Abstract
Aims
No previous research provided a complete biventricular and multidirectional left ventricular (LV) functional assessment by two-dimensional (2D) speckle tracking echocardiography (STE) in infants of gestational diabetic mothers (IGDM)
Methods
A total of 30 consecutive IGDM and 30 infants of healthy mothers were examined between March 2021 and July 2021. Both groups of infants underwent evaluation by neonatologist and 2D transthoracic echocardiography (TTE) implemented with 2D-STE quantification of LV-global longitudinal strain (GLS), LV-global circumferential strain (GCS), LV-global radial strain (GRS) and right ventricular (RV)-GLS, within 3 days of life and at 40 days after birth. Predictors of persistent subclinical myocardial dysfunction, defined as a LVGLS less negative than -20% at 40-day follow-up, in IGDM population, were determined.
Results
At 2.2 ± 1.3 days after birth, LV-GLS (− 17.2 ± 1.9 vs. − 23.9 ± 3.8%), LV-GCS (− 17.9 ± 2.7 vs. − 27.3 ± 3.4%), LV-GRS (25.6 ± 3.4 vs. 35.8 ± 3.6%) and RV-GLS (− 17.6 ± 3.6 vs. − 22.6 ± 3.8%) were significantly impaired in IGDM than controls (all p < 0.001). At 36.8 ± 5.2 days of life, LV-GLS was still impaired (less negative than -20%) in 26.6% of IGDM. Maternal third trimester body mass index (BMI) (OR 1.89, 95%CI 1.05–3.39) and third trimester glycosylated hemoglobin (HbA1C) (OR 1.59, 95%CI 1.08–2.19) were independently associated with persistent LV-GLS impairment in IGDM. Maternal BMI ≥ 30 Kg/m2 and HbA1C ≥ 38 mmol/mol showed the maximum of sensitivity and specificity for predicting persistent subclinical myocardial dysfunction in IGDM at 40 days of life.
Conclusions
IGDM have diffuse pattern of myocardial dysfunction during perinatal period. This dysfunction may be persistent up to 40 days of life in infants of GDM women with obesity and uncontrolled diabetes.
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Abbreviations
- 2D:
-
Two-dimensional
- AUC:
-
Area under the curve
- BMI:
-
Body mass index
- BSA:
-
Body surface area
- CI:
-
Confidence interval
- DBP:
-
Diastolic blood pressure
- GCS:
-
Global circumferential strain
- GDM:
-
Gestational diabetes mellitus
- GLS:
-
Global longitudinal strain
- GRS:
-
Global radial strain
- HbA1C:
-
Glycosylated hemoglobin
- ICC:
-
Intraclass correlation coefficient
- IGDM:
-
Infants of gestational diabetic mothers
- LV:
-
Left ventricular
- LVEDD:
-
Left ventricular end-diastolic diameter
- LVEF:
-
Left ventricular ejection fraction
- LVOT:
-
Left ventricular outflow tract
- MAP:
-
Mean arterial pressure
- MAPSE:
-
Mitral annular plane systolic excursion
- PW:
-
Posterior wall
- ROC:
-
Receiver operating characteristics
- RV:
-
Right ventricular
- RWT:
-
Relative wall thickness
- SBP:
-
Systolic blood pressure
- SPAP:
-
Systolic pulmonary artery pressure
- STE:
-
Speckle tracking echocardiography
- SV:
-
Stroke volume
- TAPSE:
-
Tricuspid annular plane systolic excursion
- TTE:
-
Transthoracic echocardiography
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Acknowledgements
"This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica".
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Andrea Sonaglioni contributed to conceptualization; data curation; investigation; methodology; software; analysis; writing—original draft. Marta Braga helped in conceptualization; data curation; investigation; methodology; writing—original draft. Maria Cristina Villa contributed to conceptualization; data curation; investigation; methodology; writing—original draft. Anna Ferrulli helped in conceptualization; supervision; validation; writing—review and editing. Gian Luigi Nicolosi contributed to conceptualization; supervision; validation; writing—review and editing. Michele Lombardo, Claudio Migliori and Livio Luzi helped in conceptualization; supervision; validation; writing—review and editing.
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We wish to confirm that there are no conflicts of interest associated with this publication. Andrea Sonaglioni declares that he has no conflict of interest. Marta Braga declares that she has no conflict of interest. Maria Cristina Villa declares that she has no conflict of interest. Anna Ferrulli declares that she has no conflict of interest. Gian Luigi Nicolosi declares that he has no conflict of interest. Michele Lombardo declares that he has no conflict of interest. Claudio Migliori declares that he has no conflicts of interest. Livio Luzi declares that he has no conflicts of interest.
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All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from parents of each infant included in the study.
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Sonaglioni, A., Braga, M., Villa, M.C. et al. Comprehensive assessment of biventricular myocardial function by two-dimensional speckle tracking echocardiography in infants of gestational diabetic mothers. Acta Diabetol 59, 1145–1156 (2022). https://doi.org/10.1007/s00592-022-01906-y
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DOI: https://doi.org/10.1007/s00592-022-01906-y