Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies

Zielinsky, Paulo; Luchese, Stelamaris; Mânica, João Luiz; Piccoli, Antônio; Nicoloso, Luiz Henrique Soares; Leite, Mariana Ferreira; Hagemann, Laura Netto; Busato, André Krieger; Moraes, Mario

doi:10.1002/uog.6154

Cited by 13 publications

(13 citation statements)

References 37 publications

(53 reference statements)

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“…rats; hyperglycemia; fetal heart; hyperplasia; dysfunction ACCELERATED FETAL MYOCARDIAL GROWTH with increased interventricular septal thickness is a well-documented complication of human diabetic pregnancy, but its mechanisms are still incompletely understood (16,32). The myocardial remodeling is associated with altered fetal cardiac diastolic function during the third trimester (48). In newborns of diabetic mothers, circulating atrial natriuretic peptide concentrations are elevated and correlate with maternal first-trimester glycosylated hemoglobin values even with good maternal glycemic control and normal placental hemodynamics (11).…”

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confidence: 99%

Maternal hyperglycemia leads to fetal cardiac hyperplasia and dysfunction in a rat model

Lehtoranta

Vuolteenaho

Laine

et al. 2013

American Journal of Physiology-Endocrinology and Metabolism

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Accelerated fetal myocardial growth with altered cardiac function is a well-documented complication of human diabetic pregnancy, but its pathophysiology is still largely unknown. Our aim was to explore the mechanisms of fetal cardiac remodeling and cardiovascular hemodynamics in a rat model of maternal pregestational streptozotocin-induced hyperglycemia. The hyperglycemic group comprised 107 fetuses (10 dams) and the control group 219 fetuses (20 dams). Fetal cardiac function was assessed serially by Doppler ultrasonography. Fetal cardiac to thoracic area ratio, newborn heart weight, myocardial cell proliferative and apoptotic activities, and cardiac gene expression patterns were determined. Maternal hyperglycemia was associated with increased cardiac size, proliferative, apoptotic and mitotic activities, upregulation of genes encoding A- and B-type natriuretic peptides, myosin heavy chain types 2 and 3, uncoupling proteins 2 and 3, and the angiogenetic tumor necrosis factor receptor superfamily member 12A. The genes encoding Kv channel-interacting protein 2, a regulator of electrical cardiac phenotype, and the insulin-regulated glucose transporter 4 were downregulated. The heart rate was lower in fetuses of hyperglycemic dams. At 13-14 gestational days, 98% of fetuses of hyperglycemic dams had holosystolic atrioventricular valve regurgitation and decreased outflow mean velocity, indicating diminished cardiac output. Maternal hyperglycemia may lead to accelerated fetal myocardial growth by cardiomyocyte hyperplasia. In fetuses of hyperglycemic dams, expression of key genes that control and regulate cardiomyocyte electrophysiological properties, contractility, and metabolism are altered and may lead to major functional and clinical implications on the fetal heart.

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confidence: 99%

Maternal hyperglycemia leads to fetal cardiac hyperplasia and dysfunction in a rat model

Lehtoranta

Vuolteenaho

Laine

et al. 2013

American Journal of Physiology-Endocrinology and Metabolism

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“…An additional study by our group showed that the pulmonary venous flow pulsatility index was lower during respiratory movements than during apnea, showing that left atrium dynamics is highly influenced by left ventricle compliance (Chemello et al , ). We have also demonstrated that left atrial shortening fraction is lower in fetuses of diabetic mothers with ventricular hypertrophy than in those of nondiabetic mothers (Zielinsky et al , ).…”

Section: Discussionmentioning

confidence: 75%

“…It was shown that the left atrial shortening fraction, excursion index of septum primum and pulmonary vein pulsatility index were significantly different in fetuses of diabetic mothers than in normal fetuses because these parameters were influenced by the diastolic left ventricle functional status. We have already focused on left atrial motion to assess changes related to left ventricular diastolic function in fetuses of diabetic women and have suggested that the study of left atrial shortening fraction could offer information to follow fetal well‐being (Zielinsky et al , ).…”

Section: Discussionmentioning

confidence: 99%

Influence of fetal respiratory movements on left atrial functional status

et al. 2011

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“…Fetal echocardiographic examinations were comprehensive, following a segmental sequential approach 11–13 . Flow analysis was performed with pulsed Doppler, color flow mapping and Power Doppler, considering that the pulmonary vein flow has systolic, diastolic, and presystolic phases (Figure 1).…”

Section: Methodsmentioning

confidence: 99%