Coutinho Conrado Milani, Giorgione Veronica, Thilaganathan Basky, Patey Olga
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK.
Department of Gynecology and Obstetrics, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
BJOG. 2025 Jan;132(2):189-196. doi: 10.1111/1471-0528.17956. Epub 2024 Sep 16.
To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR).
Prospective longitudinal study.
Fetal Medicine Unit.
Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months).
Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography.
Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups.
Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (-19.0 vs. -16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all).
Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.
研究胎儿生长受限（FGR）中胎儿及子代心血管适应性的纵向变化趋势。
前瞻性纵向研究。
胎儿医学科。
35例FGR妊娠孕妇及37例健康对照者，在足月胎儿期（平均年龄37±1周）及婴儿期（平均年龄8±2个月）进行评估。
采用传统超声心动图技术、组织多普勒成像及斑点追踪超声心动图。
左心室（LV）和右心室（RV）的形态及功能。通过调整心室大小以校正组间体重差异，对超声心动图参数进行标准化。
与健康对照者相比，晚期FGR胎儿心脏形态有显著改变，左心室腔更呈球形（左心室球形指数，0.56对0.52），双心室整体纵向收缩期收缩力增加（平均心房肌峰值位移，0.29对0.25mm；三尖瓣环平面收缩期位移，0.42对0.37mm），心输出量升高（联合心输出量：592对497mL/min/kg，所有指标p<0.01）。FGR胎儿左心室舒张功能指标明显受损，心肌舒张速度（左心室A'，0.30对0.26cm/s；室间隔E'，0.19对0.16cm/s）及左心室扭转（1.2对3.5°/cm，所有指标p<0.01）。产后评估时，FGR子代显示平均心房肌峰值位移持续增加（0.27对0.24mm），左心室纵向应变降低（-19.0对-16.0%），左心室扭转减少（1.6对2.1°/cm），心输出量升高（791对574mL/min/kg，所有指标p<0.01）。
晚期FGR胎儿围产期心脏重塑及心肌功能障碍很可能是由于慢性胎盘低氧血症所致。FGR子代心脏形态和功能的持续变化可能反映了胎儿心血管适应不良，这可能使他们在以后的生活中易患长期心血管并发症。
