1. 03/05/14
Fetal Cardiovascular Programming in Maternal Diabetes Mellitus and Obesity: Insights from Deformation Imaging
Aparna Kulkarni MD1, Ling Li MD PhD2, Mary Craft RDCS2, Mitali Nanda MD1, Joel Jose Mateo Lorenzo1, Shelby Kutty MD2
1Albert Einstein College of Medicine, Bronx, New York , USA
2Children’s Hospital and Medical Center, Omaha, Nebraska, USA
No disclosures to make.
Background:
Results:
Subgroup Analysis within FDM group:
Mean gestational age (weeks) - FDM group was , the FO group and the FC group (p NS).
Mean hemoglobin A1c for FDM group was 6.4 % (5-11.4%) and the mean BMI was 35.3 kg/m2 (22-55 kg/m2, p<0.01).
Mean BMI for the FO group was 36.6 kg/m2 (31-54 kg/m2, p< 0.01) and the FC group was 25 ( kg/m2).
Subgroup 1
(n=44)
p value
(vs. normal)
Subgroup 2
(n=28)
(Group 1 vs. 2)
Subgroup 3
(n=21)
GLS (%)
-20.8±6.3
<0.001*
-21.9±7.4
0.003*
0.547
-22.1±7.2
0.007*
ALSR
(sec-1)
-1.5±0.8
0.189
-1.4±0.7
0.062
0.578
-1.6±1.1
0.492
GCS (%)
-22.6±7.2
0.013*
-22.7±5.7
0.020*
0.904
-20.5±6.3
0.001*
ACSR
-1.6±0.6
0.181
-1.4±0.5
0.008*
0.260
-1.3±0.4
ARS (%)
12.1±8.6
8.9±5.1
0.050
12.0±8.3
0.092
LV EF (%)
62.2±11.2
0.038*
61.2±13.2
0.068
0.763
62.1±10.7
Experimental evidence suggests that changes in fetal myocardium occur from intrauterine effects of maternal diabetes mellitus and obesity.
Purpose:
Figures: Deformation Imaging Parameters
Deformation imaging is known to detect preclinical myocardial dysfunction. Two-dimensional echocardiographic (Echo) evaluation with deformation imaging was utilized to assess the effects of maternal disease in fetuses of mothers with diabetes mellitus (FDM) and fetuses of obese mothers (FO). *
Methods:
Prospective observational bi-institutional case control study of fetuses, 82 fetuses of mothers with DM (FDM) and 26 fetuses of mothers with obesity (FO); these were compared to 70 normal fetal controls (FC).
Fetuses with congenital heart disease (CHD), extracardiac or chromosomal anomaly, multiple gestations, hydrops, arrhythmia, cardiac dysfunction, family history of cardiomyopathy and those with suboptimal image quality were excluded. Fetuses of mothers without diabetes and obesity who satisfied the exclusion criteria served as fetal controls.
Apical four-chamber and left ventricular (LV) short axis views at > 80 fps were obtained on all echos (GE Vivid7 and E9). LV speckle tracking analysis was performed in apical/basal four-chamber (longitudinal strain, LS) and short axis (circumferential strain, CS) images offline (Image Arena, TomTec).
Data on maternal Hgb A1c, BMI, other maternal medical conditions and fetal gestation at the time of the echo were recorded. Comparisons were made between FDM, FO and FC groups.
Subgroup 1: Hgb A1c < 6.4; Subgroup 2: Hgb A1c > 6.4; Subgroup 3: DM (non-obese) FDM: Foetuses of mothers with diabetes mellitus; GLS: Global longitudinal strain; ALSR: Average longitudinal strain rate; GCS: Global circumferential strain; ACSR: Average circumferential strain rate; ARS: Average radial strain; EF: Ejection Fraction; * Statatistically significant
Limitations:
Cross sectional design and possible referral bias.
Conclusions:
Our results indicate that subclinical unfavorable changes in myocardial contractility occur in FDM and FO; they occur despite adequate maternal glycemic control and are unrelated to maternal obesity in FDM.
These data may provide basis for further research into the role of fetal programming in adult disease and potential intervention strategies in FDM and FO.
GLS: Global Longitudinal Strain; GCS: Global circumferential strain; ARS: Average Radial Strain; ALSR: Average longitudinal strain rate; ACSR: Average circumferential strain rate; *Statistically significant; GLS ,GCS, ALSR and ACSR are negative values