Speckle Tracking and Myocardial Tissue Imaging in Infant of Diabetic Mother with Gestational and Pregestational Diabetes

Abstract

The aim of this study was to evaluate the myocardial changes in infants of diabetic mother either with gestational or pregestational diabetes and its relation to maternal diabetic control. The study included 45 infants of diabetic mother (IDMs) and 45 healthy newborn as a control group. IDMs were then categorized into 2 subgroups: twenty infants of mother with pregestational diabetes and twenty-five infants of mothers with gestational diabetes. The studied groups underwent measurement of the maternal and neonatal glycated Hb % (HbA1c), conventional echocardiography, tissue Doppler imaging (TDI) and two-dimensional speckle tracking imaging (STI). The weight, the rate of complications, and the rate of cesarean section were significantly higher in the IDMs group than in the control group. Significant positive correlation was present between the levels of HbA1c of IDMs and HbA1c of their mothers (P < 0.05). A significant deterioration of both systolic and diastolic functions measured by both conventional echocardiography and TDI was present in IDMs with both pre-gestational and gestational diabetes compared with the control group. Also, the septal/posterior wall ratio (SW/PW) was significantly higher in pregestational (1.86 ± 0.3) and gestational (2 ± 0.4) groups than in the control group (1 ± 0.06). Two-dimensional STI showed that the cardiac torsion was significantly impaired in pre-gestational (9.66 ± 2.5) and gestational (8.66 ± 3.9) groups when compared with the control group (5.4 ± 2.4) [P < 0.0001]. It also showed that the global strain was significantly impaired in pre-gestational (-10.4 ± 3.2) and gestational (-13.1 ± 4.7) groups when compared with the control group (-19 ± 2) [P < 0.0001]. However, no significant differences were present among the two patients' subgroups in echocardiographic data except for a significant decrease of E'/A' ratio and S wave at tricuspid annulus derived by TDI and impaired global strain derived by STI in infants of mothers with pre-gestational DM than those with gestational DM [P = 0.02]. SW/PW and cardiac torsion were significantly higher in infant of diabetic mother than the normal newborn and on the contrary systolic function and global strain were significantly lower in IDMs especially in infants of mother with pre-gestational diabetes. All the previous TDI findings did not show any significant correlation to neither maternal nor fetal HbA1c. Also, there was no significant correlation between cardiac torsion and the rest of TDI data neither in IDMs group nor in the control group. TDI and two-dimensional STI were efficient and sensitive tools able to early detect cardiac dysfunction in IDMs even in the absence of morphologic cardiac changes.

Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

“…Tissue Doppler was able to detect both systolic and diastolic dysfunction than conventional Doppler in infants of diabetic mothers with hypertrophic cardiomyopathy when compared to the control group. This higher sensitivity of tissue Doppler over the conventional Doppler was previously reported in various studies [20,29,30]. We also found that Tei index was more sensitive than left or right ventricle fractional shortening in detecting impaired cardiac performance.…”

“…Hypertrophic cardiomyopathy was diagnosed when the absolute values of inter ventricular septum and left ventricular posterior wall diameters were above normal ranges, and in addition, the ratio of left ventricular septum in diastole to the left ventricular posterior wall in diastole exceeded 1.3 [20].…”

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

“…Forty-one datasets with 2084 patients were eligible for the meta-analysis of GLS or LS ; 7-24,26-34,36-49 26 datasets with 1506 patients were eligible for the meta-analysis of GCS or CS , 7,9,11,12,14-20,23,25,26,28-31,33,34,41-44,46,48 and 15 datasets with 1092 patients were eligible for the meta-analysis of GRS or RS. 11,15,16,19,20,23,25,26,28,29,33,41-43,46 The patient characteristics of the included studies are listed in Table 1.…”

“…All the studies used a deformation imaging acquisition and post-processing protocol. Reproducibility analysis was performed in 32/43 7-10,14-21,23-27,33,35-46,48,49 datasets and referenced in 4/43. 11,30,31,47 …”

“…7,8,10-13,16-19,21,22,28-34,36-38,40,42,43,48 (There were four datasets that reported both the GLS and the LS from the apical 4-chamber view only. 19,28,30,33 ) The normal mean values of LS varied from -15.1% to -24.8% (mean -20.4, 95% CI -19.8% to -21.7%), (Figure 2b).…”