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

Gök, Koray; Takmaz, Taha; Köse, Osman; Kapudere, Bilge; Tüten, Nevin; Bostancı, Mehmet Sühha; Özden, Selçuk

doi:10.1590/1806-9282.20220008

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (7) • July 2022 • https://doi.org/10.1590/1806-9282.20220008 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to evaluate the effectiveness of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes for intrahepatic cholestasis of pregnancy.

METHODS:

A cross-sectional study was conducted, including 51 women with intrahepatic cholestasis of pregnancy and 80 healthy controls. Using Doppler ultrasonography, E-wave, A-wave, isovolumetric contraction time, isovolumetric relaxation time, and ejection time were recorded and the left ventricular modified myocardial performance index was measured.

RESULTS:

Findings showed that the mean left ventricular modified myocardial performance index, isovolumetric contraction time, and isovolumetric relaxation time values were statistically significantly higher while the ejection time and E/A ratios were statistically significantly lower in the intrahepatic cholestasis of pregnancy group than the control group. In the intrahepatic cholestasis of pregnancy group, a statistically significant positive correlation was found between left ventricular modified myocardial performance index and adverse perinatal outcomes in the intrahepatic cholestasis of pregnancy group (r=0.478, p<0.001), while a statistically significant negative correlation was found between the E/A ratio and adverse perinatal outcomes (r=-0.701, p<0.001).

CONCLUSIONS:

For intrahepatic cholestasis of pregnancy cases, high fetal left ventricular modified myocardial performance index values were an indicator of ventricular dysfunction, and this correlated with negative perinatal outcomes.

KEYWORDS:
Fetal heart; Intrahepatic cholestasis of pregnancy; Myocardial performance index; Perinatal outcome

	ICP group (n=51)	Control group (n=80)	p-value
Maternal age (years)	30 (21–39)	30.5 (20–39)	0.226
Gravida (n)	2 (1–5)	4 (1–7)	0.000
Parity (n)	1 (0–4)	2 (0–4)	0.000
Body mass index (kg/m²)	26.6 (21.2–29.4)	25.8 (22.4–29.1)	0.184
Gestational age at time of study (weeks)	33.9 ± 1.4	34.1 ± 1.3	0.594
Gestational age at birth (weeks)	37.1 (30.4–38.7)	39 (35.2–39.8)	0.000
Birth weight (g)	2913 ± 460	3270 ± 370	0.000
Aspartate aminotransferase (units/L)	56 (17–362)	16.5 (8–27)	0.000
Alanine aminotransferase (units/L)	95 (17–506)	10 (4–19)	0.000
Adverse perinatal outcome	16 (31.4)	3 (3.8)	0.000
Non-reassuring fetal heart rate tracing	8 (15.7)	0 (0)	0.000
Cord pH <7.20	1 (2)	0 (0)	0.210
Meconium strained-amniotic fluid	1 (2)	1 (1.3)	0.747
Neonatal intensive care unit admission	8 (15.7)	2 (2.5)	0.006
Left myocardial performance index	0.49 (0.44–0.56)	0.37 (0.36–0.38)	0.000
isovolumetric contraction time (ms)	34.8 ± 2.8	29.6 ± 1.3	0.000
ejection time (ms)	162.5 ± 4.9	170.5 ± 4.3	0.000
isovolumetric relaxation time (ms)	45.2 (41.8–52.6)	33.9 (31.4–35.8)	0.000
E-wave/A-wave peak velocity ratio	0.62 (0.56–0.75)	0.69 (0.62–0.76)	0.000
Umbilical artery pulsatility index	0.84 (0.74–0.96)	0.86 (0.75–0.94)	0.170
Middle cerebral artery pulsatility index	1.77 (1.61–1.93)	1.73 (1.6–1.93)	0.076
Uterine artery pulsatility index	0.8 (0.67–0.96)	0.77 (0.62–0.97)	0.0146

	Control group (n=80)	Mild Intrahepatic cholestasis of pregnancy (n=40)	Severe Intrahepatic cholestasis of pregnancy (n=11)	p-value
LMPI	0.37 (0.36–0.38)	0.48 (0.44–0.56)	0.52 (0.49–0.56)	0.000
E/A	0.69 (0.62–0.76)	0.64 (0.56–0.75)	0.60 (0.58–0.62)	0.000

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[1] *Corresponding author: drkorayctf@hotmail.com