Assessment of fetal left ventricular modified myocardial performance index and its prognostic significance for adverse perinatal outcome in intrahepatic cholestasis of pregnancy

Özel, Ayşegül; Davutoğlu, Ebru Alıcı; Özdemir, Mucize Eriç; Öztunç, Funda; Madazli, Rıza

doi:10.1080/14767058.2018.1535588

Cited by 15 publications

(19 citation statements)

References 19 publications

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“…Another study found that the LMPI value increased as the severity of the disease increased, as shown in our study 16 . Ozel et al stated that there was no significant difference in LMPI values as the severity of the disease increased and that there was no significant correlation between LMPI and fasting bile acid, which contradicts to this study results 17 . In all these studies, including this study, overt fetal ventricular dysfunction was reported in ICP cases.…”

Section: Discussioncontrasting

confidence: 87%

“…Very few studies investigated the efficacy of LMPI in pregnancy and ICP and determined that the LMPI value increased, similar to this study findings 15 – 17 .…”

Section: Discussionsupporting

confidence: 86%

“…It has been stated that in fetal arrhythmias, ventricular filling occurs primarily due to atrial contraction and as a result the E/A ratio decreases, while in fetal tachycardias, the gap between E and A waves is shortened and therefore fusion occurs 18 . Ozel et al found that the E/A ratio increased in ICP cases 17 . However, Sanhal et al stated that the E/A ratio decreased significantly in ICP cases, the results similar to ours 16 .…”

Section: Discussionmentioning

confidence: 97%

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Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

Gök

Takmaz

Köse

et al. 2022

Rev. Assoc. Med. Bras.

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Section: Discussioncontrasting

confidence: 87%

“…Very few studies investigated the efficacy of LMPI in pregnancy and ICP and determined that the LMPI value increased, similar to this study findings 15 – 17 .…”

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

Gök

Takmaz

Köse

et al. 2022

Rev. Assoc. Med. Bras.

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“…[7][8][9][10] In women with both ursodeoxycholic acid (UDCA)-treated and untreated ICP, fetal left ventricular (LV) function is impaired, as evidenced by increased LV myocardial performance index, increased myocardial tissue velocities, reduced LV global strain rate and increased isovolumetric contraction and relaxation times via echocardiography, all of which are more pronounced in severe ICP. [11][12][13][14][15] In addition, concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I, markers used to diagnose heart failure and LV systolic dysfunction, are increased in fetal umbilical venous blood from ICP pregnancies. 15,16 There is echocardiography evidence of increased fetal PR interval length in both UDCA-treated and untreated ICP which is associated with disease severity.…”

Section: Introductionmentioning

confidence: 99%

Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations

Vasavan

Deepak

Jayawardane

et al. 2021

Journal of Hepatology

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Background & Aims: Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of stillbirth. This study aimed to assess the relationship between bile acid concentrations and fetal cardiac dysfunction in patients with ICP who were or were not treated with ursodeoxycholic acid (UDCA). Methods: Bile acid profiles and NT-proBNP, a marker of ventricular dysfunction, were assayed in umbilical venous serum from 15 controls and 76 ICP cases (36 untreated, 40 UDCAtreated). Fetal electrocardiogram traces were obtained from 43 controls and 48 ICP cases (26 untreated, 22 UDCA-treated). PR interval length and heart rate variability (HRV) parameters were measured in 2 behavioral states (quiet and active sleep). Results: In untreated ICP, fetal total serum bile acid (TSBA) concentrations (r = 0.49, p = 0.019), hydrophobicity index (r = 0.20, p = 0.039), glycocholate concentrations (r = 0.56, p = 0.007) and taurocholate concentrations (r = 0.44, p = 0.039) positively correlated with fetal NT-proBNP. Maternal TSBA (r = 0.40, p = 0.026) and alanine aminotransferase (r = 0.40, p = 0.046) also positively correlated with fetal NT-proBNP. There were no significant correlations between maternal or fetal serum bile acid concentrations and fetal HRV parameters or NT-proBNP concentrations in the UDCA-treated cohort. Fetal PR interval length positively correlated with maternal TSBA in untreated (r = 0.46, p = 0.027) and UDCA-treated ICP (r = 0.54, p = 0.026). Measures of HRV in active sleep and quiet sleep were significantly higher in untreated ICP cases than controls. HRV values in UDCA-treated cases did not differ from controls. Conclusions: Elevated fetal and maternal serum bile acid concentrations in untreated ICP are associated with an abnormal fetal cardiac phenotype characterized by increased NT-proBNP concentration, PR interval length and HRV. UDCA treatment partially attenuates this phenotype. Lay summary: The risk of stillbirth in intrahepatic cholestasis of pregnancy (ICP) is linked to the level of bile acids in the mother which are thought to disrupt the baby's heart rhythm. We found that babies of women with untreated ICP have abnormally functioning hearts compared to those without ICP, and the degree of abnormality is closely linked to the level of harmful bile acids in the mother and baby's blood. Babies of women with ICP who received treatment with the drug UDCA do not have the same level of abnormality in their hearts, suggesting that UDCA could be a beneficial treatment in some ICP cases, although further clinical trials are needed to confirm this.

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“…Unfortunately, clear evidence for the clinical benefit of UDCA in reducing serious pregnancy complications is not extensive. Most studies suggest the fetal stillbirth in patients with ICP is caused by the toxic influence of bile acids on fetal heart cells ( Williamson et al, 2001 ; Ozel et al, 2020 ). Therefore, according to some authors, UDCA treatment may reduce the impact of the abovementioned pathological and toxic mechanisms that are implicated in the etiology of stillbirth in ICP, such as fetal arrhythmia ( Miragoli et al, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Alpha-1 Antitrypsin Z Variant (AAT PI*Z) as a Risk Factor for Intrahepatic Cholestasis of Pregnancy

et al. 2021

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Background: Intrahepatic cholestasis of pregnancy (ICP; prevalence 0.2–15.6%) is the most common pregnancy-related liver disorder. It may have serious consequences for a pregnancy, including increased risk of preterm delivery, meconium staining of amniotic fluid, fetal bradycardia, distress, and fetal demise. In cases of high bile acids (>100μmol/L), patients have 10-fold increase in the risk of stillbirth. Biophysical methods of fetal monitoring, such as cardiotocography, ultrasonography, or Doppler have been proven unreliable for risk prediction in the course of intrahepatic cholestasis. Therefore, we believe extensive research for more specific, especially early, markers should be carried out. By analogy with cholestasis in children with inherited alpha-1 antitrypsin deficiency (AATD), we hypothesized the SERPINA1 Z pathogenic variant might be related to a higher risk of cholestasis in pregnancy. This study aimed to investigate the most common AATD variants (Z and S SERPINA1 alleles) in a group of cholestatic pregnant women.Results: The Z carrier frequency was calculated to be 6.8%, which is much higher compared to the general population [2.3%; the Chi-squared test with Yates correction is 6.8774 (p=0.008)].Conclusion: Increased prevalence of SERPINA1 PI*Z variant in a group of women with intrahepatic cholestasis may suggest a possible genetic origin of a higher risk of intrahepatic cholestasis in pregnancy.

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Assessment of fetal left ventricular modified myocardial performance index and its prognostic significance for adverse perinatal outcome in intrahepatic cholestasis of pregnancy

Cited by 15 publications

References 19 publications

Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations

Alpha-1 Antitrypsin Z Variant (AAT PI*Z) as a Risk Factor for Intrahepatic Cholestasis of Pregnancy

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