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Modified myocardial performance index for evaluation of fetal heart function and perinatal outcomes in intrahepatic pregnancy cholestasis

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Abstract

This study aims to evaluate cardiac function in cases of intrahepatic cholestasis of pregnancy (ICP) and compare results with those from healthy controls using the fetal left ventricular modified myocardial performance index (LMPI) and E-wave/A-wave peak velocities (E/A ratio). Moreover, the association between LMPI values, total bile acid (TBA) levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. A prospective cross-sectional study of 120 pregnant women was conducted, with 60 having ICP and the other 60 serving as controls. Doppler ultrasound and two-dimensional gray-scale fetal echocardiography were used to calculate the LMPI values and E/A ratios, respectively. The association between LMPI values and TBA levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. Fetal LMPI values were significantly higher in the ICP group than in the control group (0.54 ± 0.54 vs. 0.44 ± 0.03; p < 0.001), but the E/A ratio was similar in both groups (0.69 ± 0.10 vs. 0.66 ± 0.14; p = 0.203). TBA levels were positively and significantly correlated with LMPI values (r = 0.546, p < 0.01); however, no significant correlation was found between umbilical arterial pulsatility index values and LMPI values (r = 0.071, p > 0.01). LMPI values were not associated with adverse neonatal outcomes in ICP cases. Fetal cardiac function (LMPI) is associated with increased bile acid levels in ICP. However, because it was not associated with adverse neonatal outcomes in ICP cases, the clinical significance of this finding is unclear. Further studies are required to evaluate the implications of increased LMPI.

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Authors and Affiliations

  1. Department of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey

    Ibrahim Omeroglu, Hakan Golbasi & Atalay Ekin

  2. Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey

    Burak Bayraktar, Ceren Golbasi & Suna Yildirim Karaca

  3. Department of Obstetrics and Gynecology, Tinaztepe University Faculty of Health Sciences, Izmir, Turkey

    Ceren Golbasi

  4. Department of Pediatric Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey

    Tulay Demircan

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Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors. The study protocol was approved by the Local Institutional Ethics Committee (approval number: 2020/ 14-45).

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Omeroglu, I., Golbasi, H., Bayraktar, B. et al. Modified myocardial performance index for evaluation of fetal heart function and perinatal outcomes in intrahepatic pregnancy cholestasis. Int J Cardiovasc Imaging 39, 907–914 (2023). https://doi.org/10.1007/s10554-022-02789-4

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