Cardiac Function in Infants Born to Mothers With Gestational Diabetes　― Estimation of Early Diastolic Intraventricular Pressure Differences ―

Abstract

prognostic value over conventional measures for predicting major adverse cardiac events. 6 Moreover, layer-specific myocardial strain can be measured in the endocardial, transmural, and epicardial left ventricular (LV) layers using this technique. 7 Further, intraventricular pressure differences (IVPD) and intraventricular pressure gradients (IVPG) can be measured on color M-mode imaging to accurately and non-invasively estimate active suction. 8-10 IVPD has an excellent correlation with Tau index, which is a gold standard, although Tau index is an invasive method of evaluating diastolic function. 11 In 2010, the International Association of Diabetes and Pregnancy Study Groups recommended new criteria for the diagnosis and classification of hyperglycemia during pregnancy, 12 recognizing the increasing prevalence of undi-G estational diabetes mellitus (GDM) increases the risk of numerous complications in the neonate, including both structural and functional cardiovascular disease. Infants, with structurally normal hearts, born to mothers with GDM (IGDM) may develop transient myocardial hypertrophy and associated systolic and diastolic dysfunction. 1 When present, IGDM with hypertrophic cardiomyopathy (HCM) tends to spontaneously regress in the first few months of life, 2 but asymptomatic IGDM without cardiac hypertrophy develop subclinical decreases in systolic and diastolic myocardial function. 3 Recently, new technology has been developed to estimate cardiac systolic and diastolic function, including 2-D speckle tracking echocardiography (2DST)-derived strain imaging. 4,5 Additionally, 2DST deformation imaging has superior Background: This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions. Methods and Results:The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid-apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG. Conclusions:Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac per...

Echocardiographic Reference Ranges of Non-Invasive Myocardial Work Indices in Newborns

“…27 Furthermore, IVPD and IVPG could be determined using color M-mode images for the non-invasive estimation of active suction during the neonatal period. 6 IVPD and IVPG measurements using color M-mode images are reported to be accurate and reproducible. 24 Baseline BP and Cord Blood Examinations BP measurements in newborns were performed in the left or right leg, with subjects in a relaxed supine position, at the time of echocardiographic evaluation.…”

“…Myocardial deformation analysis is an emerging quantitative echocardiographic technique for characterizing global and regional ventricular function in newborns. [4][5][6] Myocardial deformation analysis is influenced by several factors that should be considered when using echocardiography in clinical practice. Specifically, the preload and afterload (which increase and decrease the wall strain, respectively) affect the global and regional strains.…”

Implantable Triboelectric Nanogenerators for Self‐Powered Cardiovascular Healthcare

“…In individuals with impaired cardiac function, significant changes in endocardial pressure can indicate heart failure in these patients. [69][70][71] Endocardial pressure is commonly monitored by invasive and expensive catheterization, which is not feasible for long-term and continuous data collection and is not optimal for the patient's quality of life. [72][73][74] Highlighted in the research conducted in Liu et al, a TENG based self-powered endocardial pressure sensor (SEPS) was developed to act as a miniature and flexible implantable device to be integrated with a surgical catheter for minimally invasive implantation.…”

Non-Invasive Myocardial Work Indices in Infants Born to Mothers With Diabetes in Pregnancy

“…Myocardial deformation analysis is an emerging quantitative echocardiographic technique for characterizing global and regional ventricular function in infants. [7][8][9] Over the past few years, several 2-dimensional (2D)-speckle tracking echocardiography (STE) studies have demonstrated that myocardial function is impaired in both the fetuses 10-12 and infants 6,13-15 of mothers with GDM.…”

“…[4][5][6] Using the new GDM definition, we previously investigated the cardiac performance of infants with GDM. 7 Advances in cardiac imaging of infants have enabled more comprehensive assessments of their myocar-(GLS) values were obtained from apical 2-, 3-, and 4-chamber images. We visually verified these time points in the apical 3-chamber view and manually adjusted them, as necessary, because changes in the heart rate (HR) during the examination can affect the loop area.…”