Utility of cardiac monitoring in fetuses at risk for congenital heart block - The PR interval and dexamethasone evaluation (PRIDE) prospective study
Utility of cardiac monitoring in fetuses at risk for congenital heart block - The PR interval and dexamethasone evaluation (PRIDE) prospective study
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DOI：
10.1161/circulationaha.107.707661
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发表时间：
2008-01-29
期刊：
影响因子：
37.8
通讯作者：
Buyon, Jill P.
中科院分区：
文献类型：
--
作者：
Friedman, Deborah M.;Kim, Mimi Y.;Buyon, Jill P.
背景-抗SSA/RO相关的第三度先天性心脏传导阻滞是不可逆的，促使寻找早期标记物和有效的therapy.Methods和结果-一百二十七名孕妇与抗SSA/RO抗体入组; 95完成了98个怀孕的可评估的过程。该方案包括从妊娠16至26周每周进行一次胎儿超声心动图检查，从26至34周每两周进行一次。PR间期> 150 ms被认为是延长的，与一度阻滞一致。92只胎仔PR间期正常。10例发生新生儿狼疮，4例仅为新生儿狼疮疹。三个胎儿有三度传导阻滞，没有一个胎儿有异常的PR间期，尽管有两个胎儿的超声心动图评估间隔> 1周。三尖瓣返流先于三度阻滞1例，心房回声密度先于阻滞1例。两个胎儿的PR间期> 150 ms，均在22周或22周前检测到，并在1周内用4 mg地塞米松逆转。另外1名新生儿的ECG显示PR间期延长，持续至3年，尽管整个妊娠期的间期正常。出生时心电图正常，无一度传导阻滞。心脏传导阻滞发生在3/16例（19%）的母亲与以前的孩子与先天性心脏传导阻滞，在3/74例（4%）的母亲没有以前的孩子与先天性心脏传导阻滞或皮疹（P = 0.067）结论-PR间期延长是罕见的，并没有之前更先进的阻滞。有先天性心脏传导阻滞倾向的女性胎儿中，有先前受影响的后代比那些没有先前受影响的后代。晚期传导阻滞和心肌病可在超声心动图正常的1周内发生，最初无一度传导阻滞。回声密度和中度/重度三尖瓣返流作为损伤的早期体征值得注意。
Background - Anti-SSA/Ro-associated third-degree congenital heart block is irreversible, prompting a search for early markers and effective therapy.Methods and Results - One hundred twenty-seven pregnant women with anti-SSA/Ro antibodies were enrolled; 95 completed an evaluable course in 98 pregnancies. The protocol included fetal echocardiograms performed weekly from 16 to 26 weeks' gestation and biweekly from 26 to 34 weeks. PR intervals > 150 ms were considered prolonged, consistent with first-degree block. Ninety-two fetuses had normal PR intervals. Neonatal lupus developed in 10 cases; 4 were neonatal lupus rash only. Three fetuses had third-degree block; none had a preceding abnormal PR interval, although in 2 fetuses > 1 week elapsed between echocardiographic evaluations. Tricuspid regurgitation preceded third-degree block in 1 fetus, and an atrial echodensity preceded block in a second. Two fetuses had PR intervals > 150 ms. Both were detected at or before 22 weeks, and each reversed within 1 week with 4 mg dexamethasone. The ECG of 1 additional newborn revealed a prolonged PR interval persistent at 3 years despite normal intervals throughout gestation. No first-degree block developed after a normal ECG at birth. Heart block occurred in 3 of 16 pregnancies (19%) in mothers with a previous child with congenital heart block and in 3 of 74 pregnancies (4%) in mothers without a previous child with congenital heart block or rash (P = 0.067).Conclusions - Prolongation of the PR interval was uncommon and did not precede more advanced block. There was a trend toward more congenital heart block in fetuses of women with previously affected offspring than those without previously affected offspring. Advanced block and cardiomyopathy can occur within 1 week of a normal echocardiogram without initial first-degree block. Echodensities and moderate/severe tricuspid regurgitation merit attention as early signs of injury.