precise anatomic imaging. In conclusion, KI may be a useful tool to explore the healthy development of fetal myocardial function. More research is needed to check if KI could recognize the compromised fetuses from normal ones in future.