Dynamic left ventricular changes in patients with gestational diabetes: A speckle tracking echocardiography study

Meera, Srinidhi J.; Ando, Tomo; Pu, Daniel; Manjappa, Shivaprasad; Taub, Cynthia C.

doi:10.1002/jcu.22399

Cited by 19 publications

(18 citation statements)

References 22 publications

(34 reference statements)

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“…Maternal cardiovascular indices in GDM were examined previously in four case–control studies. Two studies in 13 and 18 women with GDM, respectively, reported a mild degree of diastolic abnormality both during pregnancy and postpartum 3,4 ; the diastolic changes were subtle and did not fulfil the criteria for adult clinical diastolic dysfunction as per European or American guidelines 10,18 . Similarly, in a previous study by our group involving 161 women with GDM and 483 women with uncomplicated pregnancy at 35–36 weeks' gestation, we found that women with GDM had lower left ventricular diastolic and systolic functional indices with no significant differences in cardiac output, peripheral vascular resistance, left ventricular global longitudinal functional changes or left ventricular mass after adjustment for maternal characteristics 6 .…”

Section: Discussionsupporting

confidence: 66%

Maternal cardiac function at 19–23 weeks' gestation in prediction of gestational diabetes mellitus

Gibbone

Wright

Campos

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To examine differences in maternal cardiovascular indices at 19–23 weeks' gestation between pregnancies that develop gestational diabetes mellitus (GDM) and those without GDM, and to determine whether such cardiovascular changes are the consequence of maternal demographic characteristics and medical history or GDM per se. Methods This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, and maternal echocardiography for assessment of E/A ratio, E/e′ ratio, myocardial performance index, global longitudinal systolic strain, left ventricular ejection fraction, peripheral vascular resistance, left ventricular cardiac output and left ventricular mass indexed for body surface area. The measurements of the maternal cardiac indices were standardized to remove the effects of maternal characteristics and elements from the medical history, and the adjusted values in the GDM group were compared to those in the non‐GDM group. Likelihood ratios were derived for those indices that were altered significantly in GDM, and these were used to modify the prior risk derived from maternal demographic characteristics and medical history. The area under the receiver‐operating‐characteristics curve and the detection rate of GDM, at 10%, 20% and 40% false‐positive rates, in screening by a combination of maternal factors with cardiovascular indices were determined. Results The study population of 2853 pregnancies contained 199 (7.0%) that developed GDM. In pregnancies that developed GDM, there were significant differences from the non‐GDM group in E/A ratio, E/e′ ratio, myocardial performance index and global longitudinal systolic strain. After adjustment for maternal demographic characteristics and factors from the medical history known to affect cardiac indices, the only cardiovascular indices that were significantly different between the GDM and non‐GDM groups were peripheral vascular resistance and myocardial performance index, both of which were marginally increased in the GDM group. The performance of screening for GDM by maternal demographic characteristics and medical history was not improved by the addition of cardiovascular indices. Conclusions Women with GDM have subtle functional and hemodynamic cardiac changes prior to the development of GDM. These cardiac changes are mostly related to the adverse risk‐factor profile of these women. Maternal cardiac assessment at 20 weeks does not offer additional predictive information for GDM development in pregnancy to that calculated based on demographic characteristics and medical history. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionsupporting

confidence: 66%

Maternal cardiac function at 19–23 weeks' gestation in prediction of gestational diabetes mellitus

Gibbone

Wright

Campos

et al. 2021

Ultrasound in Obstet & Gyne

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“…Just like the essential hypertension, diabetes was also an important factor for stimulating LVR . Meera et al found that pregnant women with gestational diabetes mellitus (DM) had significantly higher LV posterior wall thickness when compared with women without gestational DM. Zhang et al also found that both T2DM patients with well‐controlled blood glucose and those with poorly controlled blood glucose had significantly higher LV wall thickness when compared with the controls.…”

Section: Discussionmentioning

confidence: 92%

Left ventricular structural alterations are accompanied by subclinical systolic dysfunction in type 2 diabetes mellitus patients with concomitant hyperlipidemia: An analysis based on 3D speckle tracking echocardiography

et al. 2018

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“…Exposure of the maternal heart to hyperglycemia for a short period of time parallels the cardiac dysfunction seen in non-pregnant patients after decades of diabetes. In a retrospective study of 18 pregnant women with GDM at the end of the second trimester, the authors demonstrated differences only in GLS with preserved circumferential and radial strain in GDM 25 . Although these data support the findings of the present study, the lack of additional cardiovascular findings may be explained by the retrospective nature of the study, smaller sample size, reduced loading conditions of earlier gestational age at assessment and a shorter period of exposure to hyperglycemia.…”

Section: Discussionmentioning

confidence: 97%

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Buddeberg

Sharma

O’Driscoll

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To determine whether maternal cardiac adaptation at term differs between women with, and those without, gestational diabetes mellitus (GDM). Methods This was a prospective case–control study of pregnant women at term with or without GDM. For both cases and controls, only women without any comorbidity or form of pre‐existing diabetes who had a singleton pregnancy without complication (such as pre‐eclampsia or fetal growth restriction) were included. All women underwent conventional and speckle‐tracking echocardiography to assess both the left‐ and right‐heart geometry and function. Results A total of 40 women with GDM and 40 healthy controls were enrolled. Women with GDM, compared with controls, had a significantly higher heart rate (83 ± 10 vs 75 ± 9 beats per min; P < 0.001), left ventricular (LV) relative wall thickness (0.43 ± 0.07 vs 0.37 ± 0.08; P < 0.001), LV early diastolic transmitral valve velocity (E) (0.80 ± 0.15 vs 0.73 ± 0.12 m/s; P = 0.026) and LV late diastolic transmitral valve velocity (A) (0.65 ± 0.13 vs 0.57 ± 0.11 m/s; P = 0.006). In women with GDM compared with controls, speckle‐tracking analysis revealed a significant reduction in LV global longitudinal strain (GLS) (−16.29 ± 2.26 vs −17.61 ± 1.89; P = 0.012), LV endocardial GLS (−18.50 ± 2.59 vs −19.84 ± 2.35; P = 0.031) and LV epicardial GLS (−14.40 ± 2.01 vs −15.73 ± 1.66; P = 0.005). Right ventricular (RV) analysis revealed a reduced pulmonary acceleration time (58 ± 10 vs 66 ± 11 ms; P = 0.001) and RV E/A ratio (1.13 ± 0.18 vs 1.29 ± 0.35; P = 0.017), as well as a higher RV myocardial systolic annular velocity (0.16 ± 0.04 vs 0.14 ± 0.02; P = 0.023) and peak late diastolic transtricuspid valve velocity (0.46 ± 0.1 m/s vs 0.39 ± 0.08 m/s; P = 0.001), in women with GDM compared to controls. Conclusions Our findings show that even a short period of exposure to hyperglycemia, as occcurs in women with GDM, is associated with significant maternal functional cardiac impairment at term. Given these findings, further study of postnatal maternal cardiovascular recovery after GDM pregnancy is warranted. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Dynamic left ventricular changes in patients with gestational diabetes: A speckle tracking echocardiography study

Abstract: Although conventional TTE variables show preserved LV size and function, LV longitudinal strain suggests subclinical myocardial dysfunction in patients with GDM. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:20-27, 2017.

Cited by 19 publications

References 22 publications

Maternal cardiac function at 19–23 weeks' gestation in prediction of gestational diabetes mellitus

Maternal cardiac function at 19–23 weeks' gestation in prediction of gestational diabetes mellitus

Left ventricular structural alterations are accompanied by subclinical systolic dysfunction in type 2 diabetes mellitus patients with concomitant hyperlipidemia: An analysis based on 3D speckle tracking echocardiography

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

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