Cardiac Diastolic Evaluation in Pregnant Women with Abnormal Glucose Tolerance: An Opportunity to Detect the Early and Subclinical Alterations and Prevent Cardiovascular Diseases

Abstract

Objectives of this study were to assess diastolic function in pregnant women with abnormal glucose tolerance (AGT), compared with normal glucose tolerance (NGT) women, and to evaluate the insulin resistance status and its association with Doppler-echocardiographic indexes. Echocardiograms of 108 consecutive Caucasian women with singleton pregnancies were performed. Insulin resistance status was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). All the studied women showed normal diastolic patterns. Patients with AGT (50.9%), as compared with NGT women, had higher HOMA-IR (1.70 ± 1.30 versus 1.01 ± 0.81, P = 0.003), lower QUICKI (0.36 ± 0.005 versus 0.40 ± 0.06, P = 0.004), higher lateral mitral annulus late diastolic velocity (13.6 ± 4.9 versus 11.9 ± 4.9, P = 0.03), and higher A-wave velocity, the wave responsible for the active atrial contraction component (75.2 ± 14.2 versus 67.7 ± 16.2, P = 0.01). At multivariate regression analysis HOMA-IR was the only parameter associated with A-wave velocity. In conclusion, women with AGT had an increased subclinical diastolic active participation, which is associated with higher levels of insulin resistance. For the increased risk of deterioration of cardiac diastolic function, earlier and more seriously than normal pregnancy, AGT women may have a careful followup to detect the early signs of cardiac alteration and to prevent cardiovascular diseases.

Assessment of structural cardiac abnormalities and diastolic function in women with gestational diabetes mellitus

“…Our findings are corroborated by the results of two other studies. 17,30 The tissue parameters of diastolic function (E′ and A′) have a higher accuracy for this analysis because they are relatively load-independent and thus suitable for evaluation of ventricular overload states, such as pregnancy.…”

The correlation between maternal age, parity, cardiac diastolic function and occurrence rate of pre-eclampsia

“…There was no difference of rate of gestational diabetes between Impaired cardiac diastolic function group and normal cardiac diastolic function group (9.1% vs. 8.4%, p = 0.833). Previous study 27 showed that abnormal glucose tolerance was associated with higher A wave but had no influence on E/A ratio or Em, indicating Glucose metabolic disorders might influence cardiac diastolic function. Further study is worth to explore the relation between Glucose metabolism, hypertensive disorder and cardiac function.…”

What We Know and What We Don’t Know About the Adaptation to Pregnancy and Left Ventricular Diastolic Dysfunction

“…Pintaudi et al reported lateral mitral annulus late diastolic velocity and A wave velocity increased in pregnant females with impaired glucose tolerance compared with normal pregnant cases. 8 Scantlebury et al reported that women with hypertensive pregnancies also had larger left atrial size and lower mitral E/A ratio after adjusting for demographic variables. 9 Preeclampsia is a form of gestational hypertension syndrome, defined as the first onset of hypertension after 20 weeks of pregnancy and with proteinuria.…”