Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies

Fouda, Usama M.; ElKassem, Mohamed M. Abou; Hefny, Shamel M.; Fouda, Ragai; Hashem, Ahmed T.

doi:10.3109/14767058.2012.743521

Cited by 35 publications

(42 citation statements)

References 16 publications

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“…The M-mode is widely used in fetal 2D echocardiography, especially to assess cardiac arrhythmias; 30 however, it can also be applied to evaluate cardiac function by f-TAPSE and f-VSF. 14,31 The greatest disadvantage of the real-time M-mode is achieving an adequate fetal position and the need for minimal fetal movements and maternal breathing. STIC enables the acquisition and offline analysis of 3D fetal heart volume, with less dependence on the fetal position and experience of the examiner.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] Another parameter frequently evaluated using the M-mode is the ventricular shortening fraction (VSF), which is abnormal in fetuses of pregnant women with preexisting diabetes. 14 The evaluation of fetal cardiac function using three-dimensional ultrasonography (3DUS) and spatiotemporal image correlation (STIC), virtual organ computer-aided analysis (VOCAL), and automated volume calculation (SonoAVC) softwares was shown to be reproducible in the evaluation of stroke volume, fraction ejection, and cardiac output in normal fetuses. [15][16][17] STIC M-mode enables the easy acquisition of the plane of four chambers via offline analysis of fetal heart volume.…”

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confidence: 99%

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Fetal Heart Function by Tricuspid Annular Plane Systolic Excursion and Ventricular Shortening Fraction Using STIC M-Mode: Reference Ranges and Validation

et al. 2017

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Objective To determine the reference values for fetal tricuspid annular plane systolic excursion (f-TAPSE) and fetal ventricular shortening fraction (f-VSF) using spatiotemporal image correlation (STIC) with M-mode, and validate these curves in fetuses of pregnant women with preexisting diabetes mellitus (DM) and with intrauterine growth restriction (IUGR). Study Design Crosssectional study assessed 300 fetal cardiac volumes of normal pregnancies between 20 and 33 + 6 weeks of gestation. For the construction of the reference curves, we used a polynomial regression model adjusted with the coefficient of determination (R2). For the calculation of reproducibility, the concordance correlation coefficient (CCC) was used. Results f-TAPSE value correlated with gestational age (GA, R2 = 0.46), whereas fetal right ventricular shortening fraction (f-RVSF, R2 = 0.02) and fetal left ventricular shortening fraction (f-LVSF, R2 = 0.005) did not vary with GA. Fetuses of pregnant women with preexisting DM (30) had lower values of f-RVSF (p = 0.028), f-LVSF (p = 0.001), and f-TAPSE (p = 0.009) than normal fetuses. The f-TAPSE values were lower (p = 0.005) in IUGR group (17). The f-TASPSE values showed adequate reliability as well as good intra and interobserver concordance (CCC = 0.95 and 0.79, respectively). Conclusion The reference ranges for f-TAPSE, f-RVSF, and f-LVSF using the STIC M-mode were established and had good reproducibility for f-TAPSE measurements.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Fetal Heart Function by Tricuspid Annular Plane Systolic Excursion and Ventricular Shortening Fraction Using STIC M-Mode: Reference Ranges and Validation

et al. 2017

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“…The MPI is calculated using a formula for which the isovolumetric contraction time (ICT) plus isovolumetric relaxation time (IRT) is divided by ejection time (ET) ([ICT + IRT]/ET) . Isovolumetric contraction time (ICT) is related to systolic function, while IRT is related to diastolic function . As the heart rate or ventricular structure or gestational age is less likely to affect the result of equation, the MPI mainly depends on the elapsed times .…”

Section: Functional Evaluationmentioning

confidence: 99%

Exposure of the developing heart to diabetic environment and early cardiac assessment: A review

et al. 2018

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Hyperglycemia during organogenesis is associated with an increased risk of congenital cardiac defects (CHDs). The pathophysiology leading to CHDs is not completely uncovered. However, elevated oxidative stress is considered to be the primary trigger that causes CHDs in fetuses of diabetic mothers. Maternal diabetes has been found to increase the risk for all types of CHDs. Diabetes may also impact the fetal cardiac performance at all gestational ages. Early detection of CHDs has certain advantages, such as making early decision about termination of pregnancy, enabling early genetic testing, and early reassurance if scan is normal. Combined transabdominal and transvaginal approach at 13-14 weeks of gestation is a reasonable strategy to assess fetal heart in diabetic women. Diagnostic accuracy of early fetal echocardiography has reached to above a reasonable cutoff when it is done in the late first trimester or early second trimester in the hands of expert sonographers. However, the literature is less certain to provide a firm conclusion about functional heart assessment in fetuses of diabetic mothers.

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“…Hypertrophic cardiomyopathy affects the right ventricle and the posterior left ventricular wall, but the septal hypertrophy is more evident because of the large number of insulin receptors in the septum of the heart. 9,19,20 In our study, we observed that only 2 of the 34 fetuses with HCM exhibited alterations in the left ventricular wall, but none of them exhibited alterations in the septum.…”

Section: Discussionmentioning

confidence: 52%

“…[6][7][8] An increase in the ventricular wall thickness may also be involved in the cardiac changes observed in fetuses of mothers with GDM, but septal hypertrophy is more studied because of the higher number of insulin receptors in the septum of the heart. 9 Prenatal HCM is diagnosed through intrauterine two-dimensional echocardiography, and, based on the results, physicians may provide appropriate postnatal care and follow-up for cardiac hypertrophy progression during the gestational period. 10 Some authors claim that fetal echocardiography should be recommended to all pregnant women with GDM.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment

Palmieri

Simões²,

Silva

et al. 2017

Rev Bras Ginecol Obstet

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Objective To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) in fetuses of pregnant women with gestational diabetes mellitus (GDM) in the beginning of the treatment. Methods A cross-sectional study was performed between July 1, 2013, and December 20, 2013, in a public maternity clinic in southern Brazil. The subjects were 63 fetuses of mothers with gestational diabetes, with a single pregnancy and no other associated pathologies. We diagnosed HCM through a fetal echocardiography before treatment and evaluated the maternal and fetal characteristics. Results The average age of the pregnant women was 32.32 (AE6.2) years, and the average gestational age at the time of the evaluation was 30.59 (AE2.27) weeks. The interventricular septum thickness showed a standard deviation of more than two in 50.8% of the fetuses (95% confidence interval [95%CI]: 38.1-63.5%). The left ventricular wall thickness showed a standard deviation of more than 2 in 13 (20.6%) fetuses (95%CI: 11.1-30.2%). The HCM was confirmed in 54% of the fetuses (95%CI: 41.3-65.1%). The fetal abdominal circumference was normal in 46 (73%) fetuses, and 50% of these fetuses had HCM. Conclusion The prevalence of hypertrophic cardiomyopathy in fetuses of pregnant women with GDM before treatment was of 54% (95%CI: 41.3-65.1%).

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Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies

Abstract: Fetuses of women with well-controlled gestational diabetes lack the diastolic dysfunction that is present in fetuses of women with pre-existing diabetes.

Cited by 35 publications

References 16 publications

Fetal Heart Function by Tricuspid Annular Plane Systolic Excursion and Ventricular Shortening Fraction Using STIC M-Mode: Reference Ranges and Validation

Fetal Heart Function by Tricuspid Annular Plane Systolic Excursion and Ventricular Shortening Fraction Using STIC M-Mode: Reference Ranges and Validation

Exposure of the developing heart to diabetic environment and early cardiac assessment: A review

Prevalence of Hypertrophic Cardiomyopathy in Fetuses of Mothers with Gestational Diabetes before Initiating Treatment

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