Academic Journal
Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies
| العنوان: | Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies |
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| المؤلفون: | Buyon, Jill P, Masson, Mala, Izmirly, Caroline G, Phoon, Colin, Acherman, Ruben, Sinkovskaya, Elena, Abuhamad, Alfred, Makhoul, Majd, Satou, Gary, Hogan, Whitnee, Pinto, Nelangi, Moon-Grady, Anita, Howley, Lisa, Donofrio, Mary, Krishnan, Anita, Ahmadzia, Homa, Levasseur, Stephanie, Paul, Erin, Owens, Sonal, Cumbermack, Kristopher, Matta, Jyothi, Joffe, Gary, Lindblade, Christopher, Haxel, Caitlin, Kohari, Katherine, Copel, Joshua, Strainic, James, Doan, Tam, Bermudez-Wagner, Karla, Holloman, Conisha, Sheth, Shreya S, Killen, Stacy |
| المصدر: | GW Authored Works |
| بيانات النشر: | Health Sciences Research Commons |
| سنة النشر: | 2023 |
| المجموعة: | George Washington University: Health Sciences Research Commons (HSRC) |
| الوصف: | OBJECTIVE: This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). METHODS: Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. RESULTS: Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. CONCLUSION: High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction ... |
| نوع الوثيقة: | text |
| اللغة: | unknown |
| Relation: | https://hsrc.himmelfarb.gwu.edu/gwhpubs/3821; https://doi.org/10.1002/art.42733 |
| DOI: | 10.1002/art.42733 |
| الاتاحة: | https://hsrc.himmelfarb.gwu.edu/gwhpubs/3821 https://doi.org/10.1002/art.42733 |
| رقم الانضمام: | edsbas.877655FA |
| قاعدة البيانات: | BASE |
| DOI: | 10.1002/art.42733 |
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