Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM- UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba, MG, Brazil.
Int J Cardiovasc Imaging. 2020 Jul;36(7):1237-1247. doi: 10.1007/s10554-020-01821-9. Epub 2020 Mar 31.
The aim of this study was to evaluate the impact of pregestational diabetes mellitus (DM) on fetal cardiac function two-dimensional parameters using spectral and tissue Doppler. Pregnant women between 20 and 36 + 6 weeks gestation were divided into three groups: controls, type I DM, and type II DM. The right ventricle (RV) and left ventricle (LV) annular velocity peaks were measured using spectral (E, A) and tissue (E', A', S') Doppler. The myocardial performance index was calculated as (isovolumetric contraction time [ICT] + isovolumetric relaxation time [IRT])/ejection time using tissue (MPI') and the spectral Doppler (MPI). A general linear model, with fetal heart rate as a covariant, was used to evaluate the effect of DM on the fetal heart function assessment parameters. To assess the association of type I and II DM with adverse perinatal outcomes, Fisher's exact test was used. A receiver operating characteristic curve was used to determine the best cutoff for fetal cardiac function assessment parameters to identify the neonatal composite outcomes. The sample comprised 179 pregnant women. DM had significant effect on RV and LV A peak velocities (p = 0.026 and p = 0.011, respectively). LV ICT (p < 0.001) and LV MPI (p < 0.001) were significantly affected by maternal DM. Fetuses from pregnant women with type II DM showed significantly higher LV MPI (0.492 vs. 0.459, p = 0.006) and RV S' (7.2 vs. 6.44 cm/s, p = 0.024) than controls. Fetuses from type I DM pregnant women showed increase in cardiac parameters that evaluated the LV and RV diastolic function (LV IRT' p < 0.001 and RV MPI' p = 0.044). Type I and II DM were associated with adverse perinatal outcomes: neonatal intensive care unit stay (p < 0.0001), macrosomia (p < 0.0001), hyperbilirubinemia (p < 0.0001), and hypoglycemia (p < 0.0001). The LV MPI' showed significant but moderate sensitivity in identifying the composite neonatal outcomes (AUC: 0.709, 95% CI 0.629-0.780, p < 0.001). Tissue Doppler and MPI parameters can be useful to detect subclinical cardiac dysfunction in the fetal heart of pregestational DM pregnant women.
本研究旨在使用频谱和组织多普勒评估孕前糖尿病（DM）对胎儿心脏功能二维参数的影响。将 20 至 36+6 周妊娠的孕妇分为三组：对照组、I 型 DM 组和 II 型 DM 组。使用频谱（E、A）和组织（E'、A'、S'）多普勒测量右心室（RV）和左心室（LV）环形速度峰值。使用组织多普勒（MPI'）和频谱多普勒（MPI）计算心肌做功指数（等容收缩时间[ICT]+等容舒张时间[IRT]）/射血时间。使用一般线性模型，以胎儿心率为协变量，评估 DM 对胎儿心脏功能评估参数的影响。为了评估 I 型和 II 型 DM 与不良围生期结局的关系，使用 Fisher 确切检验。使用受试者工作特征曲线确定胎儿心脏功能评估参数的最佳截断值，以识别新生儿复合结局。该样本包括 179 名孕妇。DM 对 RV 和 LV A 峰值速度有显著影响（p=0.026 和 p=0.011）。LV ICT（p<0.001）和 LV MPI（p<0.001）受母体 DM 显著影响。与对照组相比，患有 II 型 DM 的孕妇的胎儿 LV MPI（0.492 与 0.459，p=0.006）和 RV S'（7.2 与 6.44cm/s，p=0.024）明显升高。患有 I 型 DM 的孕妇的胎儿表现出 LV 和 RV 舒张功能评估的心脏参数增加（LV IRT' p<0.001 和 RV MPI' p=0.044）。I 型和 II 型 DM 与不良围生期结局相关：新生儿重症监护病房入住（p<0.0001）、巨大儿（p<0.0001）、高胆红素血症（p<0.0001）和低血糖症（p<0.0001）。LV MPI' 在识别新生儿复合结局方面具有显著但中等的敏感性（AUC：0.709，95%CI 0.629-0.780，p<0.001）。组织多普勒和 MPI 参数可用于检测孕前 DM 孕妇胎儿心脏的亚临床心功能障碍。
