Left ventricular dimensions, systolic functions, and mass in term neonates with symmetric and asymmetric intrauterine growth restriction

Cinar, Bahar; Sert, Ahmet; Gökmen, Zeynel; Aypar, Ebru; Aslan, Eyüp; Odabaş, Dursun

doi:10.1017/s1047951113002199

Cited by 16 publications

(11 citation statements)

References 28 publications

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“…Previous studies have shown increased septal thickness in LGA infants or in the presence of maternal diabetes [6][7][8]22 , as well as a thicker left ventricular posterior free wall 23 . Septal hypertrophy has been demonstrated previously in infants that were growth restricted in utero 24 , but smaller ventricular walls have also been reported 25 . In contrast, we found no statistically significant difference between the groups for septal thickness.…”

Section: Discussionmentioning

confidence: 64%

Differences in cardiac geometry in relation to body size among neonates with abnormal prenatal growth and body size at birth

Olander

Sundholm

Ojala

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives Both excessive and restricted fetal growth are associated with changes in cardiac geometry and function at birth. There are significant issues when indexing cardiac parameters for body size in the neonatal period. The aims of this study were to determine to what extent cardiac geometry is dependent on body size in term and preterm neonates with restricted or excessive fetal growth and how this is affected by adiposity. Methods This was a cross‐sectional study of neonates born between 31 and 42 weeks of gestation, divided into three groups: (1) small‐for‐gestational age (SGA, birth weight > 2 SD below the mean); (2) large‐for‐gestational age (LGA, birth weight > 2 SD above the mean); and (3) appropriate‐for‐gestational‐age controls (AGA, birth weight ≤ 2 SD from the mean). Cardiac geometry and function were compared between the study groups, adjusting for body size. The potential impact of infant adiposity and maternal disease was assessed. Results In total, 174 neonates were included, of which 39 were SGA, 45 were LGA and 90 were AGA. Body size was reflected in cardiac dimensions, with differences in cardiac dimensions disappearing between the SGA and AGA groups when indexed for body surface area (BSA) or thoracic circumference. The same was true for the differences in atrial and ventricular areas between the LGA and AGA groups. However, left ventricular inflow and outflow tract dimensions did not follow this trend as, when indexed for BSA, they were associated negatively with adiposity, resulting in diminished dimensions in LGA compared with AGA and SGA neonates. Adiposity was associated positively with left ventricular mass, right ventricular length and area and right atrial area. The SGA group showed increased right ventricular fractional area change, possibly reflecting differences in the systolic function of the right ventricle. We found evidence of altered diastolic function between the groups, with the mitral valve inflow E‐ to lateral E′‐wave peak velocity ratio being increased in the LGA group and decreased in the SGA group. Conclusions Cardiac geometry is explained by body size in both term and preterm AGA and SGA infants. However, the nature of the relationship between body size and cardiac dimensions may be influenced by adiposity in LGA infants, leading to underestimation of left ventricular inflow and outflow tract dimensions when adjusted for BSA. Adjustments for thoracic circumference provide similar results to those for BSA. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 64%

Differences in cardiac geometry in relation to body size among neonates with abnormal prenatal growth and body size at birth

Olander

Sundholm

Ojala

et al. 2020

Ultrasound in Obstet & Gyne

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“…The ratio of the left ventricular wall thickness to diastolic diameter ("relative wall thickness") has been found to be decreased in infants born growth restricted compared to their AGA peers, indicating dilation of the ventricle (eccentric hypertrophy) (37,39). Another measure that is used to detect ventricle dilation, the left ventricular end diastolic internal diameter, has been found to be greater in infants born growth restricted than in AGA controls (38,40), although this finding has not been consistently reported (6,41).…”

Section: Cardiac Morphologymentioning

confidence: 99%

“…Dilation of the left atrium has been demonstrated by an increased left atrium/aortic root ratio in comparison to AGA controls (26). Cardiac changes in IUGR are thus most often described as cardiomyopathy-like, with dilated ventricles and a more globular cardiac shape compared to controls (10,26,32,34,(37)(38)(39)(40)42). …”

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confidence: 99%

“…They are however more likely to result from increased afterload in relation to high placental resistance, since most growth-restricted fetuses are capable of maintaining their cardiac output (7,48,50) and the majority of studies also report normal postnatal systolic function (10,(36)(37)(38)(39)(40)(41)51). Fractional shortening and ejection fraction, both measurements that give an indication of left ventricular pump function, have been found to be similar in growth-restricted and AGA neonates and infants (10,(36)(37)(38)(39)(40)(41). In most studies, cardiac output of neonates and infants born growth restricted has also been found comparable to controls (36)(37)(38)40,51).…”

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confidence: 99%

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Intrauterine growth restriction: impact on cardiovascular development and function throughout infancy

et al. 2016

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Intrauterine growth restriction (IUGR) refers to the situation where a fetus does not grow according to its genetic growth potential. One of the main causes of IUGR is uteroplacental vascular insufficiency. Under these circumstances of chronic oxygen and nutrient deprivation, the growth-restricted fetus often displays typical circulatory changes, which in part represent adaptations to the suboptimal intrauterine environment. These fetal adaptations aim to preserve oxygen and nutrient supply to vital organs such as the brain, the heart, and the adrenals. These prenatal circulatory adaptations are thought to lead to an altered development of the cardiovascular system and "program" the fetus for life long cardiovascular morbidities. In this review, we discuss the alterations to cardiovascular structure, function, and control that have been observed in growth-restricted fetuses, neonates, and infants following uteroplacental vascular insufficiency. We also discuss the current knowledge on early life surveillance and interventions to prevent progression into chronic disease. Intrauterine growth restriction (IUGR) refers to the situation where a fetus does not grow according to its genetic growth potential. The main cause of IUGR in developed countries is uteroplacental vascular insufficiency (1), which drives the fetus to redistribute its cardiac output to preserve oxygen and nutrient supply to the brain, heart, and adrenals. Although these adaptive circulatory changes are beneficial during intrauterine life, they are thought to cause dysfunctional development of the cardiovascular system and "program" the fetus for life long cardiovascular morbidities (2). This is also known as the Developmental Origins of Health and Disease hypothesis, which postulates that insults during intrauterine and early postnatal development can permanently change the body's structure, function, and metabolism and influence susceptibility to adult noncommunicable diseases (2). Despite their increased risk of cardiovascular disease, infants born growth restricted usually do not receive long-term cardiovascular follow-up. Depending on the definition used, IUGR can occur in up to 10% of pregnancies, and as cardiovascular disease is the number one cause of death worldwide (3), early identification of cardiovascular risk factors and targeted interventions in this high-risk population are of major clinical importance. In this review, we discuss the alterations of cardiovascular structure, function, and control that have been observed in infants born growth restricted and their implications for surveillance and intervention to prevent progression into chronic disease. CHALLENGES IN IDENTIFYING IUGRThe current literature uses many different definitions of IUGR, which may explain some of the contradicting findings discussed in this review. Traditionally, and most commonly, IUGR is defined as a birth weight below the 10th percentile for gestational age on the normative population growth curve (4). This definition, however, merely describes those who ...

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“…Studies conducted in the 1990s suggested cardiomegaly as a typical sign of severe FGR, but increased, preserved or decreased cardiac dimensions have also been reported. The presence of myocardial hypertrophy is also controversial, with results suggesting increased, lower or even normal wall thickness. Recently, a more spherical cardiac shape has been reported as a typical feature in FGR.…”

Section: Introductionmentioning

confidence: 99%

Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction

Rodríguez‐López

Cruz‐Lemini

Valenzuela-Alcaráz

et al. 2017

Ultrasound in Obstet & Gyne

107

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Left ventricular dimensions, systolic functions, and mass in term neonates with symmetric and asymmetric intrauterine growth restriction

Cited by 16 publications

References 28 publications

Differences in cardiac geometry in relation to body size among neonates with abnormal prenatal growth and body size at birth

Differences in cardiac geometry in relation to body size among neonates with abnormal prenatal growth and body size at birth

Intrauterine growth restriction: impact on cardiovascular development and function throughout infancy

Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction

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