Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses

Objectives To evaluate the predictive value for perinatal death of the myocardial performance index (MPI) and aortic isthmus flow index (IFI), as isolated parameters and in a combined model including currently used Doppler indices, in preterm growth restricted (IUGR) fetuses. Methods Umbilical artery, fetal middle cerebral artery (MCA) and ductus venosus (DV) pulsatility indices (PIs) were recorded, along with IFI and MPI, in a cohort of 97 preterm (delivered at between 24 and 34 weeks) IUGR fetuses. Logistic regression analysis was performed to identify those variables that were independently associated with perinatal mortality, and an algorithm to estimate probability of death was constructed including the best combination of parameters. Results With the exception of MCA, all Doppler indices were significantly associated with perinatal death as isolated parameters, but only DV-PI and MPI were found to be independent predictors on multivariate analysis. An algorithm combining D V atrial flow (positive or absent/reversed) and MPI (normal or above 95(th) percentile) had a better predictive accuracy than did any single parameter. The risk for death in IUGR fetuses below 28 weeks' gestation with present atrial flow in the D V and normal MPI was 18%, with either characteristic abnormal it was 70-73%, and with both abnormal it was 97%. The risk for death in IUGR fetuses above 28 weeks with present atrial flow in the DV and normal MPI was 0.1%, with either abnormal it was 6-7%, and with both abnormal it was 45%. Conclusions MPI is an independent predictor of perinatal death in preterm IUGR fetuses with accuracy similar to that of D V flow. A combination of D V flow with MPI may better stratify the estimated probability of death. IFI does not add to the prediction of perinatal death when used in combination with DV flow. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.