Neonatal cardiac hypertrophy: the role of hyperinsulinism—a review of literature

Abstract

Hypertrophic cardiomyopathy (HCM) in neonates is a rare and heterogeneous disorder which is characterized by hypertrophy of heart with histological and functional disruption of the myocardial structure/composition. The prognosis of HCM depends on the underlying diagnosis. In this review, we emphasize the importance to consider hyperinsulinism in the differential diagnosis of HCM, as hyperinsulinism is widely associated with cardiac hypertrophy (CH) which cannot be distinguished from HCM on echocardiographic examination. We supply an overview of the incidence and treatment strategies of neonatal CH in a broad spectrum of hyperinsulinemic diseases. Reviewing the literature, we found that CH is reported in 13 to 44% of infants of diabetic mothers, in approximately 40% of infants with congenital hyperinsulinism, in 61% of infants with leprechaunism and in 48 to 61% of the patients with congenital generalized lipodystrophy. The correct diagnosis is of importance since there is a large variation in prognoses and there are various strategies to treat CH in hyperinsulinemic diseases. Conclusion: The relationship between CH and hyperinsulism has implications for clinical practice as it might help to establish the correct diagnosis in neonates with cardiac hypertrophy which has both prognostic and therapeutic consequences. In addition, CH should be recognized as a potential comorbidity which might necessitate treatment in all neonates with known hyperinsulinism. What is Known: • Hyperinsulinism is currently not acknowledged as a cause of hypertrophic cardiomyopathy (HCM) in textbooks and recent Pediatric Cardiomyopathy Registry publications. What is New: • This article presents an overview of the literature of hyperinsulinism in neonates and infants showing that hyperinsulinism is associated with cardiac hypertrophy (CH) in a broad range of hyperinsulinemic diseases. • As CH cannot be distinguished from HCM on echocardiographic examination, we emphasize the importance to consider hyperinsulinism in the differential diagnosis of HCM/CH as establishing the correct diagnosis has both prognostic and therapeutic consequences.

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…A meta-analysis of 39 studies showed that fetuses of both PGDM and GDM pregnancies had in the third trimester increased intraventricular septal thickness compared to controls [ 196 ]. A literature review found an incidence ranging from 13% to 44% among asymptomatic and symptomatic neonates [ 197 ]. El-Ganzoury et al found a correlation between poor maternal glycemic control (HbA1c ≥ 7%) and interventricular septal thickness [ 198 ].…”

Dihydrotanshinone I Ameliorates Cardiac Hypertrophy in Diabetic Mice Induced by Chronic High-Fat Feeding

“…It has been shown that hyperinsulinemia was associated with cardiac hypertrophy in neonates. 26 A study in db/db mice suggested that systemic hyperinsulinemia contributed to cardiac hypertrophy, which could be blocked by the deletion of insulin-like growth factor-1R. 27 Continuous administration of insulin for 7 weeks using osmotic pumps increased LV mass and relative wall thickness in rats.…”

Adaptation of the cardiovascular system of infants born by mothers with diabetes mellitus

“…Определение «гипертрофическая кардиомиопатия» нередко встречается в научных статьях, посвященных влиянию СД матери в период беременности на сердце плода и новорожденного. Другие исследователи оспаривают правомерность использования данного термина в отношении детей от матерей с СД [30]. Это связано с тем, что гиперинсулинизм ассоциирован с гипертрофией сердца, но возникающие изменения не соответствуют критериям гистологических и функциональных нарушений, необходимых для постановки диагноза ГКМП.…”

“…Это, вероятно, является следствием разнородности с точки зрения отбора пациентов (СД1, СД2 и ГСД), степени компенсации уровня глюкозы у матери, времени исследования и, что немаловажно, опыта специалиста, проводившего эхокардиографическое исследование (ЭХО-КГ) (табл. 4) [30]. Несколько исследований продемонстрировали связь между формированием гипертрофии сердца у детей и типом материнского диабета.…”

“…Тем не менее эпизоды гипергликемии могут запускать каскад патогенетических реакций и способствовать развитию патологических изменений в сердечно-сосудистой системе плода. В связи с этим, по мнению некоторых ученых, необходим более строгий контроль гликемии в период беременности [30].…”