von Arx Robert, Allemann Yves, Sartori Claudio, Rexhaj Emrush, Cerny David, de Marchi Stefano F, Soria Rodrigo, Germond Marc, Scherrer Urs, Rimoldi Stefano F
Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland;
Department of Internal Medicine, University Hospital, Lausanne, Switzerland;
J Appl Physiol (1985). 2015 May 15;118(10):1200-6. doi: 10.1152/japplphysiol.00533.2014. Epub 2015 Apr 2.
Assisted reproductive technologies (ART) predispose the offspring to vascular dysfunction, arterial hypertension, and hypoxic pulmonary hypertension. Recently, cardiac remodeling and dysfunction during fetal and early postnatal life have been reported in offspring of ART, but it is not known whether these cardiac alterations persist later in life and whether confounding factors contribute to this problem. We, therefore, assessed cardiac function and pulmonary artery pressure by echocardiography in 54 healthy children conceived by ART (mean age 11.5 ± 2.4 yr) and 54 age-matched (12.2 ± 2.3 yr) and sex-matched control children. Because ART is often associated with low birth weight and prematurity, two potential confounders associated with cardiac dysfunction, only singletons born with normal birth weight at term were studied. Moreover, because cardiac remodeling in infants conceived by ART was observed in utero, a situation associated with increased right heart load, we also assessed cardiac function during high-altitude exposure, a condition associated with hypoxic pulmonary hypertension-induced right ventricular overload. We found that, while at low altitude cardiac morphometry and function was not different between children conceived by ART and control children, under the stressful conditions of high-altitude-induced pressure overload and hypoxia, larger right ventricular end-diastolic area and diastolic dysfunction (evidenced by lower E-wave tissue Doppler velocity and A-wave tissue Doppler velocity of the lateral tricuspid annulus) were detectable in children and adolescents conceived by ART. In conclusion, right ventricular dysfunction persists in children and adolescents conceived by ART. These cardiac alterations appear to be related to ART per se rather than to low birth weight or prematurity.
辅助生殖技术（ART）使后代易患血管功能障碍、动脉高血压和低氧性肺动脉高压。最近，有报道称ART后代在胎儿期和出生后早期存在心脏重塑和功能障碍，但尚不清楚这些心脏改变在生命后期是否持续存在，以及混杂因素是否导致了这一问题。因此，我们通过超声心动图评估了54名通过ART受孕的健康儿童（平均年龄11.5±2.4岁）和54名年龄匹配（12.2±2.3岁）及性别匹配的对照儿童的心脏功能和肺动脉压力。由于ART常与低出生体重和早产相关，这两个是与心脏功能障碍相关的潜在混杂因素，所以仅研究了足月出生且出生体重正常的单胎婴儿。此外，由于在子宫内观察到ART受孕婴儿的心脏重塑，这与右心负荷增加的情况相关，我们还评估了高原暴露期间的心脏功能，这是一种与低氧性肺动脉高压引起的右心室超负荷相关的情况。我们发现，虽然在低海拔地区，ART受孕儿童和对照儿童的心脏形态学和功能没有差异，但在高原诱导的压力超负荷和缺氧这种应激条件下，ART受孕的儿童和青少年中可检测到更大的右心室舒张末期面积和舒张功能障碍（由三尖瓣环外侧的E波组织多普勒速度和A波组织多普勒速度降低证明）。总之，ART受孕的儿童和青少年存在右心室功能障碍。这些心脏改变似乎与ART本身有关，而非与低出生体重或早产有关。
