Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies.

Autor: Buyon JP; NYU Langone Health, New York City, New York., Masson M; NYU Langone Health, New York City, New York., Izmirly CG; NYU Langone Health, New York City, New York., Phoon C; NYU Langone Health, New York City, New York., Acherman R; Children's Heart Center, Las Vegas, Nevada., Sinkovskaya E; East Virginia Medical School, Norfolk, Virginia., Abuhamad A; East Virginia Medical School, Norfolk, Virginia., Makhoul M; University of Kentucky, Lexington, Kentucky., Satou G; University of California, Los Angeles, California., Hogan W; University of Utah, Salt Lake City, Utah., Pinto N; University of Utah, Salt Lake City, Utah., Moon-Grady A; University of California San Francisco, California., Howley L; Midwest Fetal Care Center, Children's Minnesota/Allina Health, Minneapolis, Minnesota., Donofrio M; Children's National Hospital, Washington, DC., Krishnan A; Children's National Hospital, Washington, DC., Ahmadzia H; George Washington University, Washington, DC., Levasseur S; Columbia University, New York City, New York., Paul E; Mount Sinai Hospital, New York City, New York., Owens S; University of Michigan, Ann Arbor, Michigan., Cumbermack K; University of Kentucky, Lexington, Kentucky., Matta J; University of Louisville, Louisville, Kentucky., Joffe G; Perinatal Associates of New Mexico, Rio Rancho, New Mexico., Lindblade C; Phoenix Children's Hospital, Phoenix, Arizona., Haxel C; University of Vermont Children's Hospital, Burlington, Vermont., Kohari K; Yale University, New Haven, Connecticut., Copel J; Yale University, New Haven, Connecticut., Strainic J; UH Rainbow Babies & Children's Hospital, Cleveland, Ohio., Doan T; Baylor School of Medicine, Baylor College of Medicine, Houston, Texas., Bermudez-Wagner K; Baylor School of Medicine, Baylor College of Medicine, Houston, Texas., Holloman C; Baylor School of Medicine, Baylor College of Medicine, Houston, Texas., Sheth SS; Baylor School of Medicine, Baylor College of Medicine, Houston, Texas., Killen S; Vanderbilt University, Nashville., Tacy T; Stanford University, Stanford, California., Kaplinski M; Stanford University, Stanford, California., Hornberger L; Stollery Children's Hospital, Edmonton, Alberta, Canada., Carlucci PM; NYU Langone Health, New York City, New York., Izmirly P; NYU Langone Health, New York City, New York., Fraser N; NYU Langone Health, New York City, New York., Clancy RM; NYU Langone Health, New York City, New York., Cuneo BF; University of Colorado, Denver, Colorado.
Jazyk: angličtina
Zdroj: Arthritis & rheumatology (Hoboken, N.J.) [Arthritis Rheumatol] 2024 Mar; Vol. 76 (3), pp. 411-420. Date of Electronic Publication: 2023 Nov 10.
DOI: 10.1002/art.42733
Abstrakt: 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 abnormalities, which may reduce the need for serial echocardiograms.
(© 2023 American College of Rheumatology.)
Databáze: MEDLINE
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