Evaluation of fetal ventricular systolic function in women with intrahepatic cholestasis of pregnancy by quantitative fetal heart analysis

Wang Wan; Tang Xiaoqin; Wang Qi; Qiu Xia; Li Rui

doi:10.13406/j.cnki.cyxb.003377

您当前的位置：

首页 >

文章列表页 >

Evaluation of fetal ventricular systolic function in women with intrahepatic cholestasis of pregnancy by quantitative fetal heart analysis

Clinical research | 更新时间：2025-12-29

- Evaluation of fetal ventricular systolic function in women with intrahepatic cholestasis of pregnancy by quantitative fetal heart analysis
- Journal of Chongqing Medical University Vol. 49, Issue 1, Pages: 85-90(2024)
- 作者机构：
  
  川北医学院附属医院妇产科，南充 637000
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003377
  CLC： R714.255
- Received：15 May 2023，
  
  Revised：2023-09-11，
  
  Accepted：01 November 2023，
  
  Published：28 January 2024
- 稿件说明：
移动端阅览
王婉,唐小琴,王琦,等.胎儿心脏定量分析技术评价妊娠期肝内胆汁淤积症孕妇胎儿心室收缩功能[J].重庆医科大学学报,2024,49(1):85-90.

Wang Wan,Tang Xiaoqin,Wang Qi,et al.Evaluation of fetal ventricular systolic function in women with intrahepatic cholestasis of pregnancy by quantitative fetal heart analysis[J].Journal of Chongqing Medical University,2024,49(1):85-90.
王婉,唐小琴,王琦,等.胎儿心脏定量分析技术评价妊娠期肝内胆汁淤积症孕妇胎儿心室收缩功能[J].重庆医科大学学报,2024,49(1):85-90. DOI： 10.13406/j.cnki.cyxb.003377.

Wang Wan,Tang Xiaoqin,Wang Qi,et al.Evaluation of fetal ventricular systolic function in women with intrahepatic cholestasis of pregnancy by quantitative fetal heart analysis[J].Journal of Chongqing Medical University,2024,49(1):85-90. DOI： 10.13406/j.cnki.cyxb.003377.

摘要

目的

探讨妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）对胎儿心室收缩功能的影响，为临床早期发现ICP胎儿心功能异常提供依据。

方法

选取2022年7月至2023年4月于川北医学院附属医院就诊孕妇67例，孕周27~40周，其中ICP孕妇29例（ICP组），正常孕妇38例（对照组）。应用胎儿心脏定量分析（fetal heart quantification，Fetal HQ）软件测量胎儿心室收缩功能，包括纵向收缩功能：左、右心室整体纵向应变（global strain，GLS）、间隔壁应变（sept wall strain，SWS）、侧壁应变（free wall strain，FWS）；横向收缩功能：左、右心室24节段短轴缩短率（fractional shortening，FS）；整体收缩功能：左、右心室面积变化分数（fetal area change，FAC）、左心室射血分数（ejection fraction，EF）。

结果

ICP组纵向收缩功能指标左、右心室GLS、SWS、FWS均低于对照组，差异有统计学意义（

0.05）；两组间横向收缩功能指标左、右心室24节段FS比较，差异均无统计学意义（

0.05）；ICP组整体收缩功能指标左、右心室FAC均低于对照组，差异有统计学意义（

0.05），而两组间左心室EF比较，差异无统计学意义（

0.05）。

结论

在宫内高胆汁酸环境下，ICP胎儿心脏左、右心室整体及纵向收缩功能明显受损，横向收缩功能未见明显改变；并且与传统心脏功能评价指标左心室EF相比，FAC可以更加敏感地反映胎儿心脏整体功能的改变。

Abstract

Objective

To investigate the influence of intrahepatic cholestasis of pregnancy（ICP） on fetal ventricular systolic function，and to provide a basis for the early identification of fetal cardiac dysfunction in ICP.

Methods

A total of 67 pregnant women at 27-40 weeks of pregnancy who attended Affiliated Hospital of North Sichuan Medical College from July 2022 to April 2023 were enrolled，among whom there were 29 women with ICP（ICP group） and 38 normal pregnant women（control group）. Quantitative fetal heart analysis software was used to measure fetal ventricular systolic function，including longitudinal systolic function（global longitudinal strain ［GLS］，septal wall strain［SWS］，and free wall strain［FWS］ of the left and right ventricles），traverse systolic function（24-segment fractional shortening［FS］ of the left and right ventricles），and global systolic function（fetal area change［FAC］ of the left and right ventricles and ejection fraction［EF］ of the left ventricle）.

Results

As for longitudinal systolic function，the ICP group had significantly lower GLS，SWS，and FWS of the left and right ventricles than the control group（

0.05）. As for traverse systolic function，there was no significant difference in the 24-segment FS of the left and right ventricles between the two groups（

0.05）. As for global systolic function，the ICP group had significantly lower FAC of the left and right ventricles than the control group（

0.05），while there was no significant difference in EF of the left ventricule between the two groups（

0.05）.

Conclusion

In the intrauterine environment with high bile acid，the global systolic function and longitudinal systolic function of the left and right ventricles are significantly impaired in the fetus of women with ICP，and there is no significant change in traverse systolic function. Compared with EF of the left ventricule as the traditional indicator for evaluating cardiac function，FAC can be a more sensitive indicator in reflecting the changes of fetal heart function.

关键词

Keywords

references

Gardiner FW ， McCuaig R ， Arthur C ， et al . The prevalence and pregnancy outcomes of intrahepatic cholestasis of pregnancy： A retrospective clinical audit review [J ] . Obstet Med ， 2019 ， 12 （ 3 ）： 123 - 128 .

Bicocca MJ ， Sperling JD ， Chauhan SP . Intrahepatic cholestasis of pregnancy： Review of six national and regional guidelines [J ] . Eur J Obstet Gynecol Reprod Biol ， 2018 ， 231 ： 180 - 187 .

Zhang Y ， Pan Y ， Lin C ， et al . Bile acids evoke placental inflammation by activating Gpbar1/NF-kappaB pathway in intrahepatic cholestasis of pregnancy [J ] . J Mol Cell Biol ， 2016 ， 8 （ 6 ）： 530 - 541 .

Brouwers L ， Koster MP ， Page-Christiaens GC ， et al . Intrahepatic cholestasis of pregnancy： maternal and fetal outcomes associated with elevated bile acid levels [J ] . Am J Obstet Gynecol ， 2015 ， 212 （ 1 ）： 100 - 101 .

Sheikh AKS ， Miragoli M ， Abu-Hayyeh S ， et al . Bile acid-induced arrhythmia is mediated by muscarinic M2 receptors in neonatal rat cardiomyocytes [J ] . PLoS One ， 2010 ， 5 （ 3 ）： e9689 .

Gorelik J ， Harding SE ， Shevchuk AI ， et al . Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics [J ] . Clin Sci（Lond）， 2002 ， 103 （ 2 ）： 191 - 200 .

Williamson C ， Gorelik J ， Eaton BM ， et al . The bile acid taurocholate impairs rat cardiomyocyte function： a proposed mechanism for intra-uterine fetal death in obstetric cholestasis [J ] . Clin Sci（Lond）， 2001 ， 100 （ 4 ）： 363 - 369 .

Wang D ， Liu C ， Liu X ， et al . Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis： a prospective cohort study [J ] . Cardiovasc Ultrasound ， 2021 ， 19 （ 1 ）： 25 .

詹梦娜，赵博文，彭晓慧，等 . 胎儿心脏定量分析技术评价左心室流出道梗阻胎儿心脏功能和形态 [J ] . 中华超声影像学杂志， 2021 ， 30 （ 10 ）： 854 - 860 .

Zhan MN ， Zhao BW ， Peng XH ， et al . Investigation of fetal cardiac function and morphology in fetuses with left ventricular outflow tract obstruction using fetal heart quantification [J ] . Chinese Journal of Ultrasonography ， 2021 ， 30 （ 10 ）： 854 - 860 .

Huntley ES ， Hernandez-Andrade E ， Soto E ， et al . Novel Speckle Tracking Analysis Showed Excellent Reproducibility for Size and Shape of the Fetal Heart and Good Reproducibility for Strain and Fractional Shortening [J ] . Fetal Diagn Ther ， 2021 ， 48 （ 7 ）： 541 - 550 .

中华医学会妇产科学分会产科学组 . 妊娠期肝内胆汁淤积症诊疗指南（2015） [J ] . 中华妇产科杂志， 2015 （ 7 ）： 481 - 485 .

SubgroupObstetrics，Chinese Society of Obstetrics and Gynecology，Chinese Medical Association . Guidelines for the management of intrahepatic cholestasis of pregnancy（ 2015） [J ] . Chinese Journal of Obstetrics and Gynecology ， 2015 （ 7 ）： 481 - 485 .

Gorelik J ， Shevchuk A ， de Swiet M ， et al . Comparison of the arrhythmogenic effects of tauro- and glycoconjugates of cholic acid in an in vitro study of rat cardiomyocytes [J ] . BJOG ， 2004 ， 111 （ 8 ）： 867 - 870 .

Smiseth OA ， Torp H ， Opdahl A ， et al . Myocardial strain imaging： how useful is it in clinical decision making? [J ] . Eur Heart J ， 2016 ， 37 （ 15 ）： 1196 - 1207 .

DeVore GR ， Polanco B ， Satou G ， et al . Two-Dimensional Speckle Tracking of the Fetal Heart： A Practical Step-by-Step Approach for the Fetal Sonologist [J ] . J Ultrasound Med ， 2016 ， 35 （ 8 ）： 1765 - 1781 .

DeVore GR ， Klas B ， Satou G ， et al . Twenty-four Segment Transverse Ventricular Fractional Shortening： A New Technique to Evaluate Fetal Cardiac Function [J ] . J Ultrasound Med ， 2018 ， 37 （ 5 ）： 1129 - 1141 .

Bayram E ， Gulcu O ， Aksu U ， et al . Evaluating the Association Between the Three Different Ejection Fraction Measurement Techniques and Left Ventricle Global Strain [J ] . Eurasian J Med ， 2018 ， 50 （ 3 ）： 173 - 177 .

Marwick TH ， Shah SJ ， Thomas JD . Myocardial Strain in the Assessment of Patients With Heart Failure： A Review [J ] . JAMA Cardiol ， 2019 ， 4 （ 3 ）： 287 - 294 .

Day TG ， Charakida M ， Simpson JM . Using speckle-tracking echocardiography to assess fetal myocardial deformation： are we there yet? [J ] . Ultrasound Obstet Gynecol ， 2019 ， 54 （ 5 ）： 575 - 581 .

董莉洁，曹引丽 . ICP胎鼠心肌损害机制的实验研究 [J ] . 陕西医学杂志， 2011 ， 40 （ 11 ）： 1469 - 1470 .

Dong LJ ， Cao YL . Experimental study on the mechanism of myocardial damage in fetal rats with intrahepatic cholestasis of pregnancy [J ] . Shaanxi Medical Journal ， 2011 ， 40 （ 11 ）： 1469 - 1470 .

Fan X ， Zhou Q ， Zeng S ， et al . Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy [J ] . J Ultrasound Med ， 2014 ， 33 （ 7 ）： 1171 - 1177 .

Mostafa S . Assessment of right ventricular systolic function in heart failure with preserved，reduced and mid-range ejection fraction [J ] . Indian Heart J ， 2019 ， 71 （ 5 ）： 406 - 411 .

Lee-Tannock A ， Hay K ， Gooi A ， et al . Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy [J ] . J Clin Ultrasound ， 2020 ， 48 （ 7 ）： 396 - 404 .

Younoszai AK ， Saudek DE ， Emery SP ， et al . Evaluation of myocardial mechanics in the fetus by velocity vector imaging [J ] . J Am Soc Echocardiogr ， 2008 ， 21 （ 5 ）： 470 - 474 .

Di Salvo G ， Russo MG ， Paladini D ， et al . Quantification of regional left and right ventricular longitudinal function in 75 normal fetuses using ultrasound-based strain rate and strain imaging [J ] . Ultrasound Med Biol ， 2005 ， 31 （ 9 ）： 1159 - 1162 .

DeVore GR ， Klas B ， Satou G ， et al . Quantitative evaluation of fetal right and left ventricular fractional area change using speckle-tracking technology [J ] . Ultrasound Obstet Gynecol ， 2019 ， 53 （ 2 ）： 219 - 228 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Twin pregnancy with intrahepatic cholestasis of pregnancy face more severe adverse pregnancy outcomes

Liver pathophysiology of Sprague-Dawley rat models of intrahepatic cholestasis of pregnancy induced by different sex hormones

Related Author

Geng Yanqing

Li Rong

Luo Xin

Zhang Rui

Wang Yingxiong

Liu Xueqing

Wen Yixian

Liu Taihang

Related Institution

Department of Physiology,School of Basic Medical Sciences,Chongqing Medical University

Joint International Research Laboratory of Reproduction & Development,Chongqing Medical University

Department of Obstetrics and Gynecology,The First Affiliated Hospital of Chongqing Medical University

Department of Obstetrics and Gynecology，The First Affiliated Hospital，Institute of Life Science， Chongqing Medical University

Key Laboratory of Clinical Laboratory Diagnostics,Ministry of Education,School of Laboratory Medicine,Chongqing Medical University

⁰