Ursodeoksikolik asit tedavisinin gebelik kolestazlı olgularda miyokardiyal performans indeksi üzerine etkisi

The impact of ursodeoxycholic acid treatment on myocardial performance index in the obstetric cholestasis cases

Özet

Amaç: Gebelik kolestaz› olgular›nda ani fetal kayb›n nedeni safra asitlerinin fetal kardiyak iletiyi bozmas› olarak öne sürülmektedir. Biz çal›flmam›zda ursodeoksikolik asit tedavisinin fetal kardiyak fonksiyonlar üzerine etkisini incelemeyi planland›k. Yöntem: Prospektif kohort çal›flmas› üçüncü basamak bir merkezde planland›. Çal›flmaya gebelik kolestaz› tan›s› alm›fl olgular dahil edildi. Fetal kardiyak fonksiyonlar ursodeoksikolik asit tedavisi öncesi ve sonras› de¤erlendirildi. Fetal miyokardiyal performans indeksi (MP‹), AV ileti zaman› (mekanik PR aral›¤›) ve E/A oranlar› incelendi. Bulgular: Ursodeoksikolik asit tedavisi sa¤ ve sol ventrikül miyokardiyal performans indeksinde düzelmeye neden olmaktad›r. Tedavi öncesi sa¤ ventrikül MPI 0.44±0.02 ms iken tedavi sonras› 0.43±0.01 ms olarak bulundu. Tedavi öncesi sol ventrikül MP‹ 0.45±0.02 ms iken tedavi sonras› 0.43±0.02 ms olarak bulundu. AV ileti zaman›n›n ursodeoksikolikasit tedavisi sonras› k›sald›¤›n› tespit edildi (116.4±4.1’e karfl› 112.2±4.1). E/A oranlar›, periferik ve santral Doppler dirençleri tedaviden etkilenmemektedir. Sonuç: Ursodeoksikolik asit tedavisi sonras› MP‹ düzelmektedir. Bu düzelmenin klinik olarak perinatal morbidite ve mortalite üzerine etkisi ancak daha fazla hasta ile prospektif çal›flmalar yap›larak gösterilebilir.

Abstract

Objective: It is asserted that the reason of sudden fetal death in obstetric cholestasis cases is the disruption of fetal cardiac conduction by bile acids. In our study, we aimed to investigate the impact of ursodeoxycholic acid treatment on fetal cardiac functions. Methods: The prospective cohort study was planned in a tertiary center. The cases diagnosed with obstetric cholestasis were included in the study. Fetal cardiac functions were assessed before and after ursodeoxycholic acid treatment. Fetal myocardial performance index (MPI), AV conduction time (mechanical PR interval), and E/A ratios were evaluated. Results: Ursodeoxycholic acid treatment provides an improvement in the myocardial performance index of right and left ventricles. While the MPI of right ventricle was 0.44±0.02 ms before the treatment, it was 0.43±0.01 ms after the treatment. These values were and 0.45±0.02 ms and 0.43±0.02 ms, respectively for the MPI of left ventricle. It was found that AV conduction time was shortened after ursodeoxycholic acid treatment (116.4±4.1 vs. 112.2±4.1). E/A ratios and peripheral and central Doppler resistance indices are affected by the treatment. Conclusion: The MPI improves after ursodeoxycholic acid treatment. The clinical impact of this improvement on perinatal morbidity and mortality can only be shown by conducting prospective studies with more cases.