Quantification of fetal myocardial function in pregnant women with diabetic diseases and in normal controls using speckle tracking echocardiography (STE)

Rolf, Norbert; Kerschke, Laura; Braun, Janina; Falkenberg, Maria; Hammer, K; Köster, Helen Ann; Möllers, Mareike; Murcia, Kathrin Oelmeier de; Klockenbusch, Walter; Schmitz, Ralf

doi:10.1515/jpm-2018-0031

Cited by 16 publications

(20 citation statements)

References 27 publications

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“…By using a variety of echocardiographic modalities we showed that right and left longitudinal myocardial deformation was reduced in fetuses exposed to GDM compared with controls but that diastolic indices were similar between the two groups when analysis was adjusted for differences in maternal characteristics, estimated fetal weight and heart rate. Similar results have been reported in some studies, 12,13,14 but not in all. 15 For example, in a combined group of 76 women with pregestational diabetes and GDM Miranda et al demonstrated biventricular diastolic dysfunction in their fetuses.…”

Section: Interpretation Of Results and Comparison With Existing Litersupporting

confidence: 92%

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Aguilera

Semmler

Anzoategui

et al. 2020

BJOG

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Objective To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Design Longitudinal study. Setting Fetal Medicine Unit in a UK teaching hospital. Methods 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36 weeks' gestation. Repeat echocardiogram was performed in their offspring during infancy. Main outcome measures Fetal and infant cardiac functional and structural changes. Results Fetuses of mothers with GDM, compared with controls, had more globular right ventricles (sphericity index 0.7, interquartile range [IQR] 0.6/0.7 versus 0.6, IQR 0.5/0.6, P < 0.001) and reduced right global longitudinal systolic strain (À16.4, IQR À18.9/À15.3 versus À18.5, IQR À20.6/À16.8, P = 0.001) and left global longitudinal systolic strain (À20.1, IQR À22.5/À16.9 versus À21.3, IQR À23.5/À19.5), P = 0.021). In the GDM group, compared with controls, in infancy there was higher left ventricular E/e' (

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Section: Interpretation Of Results and Comparison With Existing Litersupporting

confidence: 92%

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Aguilera

Semmler

Anzoategui

et al. 2020

BJOG

View full text Add to dashboard Cite

show abstract

“…Right and left longitudinal myocardial deformation were reduced in fetuses exposed to GDM compared to controls but diastolic indices were similar between the two groups when analysis was adjusted for differences in maternal characteristics, estimated fetal weight and heart rate. Similar results have been reported before, in some studies (11,12) but not in all (13). For example, Miranda et al in a combined group of 76 women with pregestational diabetes and GDM demonstrated biventricular diastolic dysfunction in their fetuses (4).…”

Section: Interpretation Of Results and Comparison With Existing Literaturesupporting

confidence: 81%

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Charakida

Nicolaides

Semmler

et al. 2020

Preprint

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Objective: To determine whether cardiac functional and structural changes in fetuses of mothers with gestational diabetes mellitus (GDM) persist in the offspring beyond the neonatal period. Design: Longitudinal study Setting: Fetal Medicine Unit in a UK teaching hospital Population: 73 women with GDM and 73 women with uncomplicated pregnancy were recruited and fetal cardiac scans were performed at 35-36 weeks' gestation. Repeat echocardiogram was performed in their offspring during infancy. Main outcome measures: Fetal and infant cardiac functional and structural changes Results: Fetuses of mothers with GDM, compared to controls, had more globular right ventricles (sphericity index 0.7, IQR 0.6/0.7 vs 0.6, IQR 0.5/ 0.6, p<0.001) and reduced right global longitudinal systolic strain p=0.001) and left global longitudinal systolic strain (-20.1, IQR -22.5/-16.9 vs -21.3, IQR -23.5/-19.5), p=0.021). In the GDM group, compared to controls, in infancy there was higher left ventricular E/e' (

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“…Wang et al [ 19 ] analyzed 35 fetuses of mothers with GDM (gestational age: 28–38 weeks) and found that the GLS values of the apical segment of the left ventricular side wall and interventricular septum were reduced. Rolf et al [ 6 ], who examined 53 fetuses of mothers with GDM and 127 fetuses of healthy mothers at a gestational age of 19–39 weeks, found reduced GLS for both the ventricles. The results of Kulkarni et al’s study [ 20 ] also showed that maternal hyperglycemia may cause a reduction in the GLS of the LV in fetuses.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to traditional Doppler and tissue Doppler ultrasonography, speckle-tracking echocardiography (STE) has become a popular modality in recent years, especially for assessing adult cardiac function. The speckle-tracking mode used to assess adult cardiac function was chosen by many authors to assess changes in fetal ventricular segmental function [ 6 , 7 ]. The causes and mechanisms of changes in ventricular function in fetuses are not the same as those in adults.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

Wang

Liu

et al. 2021

Cardiovasc Ultrasound

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Background Due to metabolic changes in the second trimester and the increasing number of pregnant women with obesity and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. This study aimed to evaluate the effects of GDM on fetal cardiac morphology and function, and to determine whether these changes increase with increasing estimated fetal weight (EFW). Methods Fifty-eight women with GDM (GDM group) and 58 women with a healthy pregnancy (control group) were included in this prospective observational cohort study. Each group included subgroups of 31 pregnant women with a gestational age between 24+0 weeks and 27+6 weeks as well as 27 pregnant women with a gestational age between 28+0 weeks and 40+0 weeks. For all fetuses, a cine of 2–3 s in the four-chamber view was obtained, and online speckle-tracking analysis was performed using the GE Automatic Fetal Heart Assessment Tool (fetal HQ; General Electric Healthcare Ultrasound, Zipf, Austria) to measure the global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), 24-segment sphericity index (SI), and 24-segment end-diastolic diameter of the left ventricle (LV) and right ventricle (RV). Data were analyzed using the independent t-test and Wilcoxon rank-sum test, as applicable. Results The GDM group (mean HbA1c value was 5.3 ± 0.57 mmol/L) showed a lower GSI value than the control group (1.21 vs. 1.27, P = 0.000), which indicated a rounder shape of the heart. In addition, fetuses in the GDM group demonstrated significant impairment in cardiac function compared to those in the control group (LV-GLS: -18.26% vs. -22.70%, RV-GLS: -18.52% vs. -22.74%, LV-FAC: 35.30% vs. 42.36%, RV-FAC: 30.89% vs. 36.80%; P = 0.000 for all). Subgroup analyses according to gestational age (24+0–27+6 weeks and 28+0–40+0 weeks) showed that the statistical differences were retained between the GDM and control groups in each subgroup. Conclusions Fetuses of women with GDM present with signs of biventricular systolic dysfunction according to deformation analysis using fetal HQ. Additionally, the heart had a rounder shape in the GDM group than in the control group. This study showed that fetal HQ can be used to assess fetal cardiac morphology and function easily and quickly, and the effects of GDM on fetal cardiac morphology and function appeared from the second trimester. Thus, whether earlier and stricter clinical intervention was necessary remained to be further studied. Furthermore, future studies will need to supplement the effects of blood glucose levels on GLS, FAC, GSI, and 24-segment SI. Additionally, the long-term follow-up after birth should also be improved to observe the influence of changes in the indicators on the prognosis.

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Quantification of fetal myocardial function in pregnant women with diabetic diseases and in normal controls using speckle tracking echocardiography (STE)

Abstract: Our study demonstrates that fetal hearts affected by maternal diabetes mellitus (DM) show low myocardial strain values and high interventricular dyssynchrony. Two-chamber interventricular dyssynchrony has the potential to become a diagnostic marker for DM.

Cited by 16 publications

References 27 publications

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Cardiac function in gestational diabetes mellitus: A longitudinal study from fetal life to infancy

Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

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