Background

Intrauterine exposure to a diabetic environment is associated with adverse fetal myocardial remodeling. The aim of this study was to assess the biventricular systolic and diastolic function of fetuses exposed to maternal diabetes (MD) compared with control subjects, using a comprehensive cardiac functional assessment and exploring the role of speckle-tracking to assess myocardial deformation. The authors hypothesized that fetuses exposed to MD present signs of biventricular dysfunction, which can be detected by deformation analysis.

Methods

A cross-sectional study was conducted in 129 fetuses with structurally normal hearts, including 76 fetuses of mothers with diabetes and 53 of mothers without diabetes. Maternal baseline characteristics, standard fetoplacental Doppler indices, and conventional echocardiographic and myocardial deformation parameters were prospectively collected at 30 to 33 weeks of gestation.

Results

Fetuses of mothers with diabetes had a significantly thicker interventricular septum compared with control subjects (median, 4.25 mm [interquartile range (IQR), 3.87–4.50 mm] vs 3.67 mm [IQR, 3.40–3.93 mm), P < .001), but no effect modification was demonstrated on myocardial deformation analysis. No significant differences were found in conventional systolic and diastolic functional parameters for the left ventricle and right ventricle, except for lower left ventricular cardiac output in the MD group (median, 320 mL/min [IQR, 269–377 mL/min] vs 365 mL/min [IQR, 311–422 mL/min], P < .05]. Deformation analysis demonstrated a significantly lower early diastolic strain rate (SRe) and late diastolic strain rate (SRa) for both ventricles in the MD group (left ventricle: SRe 1.85 ± 0.72 vs 2.26 ± 0.68 sec⁻¹, SRa 1.50 ± 0.52 vs 1.78 ± 0.57 sec⁻¹; right ventricle: SRe 1.57 ± 0.73 vs 1.97 ± 0.73 sec⁻¹, SRa 2 ± 0.77 vs 1.68 ± 0.79 sec⁻¹; P < .05), suggesting biventricular diastolic impairment. Additionally, the right ventricle presented a lower global longitudinal strain in the study group (−13.67 ± 4.18% vs −15.52 ± 3.86%, P < .05). Multivariate analysis revealed that maternal age is an independent predictor of left and right ventricular global longitudinal strain (P < .05), with a significant effect only in MD after group stratification.

Conclusions

Fetuses of mothers with diabetes present signs of biventricular diastolic dysfunction and right ventricular systolic dysfunction by deformation analysis in the third trimester of pregnancy. They may represent a special indication group for functional cardiac assessment, independently of septal hypertrophy. Two-dimensional speckle-tracking could offer an additional benefit over conventional echocardiography to detect subclinical unfavorable changes in myocardial function in this population.

中文翻译：

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母体糖尿病患者的胎儿心脏功能：常规和斑点跟踪超声心动图研究。

背景

宫内暴露于糖尿病环境与不良的胎儿心肌重塑有关。这项研究的目的是评估与对照受试者相比，暴露于母体糖尿病（MD）的胎儿的双室收缩和舒张功能，使用全面的心脏功能评估，并探索斑点追踪在评估心肌变形中的作用。作者假设暴露于MD的胎儿表现出双心室功能障碍的迹象，可以通过变形分析来检测。

方法

在129例心脏结构正常的胎儿中进行了横断面研究，其中包括76例患有糖尿病的母亲和53例没有糖尿病的母亲。孕妇在妊娠30至33周时收集基线特征，标准胎盘多普勒指数以及常规超声心动图和心肌变形参数。

结果

与对照组相比，患有糖尿病的母亲的胎儿的室间隔明显更厚（中位数为4.25 mm [四分位间距（IQR），3.87–4.50 mm] vs 3.67 mm [IQR，3.40–3.93 mm]，P  <.001），但在心肌变形分析中未见任何效果改变。除了MD组左心室的心输出量较低外，常规的左心室和右心室收缩和舒张功能参数均无显着差异（中位值：320 mL / min [IQR，269–377 mL / min] vs 365）。毫升/分钟[IQR，311–422毫升/分钟]，P <.05]。变形分析显示MD组两个心室的舒张早期舒张应变率（SRe）和舒张晚期舒张率（SRa）均显着降低（左心室：SRe 1.85±0.72 vs 2.26±0.68 sec ^-1，SRa 1.50±0.52 vs 1.78 ±0.57 sec ^-1 ;右心室：SRe 1.57±0.73 vs 1.97±0.73 sec ^-1，SRa 2±0.77 vs 1.68±0.79 sec ^-1 ; P  <.05），提示双心室舒张期受损。此外，在研究组中，右心室的整体纵向应变较低（−13.67±4.18％与−15.52±3.86％，P  <.05）。多因素分析显示，产妇年龄是左心室和右心室整体纵向应变的独立预测因子（P  <.05），仅在组分层后才对MD产生显著作用。

结论

通过妊娠中期的变形分析，患有糖尿病的母亲的胎儿表现出双心室舒张功能障碍和右心室收缩功能障碍的迹象。它们可能代表功能性心脏评估的特殊适应症组，而与间隔肥大无关。二维散斑跟踪可以提供比常规超声心动图更多的益处，以检测该人群中亚临床不利的心肌功能变化。