Fetal Cardiac Function in Maternal Diabetes: A Conventional and Speckle-Tracking Echocardiographic Study

Abstract

Intrauterine exposure to a diabetic environment is associated with adverse fetal myocardial remodeling. The aim of this study was to assess the biventricular systolic and diastolic function of fetuses exposed to maternal diabetes (MD) compared with control subjects, using a comprehensive cardiac functional assessment and exploring the role of speckle-tracking to assess myocardial deformation. The authors hypothesized that fetuses exposed to MD present signs of biventricular dysfunction, which can be detected by deformation analysis. A cross-sectional study was conducted in 129 fetuses with structurally normal hearts, including 76 fetuses of mothers with diabetes and 53 of mothers without diabetes. Maternal baseline characteristics, standard fetoplacental Doppler indices, and conventional echocardiographic and myocardial deformation parameters were prospectively collected at 30 to 33weeks of gestation. Fetuses of mothers with diabetes had a significantly thicker interventricular septum compared with control subjects (median, 4.25mm [interquartile range (IQR), 3.87-4.50mm] vs 3.67mm [IQR, 3.40-3.93mm), P<.001), but no effect modification was demonstrated on myocardial deformation analysis. No significant differences were found in conventional systolic and diastolic functional parameters for the left ventricle and right ventricle, except for lower left ventricular cardiac output in the MD group (median, 320mL/min [IQR, 269-377mL/min] vs 365mL/min [IQR, 311-422mL/min], P<.05]. Deformation analysis demonstrated a significantly lower early diastolic strain rate (SRe) and late diastolic strain rate (SRa) for both ventricles in the MD group (left ventricle: SRe 1.85±0.72 vs 2.26±0.68sec-1, SRa 1.50±0.52 vs 1.78±0.57sec-1; right ventricle: SRe 1.57±0.73 vs 1.97±0.73sec-1, SRa 2±0.77 vs 1.68±0.79sec-1; P<.05), suggesting biventricular diastolic impairment. Additionally, the right ventricle presented a lower global longitudinal strain in the study group (-13.67±4.18% vs -15.52±3.86%, P<.05). Multivariate analysis revealed that maternal age is an independent predictor of left and right ventricular global longitudinal strain (P<.05), with a significant effect only in MD after group stratification. Fetuses of mothers with diabetes present signs of biventricular diastolic dysfunction and right ventricular systolic dysfunction by deformation analysis in the third trimester of pregnancy. They may represent a special indication group for functional cardiac assessment, independently of septal hypertrophy. Two-dimensional speckle-tracking could offer an additional benefit over conventional echocardiography to detect subclinical unfavorable changes in myocardial function in this population.