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Kohbodi GA, Cayabyab RG, Kibe RN, Ebrahimi M, Barton L, Uzunyan MY, Ramanathan R. Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants. Am J Perinatol 2024; 41:e3413-e3419. [PMID: 38266754 DOI: 10.1055/s-0044-1779254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics. STUDY DESIGN Case-control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants. RESULTS A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants. CONCLUSION Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants. KEY POINTS · VLBW infants exposed to severe PE have higher rate of Small for gestational age and smaller placentas.. · VLBW infants exposed to severe PE have higher systemic vascular resistance during transitional period and lower EF and fractional shortening.. · VLBW infants exposed to severe PE have higher pulmonary vascular resistance..
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Affiliation(s)
- GoleNaz A Kohbodi
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rowena G Cayabyab
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rutuja N Kibe
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Mahmoud Ebrahimi
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Lorayne Barton
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Merujan Y Uzunyan
- Division of Cardiology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
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Omeroglu I, Golbasi H, Bayraktar B, Golbasi C, Yildirim Karaca S, Demircan T, Ekin A. Modified myocardial performance index for evaluation of fetal heart function and perinatal outcomes in intrahepatic pregnancy cholestasis. Int J Cardiovasc Imaging 2023; 39:907-914. [PMID: 36607472 DOI: 10.1007/s10554-022-02789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
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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Affiliation(s)
- Ibrahim Omeroglu
- Department of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Hakan Golbasi
- Department of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ceren Golbasi
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey.,Department of Obstetrics and Gynecology, Tinaztepe University Faculty of Health Sciences, Izmir, Turkey
| | - Suna Yildirim Karaca
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tulay Demircan
- Department of Pediatric Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Department of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Cardiac Troponin T in Neonates from Normal and Gestational Diabetes Mellitus Pregnancy. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6171687. [PMID: 36303588 PMCID: PMC9596251 DOI: 10.1155/2022/6171687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
This study is aimed at testing the hypothesis that serum analysis of high-sensitivity troponin T in neonates may serve as a diagnostic tool to predict the risk of gestational diabetes mellitus (GDM). 86 newborns were studied and stratified into two groups: healthy group; newborns with body weight ≥ 10th percentile, born in good condition (APG 8-10pts) of pregnancy not complicated by diabetes, and the GDM group; neonates born to mothers with type 1 or type 2 diabetes. Results. The study revealed minimal troponin levels in GDM, and healthy groups equal to 0.02 ng/mL and 0.028 ng/mL, respectively. The GDM group is defined by an interquartile range of hs-TnT higher than the healthy group. This study confirms previously reported upper levels of troponin in healthy children. There are possible health problems that can appear during infancy and influence the further development of a child affected by GDM.
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Yu L, Zhou Q, Peng Q, Yang Z. Left ventricular function of patients with pregnancy-induced hypertension evaluated using velocity vector imaging echocardiography and N-terminal pro-brain natriuretic peptide. Echocardiography 2018; 35:459-466. [PMID: 29430691 DOI: 10.1111/echo.13817] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To investigate whether acute and transient pressure overload in patients with pregnancy-induced hypertension (PIH) affects left ventricular (LV) systolic function. METHODS From pregnancy to 3 months after delivery, 82 patients were analyzed: 27, 25, and 30 with gestational hypertension, preeclampsia, and the healthy control group, respectively. Conventional echocardiography and velocity vector imaging (VVI) were performed, and blood levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were analyzed. RESULTS Compared with the control group, patients with gestational hypertension had significantly lower mean LV peak global longitudinal strain. Importantly, during both pregnancy and after delivery, patients with preeclampsia had significantly lower global longitudinal, circumferential, and radial strain compared with the control group. The NT-pro-BNP levels were significantly higher in patients with PIH compared with normotensive pregnancies, and this situation continued for 3 months after delivery in women with preeclampsia. CONCLUSIONS In pregnancies complicated by pregnancy-induced hypertension, especially preeclampsia, the systolic function is impaired and NT-pro-BNP levels are elevated compared with normal pregnancy. Velocity vector imaging (VVI) is more sensitive than left ventricular ejection fraction to evaluate heart function in patients with PIH.
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Affiliation(s)
- Li Yu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qinghai Peng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zurong Yang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
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Mutlu K, Karadas U, Yozgat Y, Meşe T, Demirol M, Coban S, Karadeniz C, Özdemir R, Orbatu D, Karaarslan U, Tavli V. Echocardiographic evaluation of cardiac functions in newborns of mildly preeclamptic pregnant women within postnatal 24-48 hours. J OBSTET GYNAECOL 2017. [PMID: 28631496 DOI: 10.1080/01443615.2017.1322564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study is to detect preeclampsia-related cardiac dysfunction within 24-48 hours of delivery in newborns born from preeclamptic mothers. Forty newborns from mildly preeclamptic mothers formed the study group and the control group was formed by 40 healthy newborns. Cardiac function for the groups were evaluated using conventional echocardiography and myocardial performance index (MPI) within the first 24-48 hours of their lifetime and the results of both groups were compared. A significant difference between the groups was observed especially in the PW Doppler MPI measurements (the left ventricle MPI 0.37 ± 0.09 and 0.26 ± 0.11, p < .001; the right ventricle MPI 0.29 ± 0.08 and 0.26 ± 0.07, p < .035) for the control group and the study group. Elongation in the left and right ventricle MPI was detected to be more significant in terms of comparing systolic and diastolic functions to determine preeclampsia-related cardiac injury in newborns from preeclamptic mothers within the first 24-48 hours of their lifetime. Impact statement Today, the methods which may detect cardiac injury earlier than conventional echocardiographic methods are used for evaluating cardiac functions. Among them, myocardial performance index (MPI) measurement with PW Doppler is the most common ones. While studies are available in the literature evaluating foetal cardiac functions with MPI in foetuses of preeclamptic women, studies evaluating cardiac functions with MPI index within the first 24-48 hours in postnatal period are not available. This is the first study to detect cardiac injury by measuring cardiac functions of the newborns of preeclamptic babies using conventional echocardiography (EF, SF, mitral and tricuspid E/A) and myocardial performance index within the first 24-48 hours of life and compare these values with those of a control group composed of healthy newborns with similar demographic characteristics. According to the results of the study, elongation in right and left ventricle MPI was detected to be more significant compared to systolic and diastolic functions for determining preeclampsia-related cardiac injury in newborns of preeclamptic mothers within 24-48 hours of delivery. Ventricle functions of the newborns of preeclamptic mothers should also be evaluated with MPI measurement besides conventional echocardiographic measurements.
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Affiliation(s)
- Kadir Mutlu
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Ulas Karadas
- b MH Aegean Maternity , Teaching and Training Hospital , İzmir , Turkey
| | - Yilmaz Yozgat
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Timur Meşe
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Mustafa Demirol
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Senay Coban
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Cem Karadeniz
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Rahmi Özdemir
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Dilek Orbatu
- b MH Aegean Maternity , Teaching and Training Hospital , İzmir , Turkey
| | - Utku Karaarslan
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Vedide Tavli
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
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Bhorat IE, Bagratee JS, Reddy T. Assessment of fetal myocardial performance in severe early onset pre-eclampsia (EO-PET) with and without intrauterine growth restriction across deteriorating stages of placental vascular resistance and links to adverse outcomes. Eur J Obstet Gynecol Reprod Biol 2017; 210:325-333. [PMID: 28113071 DOI: 10.1016/j.ejogrb.2017.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/23/2016] [Accepted: 01/11/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether fetuses in severe early onset pre-eclampsia (EO-PET) with or without intrauterine growth restriction has cardiac dysfunction across deteriorating stages of placental vascular resistance and whether this dysfunction influences perinatal outcome. STUDY DESIGN This was a prospective cross-sectional study performed in a tertiary care university medical centre. Sixty pregnant patients with severe early-onset pre-eclampsia between 27 and 32 weeks were recruited and matched with 60 patients having normal pregnancies. An analysis of cardiac function using the myocardial performance index (MPI) and early ventricular filling (E) and late active atrial contraction (A) ratios (E/A ratios) in the study group was performed compared to controls and further analysis was performed based on worsening placental vascular resistance and presence of growth restriction. RESULTS MPI values were increased in the pre-eclamptic group, irrespective if growth restriction co-exists, compared to controls (0.61 vs 0.38, p<0.001). Its median value progressively increased with worsening placental vascular resistance. For adverse perinatal outcome cut-off MPI values have been suggested. The E/A ratios were significantly decreased in the pre-eclamptic group compared to controls (0.66 vs 0.79, p<0.0001). No adverse outcomes were noted in the control group. CONCLUSION Fetal cardiac function is significantly impaired in pregnancies complicated by severe early onset pre-eclampsia, irrespective if growth restriction co-exists and worsens with deteriorating grades of placental vascular resistance. The MPI can potentially be integrated into routine fetal surveillance techniques.
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Affiliation(s)
- I E Bhorat
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
| | - J S Bagratee
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - T Reddy
- Biostatistics Unit, Medical Research Council, Durban, South Africa
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Akil A, Api O, Oten Can E, Ozkan S, Ercan S, Orcun A, Unal O. Does preeclampsia have any adverse effect on fetal heart? J Matern Fetal Neonatal Med 2015; 29:2312-5. [PMID: 26381715 DOI: 10.3109/14767058.2015.1085013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether preeclampsia causes fetal cardiac cell damage by assessing umbilical artery NT-proBNP, cardiac troponin I and homocysteine. METHODS A cross-sectional study with 73 fetuses between 26 and 40 weeks of gestation was performed. Thirty-three healthy mothers' fetuses were control group (Group I). While 12 mildly pre-eclamptic mothers' fetuses constituted Group II, 28 fetuses of severe pre-eclamptic mothers were Group III. RESULTS Umbilical cord mean NT-proBNP levels of Group I, II and III are 520.8 ± 404.5 pg/ml; 664.2 ± 215.9 pg/ml; and 1932.8 ± 2979.5 pg/ml, respectively (p = 0.0001). The number of neonates with NT-proBNP > 500 pg/mL that indicates severe cardiac damage is higher in Group III (p = 0.001). The mean homocysteine levels are also statistically significantly higher in Group III. Cardiac troponin I levels are not different between the groups (p = 0.46). CONCLUSION Increased NT-proBNP and homocysteine might not only indicate some degree of in-utero cardiac cell damage but also feto-placental endothelial injury in the fetuses of severe pre-eclamptic mothers. Our finding that shows no evidence of correlation between cardiac troponin I levels with cell damage and endothelial injury requires further research.
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Affiliation(s)
- Aybala Akil
- a Department of Gynecology and Obstetrics , Acibadem Bodrum Hospital , Mugla , Turkey
| | - Olus Api
- b Faculty of Medicine, Department of Gynecology and Obstetrics , Yeditepe University , Istanbul , Turkey
| | - Esra Oten Can
- c Department of Gynecology and Obstetrics , Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey
| | - Sadullah Ozkan
- d Department of Gynecology and Obstetrics , Cekerek State Hospital , Yozgat , Turkey
| | - Serif Ercan
- e Department of Biochemistry , Luleburgaz State Hospital , Kirklareli , Turkey
| | - Asuman Orcun
- f Department of Biochemistry , Kartal Dr Lutfi Kirdar Education and Research Hospital , Istanbul , Turkey , and
| | - Orhan Unal
- g Faculty of Medicine, Department of Gynecology and Obstetrics , Sakarya University , Sakarya , Turkey
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Bhorat I, Bagratee J, Reddy T. Gestational age-adjusted trends and reference intervals of the Modified Myocardial Performance Index (Mod-MPI) and its components, with its interpretation in the context of established cardiac physiological principles. Prenat Diagn 2014; 34:1031-6. [DOI: 10.1002/pd.4414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Ismail Bhorat
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R. Mandela School of Medicine; University of KwaZulu Natal; Durban South Africa
| | - Jayanthilall Bagratee
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, Nelson R. Mandela School of Medicine; University of KwaZulu Natal; Durban South Africa
| | - Tarylee Reddy
- Biostatistics Unit, Medical Research Council; Durban South Africa
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Balli S, Kibar AE, Ece I, Oflaz MB, Yilmaz O. Assessment of fetal cardiac function in mild preeclampsia. Pediatr Cardiol 2013; 34:1674-9. [PMID: 23591803 DOI: 10.1007/s00246-013-0702-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/02/2013] [Indexed: 11/26/2022]
Abstract
This study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.
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Affiliation(s)
- Sevket Balli
- Department of Pediatric Cardiology, Balıkesir Atatürk Hospital, Yıldız Mahallesi, Soma Caddesi, Balıkesir, Turkey,
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Hızlı D, Altınbaş SK, Köşüş N, Köşüş A, Ayyıldız A, Gelişen O, Kafalı H. Is meconium stained amniotic fluid related to occult myocardial injury in term low risk pregnancies? Early Hum Dev 2013; 89:191-4. [PMID: 23103026 DOI: 10.1016/j.earlhumdev.2012.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 10/03/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022]
Abstract
AIM The present study aimed to compare Troponin T (Tp T) levels of infants born with meconium stained amniotic fluid (MSAF) to those with clear amniotic fluid. STUDY DESIGN Case-control study SUBJECTS Thirty-five women who had delivery complicated by MSAF between 37 and 41weeks of gestation were defined as the study group and women with healthy uncomplicated pregnancies with clear amniotic fluid who were matched for age, parity, and gestational age were defined as the control group. OUTCOME MEASURES Cord blood Tp T level, gas analysis and neonatal outcomes were compared between groups. RESULTS Tp T levels of the study and control groups were 0.026±0.013ng/ml and 0.031±0.016ng/ml, respectively. The difference was not statistically significant (p=0.132). On the other hand, the study group had a statistically lower HCO(3) level (21.80 vs 23.60mmol/l ) and higher rate of base deficit (4.85 vs 3.25mmol/l) than the control group. CONCLUSION The presence of meconium during labor is not related to occult myocardial injury in low-risk term pregnancies.
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Affiliation(s)
- Deniz Hızlı
- Department of Obstetrics & Gynecology, Fatih University, Faculty of Medicine, Ankara, Turkey.
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Cetin I, Kantar A, Unal S, Cakar N. The assessment of time-dependent myocardial changes in infants with perinatal hypoxia. J Matern Fetal Neonatal Med 2012; 25:1564-8. [PMID: 22122298 DOI: 10.3109/14767058.2011.644365] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to assess myocardial damage in infants due to perinatal hypoxia. METHODS The findings of 29 infants with perinatal hypoxia and 20 healthy infants were compared. Blood gas analysis, serum lactate, cardiac troponin I (cTnI), troponin T (cTnT), creatine kinase-MB (CK-MB) and B-type natriuretic peptide (BNP) were evaluated. Echocardiography together with tissue Doppler imaging was performed. RESULTS cTnT, CK-MB and BNP were higher in patients at the first day. There were positive correlations between the left ventricular (LV) myocardial performance index (MPI) and cTnT at first day and also at first month. LV ejection fraction and fractional shortening were lower at first day and at first month in patients. Myocardial systolic (Sm) and diastolic (Em and Am) velocities at all segments were lower at first day, and interventricular septum Sm, LV Sm, LV Em, right ventricular Em and LV Am were still lower at first month in patients. Isovolumic relaxation time at all segments together with LV MPI was higher at first day, ejection time values were lower and MPI values were higher at all segments at first month in patients. CONCLUSIONS These findings demonstrated that the signs of myocardial damage due to perinatal hypoxia still present at first month.
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Affiliation(s)
- Ilker Cetin
- Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
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12
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[Cardiac troponin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury]. VOJNOSANIT PREGL 2009; 66:881-6. [PMID: 20017418 DOI: 10.2298/vsp0911881s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Myocardial cell lesion in newborns may be clinically occult. In recent years there has been shown growing interest in the use of cardiac troponin-I (cTnI) in relation to perinatal asphyxia and hypoxic myocardial lesion. The aim of this study was to determine a relationship between high cTnI levels and outcome in critically ill newborns with perinatal asphyxia. METHODS In this study 78 patients were divided into three groups. The group I included 39 newborns (15 term and 24 preterm) with perinatal asphyxia, with no deaths, only full or partial (with some neurological sequels) recovery. The group II included 10 newborns (6 preterm and 4 term), with perinatal asphyxia who died, with critical cardio-respiratory problems and multiorgan dysfunction. The group III included 29 healthy term newborns. A level of cTnI in all three groups was measured within 24-48 hours after delivery. RESULTS A statistically significant higher value of cTnI (0.082 microg/l +/- 0.166) was found in group I than in the group III (healthy newborns). In the group I, 21/39 newborns required respiratory and 16/39 required pressure support. In the group II, the largest average value of cTnI of 0.425 +/- 0.307 was found. All of the newborns in the group II required respiratory and pressure support. In the group III the lowest average value of cTnI (0.0186 microg/L +/- 0.0286) was found. CONCLUSIONS High cTnI levels could be used as markers of perinatal asphyxia and even as predictors of future outcomes and/or mortality.
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Api O, Emeksiz MB, Api M, Ugurel V, Unal O. Modified myocardial performance index for evaluation of fetal cardiac function in pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:51-57. [PMID: 19086000 DOI: 10.1002/uog.6272] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To assess cardiac function by means of the modified myocardial performance index (Mod-MPI) in fetuses of pre-eclamptic mothers without intrauterine growth restriction and to compare this with values from normal controls. METHODS A cross-sectional study was conducted including a total of 72 fetuses at between 26 and 40 weeks' gestation. Forty fetuses of healthy mothers were assigned as the control group (Group I) while 15 fetuses of mildly pre-eclamptic mothers constituted Group II and 17 fetuses of severely pre-eclamptic mothers constituted Group III. Two-dimensional gray-scale and Doppler fetal echocardiography was used to exclude cardiac anomalies and calculate the Mod-MPI. RESULTS The mean+/-SD Mod-MPI values of Groups I, II and III were 0.43+/-0.045, 0.44+/-0.064 and 0.44+/-0.064, respectively (P=0.680). The mean aortic peak systolic velocity (PSV), the mean mitral valve early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities were significantly lower in fetuses of severely pre-eclamptic mothers than in fetuses of mildly pre-eclamptic mothers and control fetuses. CONCLUSION The fetal global myocardial function assessed by Mod-MPI does not seem to change in mild or severe pre-eclampsia. The lower mitral E-wave and A-wave peak velocities and the lower aortic PSV seem to reflect the increased cardiac afterload against which the fetal heart has to work, rather than systolic or diastolic cardiac dysfunction, in the fetuses of severely pre-eclamptic mothers.
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Affiliation(s)
- O Api
- Department of Obstetrics & Gynecology, Dr Lutfi Kirdar Kartal Teaching and Research Hospital Istanbul, Turkey.
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Ausset S, Benhamou D. Troponin I levels in preeclampsia. Am J Med 2008; 121:e7; author reply e9. [PMID: 18456022 DOI: 10.1016/j.amjmed.2007.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 10/31/2007] [Accepted: 10/31/2007] [Indexed: 11/16/2022]
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Abstract
Cardiac troponins have a major role in screening and diagnosis of myocardial ischaemia in adults and children. Their introduction has redefined the diagnosis of myocardial infarction in adults and provided valuable prognostic information. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication, and can be used as predictors of subsequent cardiac recovery and mortality. This review discusses the current established reference values in term and preterm infants and demonstrates their potential use in neonatology. They may serve as a useful adjunct in the assessment of the magnitude of myocardial injury in respiratory distress syndrome and asphyxia. They may also benefit centres without on-site echocardiography with some evidence showing good correlation with echo-derived markers of myocardial function. The use of troponins in the neonatal unit remains a research tool. More work is needed to explore their prognostic role and monitoring response to treatment following cardioprotective strategies. In preterm infants the effect of inotropes on myocardial function needs further study and troponin may form an integral part of this research.
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Affiliation(s)
- Afif F El-Khuffash
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland.
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Yang X, Wang H, Wang Z, Dong M. Alteration and significance of serum cardiac troponin I and cystatin C in preeclampsia. Clin Chim Acta 2006; 374:168-9. [PMID: 16914129 DOI: 10.1016/j.cca.2006.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Revised: 07/10/2006] [Accepted: 07/10/2006] [Indexed: 11/25/2022]
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17
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Gaze DC, Collinson PO. Interpretation of cardiac troponin measurements in neonates--the devil is in the details. Commentary to trevisanuto et Al.: cardiac troponin I in asphyxiated neonates (biol neonate 2006;89:190-193). Neonatology 2005; 89:194-6. [PMID: 16276078 DOI: 10.1159/000089549] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David C Gaze
- Chemical Pathology, St. George's Healthcare NHS Trust, London, UK.
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18
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Atalay C, Erden G, Turhan T, Yildiran G, Saraçoglu OF, Koca Y. The effect of magnesium sulfate treatment on serum cardiac troponin I levels in preeclamptic women. Acta Obstet Gynecol Scand 2005; 84:617-21. [PMID: 15954868 DOI: 10.1111/j.0001-6349.2005.00667.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To investigate serum cardiac troponin I levels before and after magnesium sulfate treatment in preeclamptic pregnant women. MATERIALS AND METHODS Fifty-five pregnant women were included in the prospectively planned study. Study group patients (n = 25) were pregnant women hospitalized with a preeclampsia diagnosis while the control group (n = 30) were pregnant women with no medical or obstetric problem who had been attending the antenatal clinic. Serum cardiac troponin I levels were compared in the normal pregnant women and in preeclamptic pregnant women. These levels were also compared in the preeclamptic women before and after magnesium sulfate treatment. Mann-Whitney U-test was used for statistical analysis. RESULTS Groups were similar with respect to age, gravity, parity, and gestational age. The median serum cardiac troponin I levels in preeclamptic patients was 0.20 ng/ml (0.02-4.53) before treatment and 0.09 ng/ml (0.02-3.91) after treatment, while it was 0.02 ng/ml (0.0-0.05) in the control group. The serum cardiac troponin I level in the preeclamptic group was significantly high (P < 0.01), and pretreatment values in this group were significantly higher compared with post-treatment values (P < 0.01) CONCLUSION Cardiac troponin I is a sensitive parameter for indicating minor myocardial damage which may occur in preeclampsia and for evaluating the efficiency of magnesium sulfate treatment.
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Affiliation(s)
- Cemal Atalay
- Gynecology and Obstetric Department of Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Baum H, Hinze A, Bartels P, Neumeier D. Reference values for cardiac troponins T and I in healthy neonates. Clin Biochem 2005; 37:1079-82. [PMID: 15589813 DOI: 10.1016/j.clinbiochem.2004.08.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Revised: 08/09/2004] [Accepted: 08/16/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cardiac troponins T (cTnT) and I (cTnI) are the most sensitive biochemical parameters in the detection of myocardial damage. In neonates, in utero exposure to tocolytic therapy results in detectable values of cardiac troponins after delivery. Additionally, some preliminary results suggest that the upper reference limits for healthy newborns are higher than those for adults but definitive reference limits for newborns are not available. Our objective was to determine those limits. DESIGN AND METHODS In this study we investigated the distribution of cTnT and cTnI in cord blood of 869 healthy newborns. cTnT was determined with the 3rd generation assay and cTnI with the Dade Behring assay on a Dimension RxL. For data analysis Student's t test and the Mann-Whitney U test were used. RESULTS Using the 99th percentile, the upper reference limit in healthy termed newborns was 0.097 microg/l for cTnT and 0.183 microg/l for cTnI. Compared to the adult values, the newborn upper limit was tripled for cTnT and doubled for cTnI. Statistically significant differences were found between males and females for cTnT and between natural childbirth and caesarean section for cTnI. CONCLUSION Healthy-termed newborns have a higher upper reference limit for both cTnT and cTnI compared to adults. This circumstance must be taken into account when interpreting slightly "elevated" cTnT and cTnI values in newborns.
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Affiliation(s)
- Hannsjörg Baum
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, Technische Universität München und, Germany.
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Türker G, Sarper N, Babaoğlu K, Gökalp AS, Duman C, Arisoy AE. Early prognostic significance of umbilical cord troponin I in critically ill newborns. Prospective study with a control group. J Perinat Med 2005; 33:54-9. [PMID: 15841615 DOI: 10.1515/jpm.2005.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To determine the value of cord blood cardiac troponin I levels (cTnl) as an early prognostic factor in critically ill newborns, and to compare cord cTnl levels with the prognostic value of the score for neonatal acute physiology (SNAP). METHODS Cord arterial samples were collected routinely for blood gas analysis, and cord venous samples for cTnl and cardiac-specific creatine kinase assay. The study group (n=109) comprised critically ill newborns who required mechanical ventilation. The control group (n = 96) comprised newborns who were either completely healthy (n = 48) or were followed in a level I neonatal care unit due to moderate-severity problems. RESULTS The critically ill newborns had significantly higher cTnl levels than control babies (median [min-max] 1.4 [0-13] vs. 0 [0-1.8] ng/mL, respectively; P<0.001). In critically ill newborns, non-survivors had significantly higher cTnl levels than survivors (median [min-max] 6.6 [1.3-13.0] vs. 1.3 [0-8.0] ng/mL, respectively; P<0.001). Receiver-operator curve analysis revealed that, compared with SNAP, cTnl was a more sensitive predictor of mortality in critically ill newborns (area under curve=0.96; 95% CI=0.90-1.02). CONCLUSION Significantly elevated cord cTnl may be a valuable predictor of mortality in critically ill newborns.
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Affiliation(s)
- Gülcan Türker
- Department of Pediatrics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Szymankiewicz M, Matuszczak-Wleklak M, Hodgman JE, Gadzinowski J. Usefulness of cardiac troponin T and echocardiography in the diagnosis of hypoxic myocardial injury of full-term neonates. Neonatology 2005; 88:19-23. [PMID: 15731551 DOI: 10.1159/000084067] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 11/23/2004] [Indexed: 12/19/2022]
Abstract
BACKGROUND Perinatal asphyxia constitutes a significant problem influencing neonatal mortality and morbidity. OBJECTIVES The aim of the present work was to provide evidence of the usefulness of cardiac troponin T (cTnT) and echocardiographic investigations in the diagnosis of heart damage in full-term infants after intrauterine hypoxia. MATERIAL AND METHODS The subjects were 39 asphyxiated and 44 term infants without fetal anoxia. Quantitative determinations of cTnT were performed between 12 and 24 h of life. Two-dimensional Doppler and color Doppler studies were performed at the bedside. We evaluated fractional shortening (FS), cardiac output (CO), cardiac index (CI), tricuspid (TI) and mitral (MI) insufficiency. RESULTS Asphyxiated infants presented increased cTnT (mean 0.141+/-0.226 vs. 0.087+/-0.111 ng/ml; p<0.01) and TI (38.5 vs. 11.4% of population; p<0.05) compared to healthy infants. CO, CI and FS remained in the same range. CONCLUSIONS We found cTnT to be the most useful among accessible diagnostic tools used in post-hypoxic heart damage in neonates. The data from our relatively small population study suggest a cTnT value of >0.1 ng/ml as a reliable marker of myocardial injury in neonates. Further study should be performed to generate a receiver-operator characteristic curve to discover what the cut-off level should be.
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Affiliation(s)
- Marta Szymankiewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
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Clark SJ, Newland P, Yoxall CW, Subhedar NV. Concentrations of cardiac troponin T in neonates with and without respiratory distress. Arch Dis Child Fetal Neonatal Ed 2004; 89:F348-52. [PMID: 15210673 PMCID: PMC1721706 DOI: 10.1136/adc.2002.025478] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To establish a practical postnatal reference range for cardiac troponin T in neonates and to investigate concentrations in neonates with respiratory distress. METHODS Prospective investigation in a tertiary neonatal unit, recruiting infants with and without respiratory distress (sick and healthy infants respectively). Concentrations of cardiac troponin T were compared between sick and healthy infants, accounting for confounding variables. RESULTS A total of 162 neonates (113 healthy and 49 sick infants) had samples taken. The median (interquartile range) cardiac troponin T concentration in the healthy infants was 0.025 (0.01-0.062) ng/ml, and the 95th centile was 0.153 ng/ml. There were no significant relations between cardiac troponin T and various variables. The median (interquartile range) cardiac troponin T concentration in the sick infants was 0.159 (0.075-0.308) ng/ml. This was significantly higher (p < 0.0001) than in the healthy infants. In a linear regression model, the use of inotropes and oxygen requirement were significant associations independent of other basic and clinical variables in explaining the variation in cardiac troponin T concentrations. CONCLUSIONS Cardiac troponin T is detectable in the blood of many healthy neonates, but no relation with important basic and clinical variables was found. Sick infants have significantly higher concentrations than healthy infants. The variations in cardiac troponin T concentration were significantly associated with oxygen requirement or the use of inotropic support in a regression model. Cardiac troponin T may be a useful marker of neonatal and cardiorespiratory morbidity.
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Affiliation(s)
- S J Clark
- Tree Root Walk, Sheffield S10 2SF, UK.
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