Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
Department of Cardiology, Institut Clínic del Tòrax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
Am J Obstet Gynecol. 2014 Jun;210(6):552.e1-552.e22. doi: 10.1016/j.ajog.2013.12.031. Epub 2013 Dec 22.
Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants.
One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of >95th percentile together with aortic intima-media thickness of >75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes.
Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P < .001).
Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.
宫内生长受限（IUGR）胎儿经历心血管重塑，这种重塑会持续到婴儿期，并与成年后的心血管结局有关。婴儿期高血压已被证明是成年后心血管疾病的一个强有力的危险因素。密切监测和饮食干预已被证明可以改善高血压儿童的心血管健康；然而，并非所有 IUGR 婴儿都表现出血压升高。我们评估了胎儿超声心动图在预测 6 月龄 IUGR 婴儿高血压和动脉重塑方面的潜力。
连续观察了 100 例 IUGR 和 100 例对照胎儿进入婴儿期。胎儿评估包括围产期多普勒成像、心脏形态测量、射血分数、心输出量、等容舒张时间（IVRT）、三尖瓣环平面收缩期位移（TAPSE）和组织多普勒成像。婴儿期高血压和动脉重塑定义为 6 个月龄时平均血压>第 95 百分位数，同时主动脉内中膜厚度>第 75 百分位数。获得了与婴儿结局相关的胎儿参数的比值比。
胎儿 TAPSE、右球体指数、IVRT 和脑胎盘比是预测新生儿血管重塑的最强预测因子。基于胎儿 TAPSE、脑胎盘比、右球体指数和 IVRT 的心血管风险评分对婴儿高血压和动脉重塑具有高度预测性（曲线下面积，0.87；95%置信区间，0.79-0.93；P<.001）。
胎儿超声心动图参数可识别 IUGR 胎儿中的高危人群，这些人群可作为血压和其他心血管危险因素的早期筛查目标，并促进健康饮食和体育锻炼。
