Prospective Evaluation of Automated Right and Left Ventricular Myocardial Performance Index in Late‐Onset Fetal Growth Restriction

OBJECTIVES: To evaluate automated right- and left-ventricular myocardial performance index (Mod-MPI) using the Samsung Hera W10 (MPI+™) system in fetuses with late-onset fetal growth restriction (FGR) and to explore its association with Doppler parameters and perinatal outcomes. METHODS: This prospective study included 177 singleton pregnancies between 32 and 39 weeks of gestation-87 with late-onset FGR and 90 gestational-age-matched controls. Fetal echocardiography and Doppler examinations were performed using the Samsung Hera W10 system with integrated MPI+™ software. Automated right and left Mod-MPI, atrioventricular valve E/A ratios, and Doppler indices were recorded. Neonatal outcomes were analyzed in relation to MPI measurements. RESULTS: Right-ventricular MPI and isovolumic contraction time (ICT) were significantly increased in FGR fetuses compared with controls (p = .001), whereas left-ventricular MPI showed no significant difference. Umbilical artery PI and RI were higher, and CPR and umbilical peak systolic velocity were lower in FGR. Right-sided MPI correlated negatively with gestational age, birth weight, and Apgar scores. CONCLUSION: Automated right-ventricular Mod-MPI provides a reproducible, objective indicator of early cardiac dysfunction in late-onset FGR. Elevation of right-sided MPI and prolongation of contraction time may reflect early myocardial adaptation preceding classical Doppler deterioration.