title: Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy?
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.
authors.affiliation: a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey.
authors.forename: Cem Yasar
authors.initials: CY
authors.lastname: Sanhal
authors.affiliation: a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kara
authors.affiliation: a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey.
authors.forename: Aykan
authors.initials: A
authors.lastname: Yucel
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis* / Q000453:epidemiology*; D015150:Echocardiography, Doppler; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D005865:Gestational Age; D006305:Health Status Indicators; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D016216:Ultrasonography, Prenatal; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult
keywords: Intrahepatic cholestasis of pregnancy; left ventricle; myocardial performance index