Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy?

J Matern Fetal Neonatal Med. 2017 Apr;30(8):911-916. doi: 10.1080/14767058.2016.1190824. Epub 2016 Jun 6.

Abstract

Objective: To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP).

Methods: Forty-one ICP cases were compared with 41 gestational age-matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods [ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)], which were employed in the calculation of mod-MPI [mod-MPI = (ICT + IRT)/ET]. The E/A ratio was calculated as well.

Results: Fetal left ventricular mod-MPI values were significantly higher in the ICP group compared to controls (0.56 ± 0.09 versus 0.37 ± 0.04, p < 0.001), whereas the E/A ratio was lower (0.62 ± 0.11 versus 0.69 ± 0.10, p = 0.011). The optimal cutoff level for mod-MPI in prediction of adverse perinatal outcomes was >0.48 [sensitivity: 81.8%, specificity: 67.6%, area under the curve (AUC): 0.750, 95% CI: 0.613-0.887, p = 0.008].

Conclusions: Fetuses of ICP cases have significant left ventricular dysfunction. Mod-MPI can be used in the prediction of adverse perinatal outcomes in ICP.

Keywords: Intrahepatic cholestasis of pregnancy; left ventricle; myocardial performance index.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cholestasis, Intrahepatic / diagnosis*
  • Cholestasis, Intrahepatic / epidemiology*
  • Echocardiography, Doppler
  • Female
  • Fetal Diseases / diagnosis*
  • Fetal Diseases / epidemiology*
  • Fetal Diseases / physiopathology
  • Fetal Heart / diagnostic imaging
  • Fetal Heart / physiopathology
  • Gestational Age
  • Health Status Indicators
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / epidemiology*
  • Pregnancy Outcome* / epidemiology
  • Prognosis
  • Ultrasonography, Prenatal
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / epidemiology*
  • Ventricular Dysfunction, Left / physiopathology
  • Young Adult

Supplementary concepts

  • Intrahepatic Cholestasis of Pregnancy