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Subclinical Decrease in Myocardial Function in Asymptomatic Infants of Diabetic Mothers: A Tissue Doppler Study.
Jenny E Zablah1, Dorota Gruber1, Guillaume Stoffels2
1Division of Pediatric Cardiology, Cohen Children's Medical Center at Northwell Health, 269-01 76th Ave, Suite 139, New Hyde Park, New York, NY, 11040, USA.
Pediatric Cardiology
|February 16, 2017
Summary
Infants of diabetic mothers (IDMs) show subclinical cardiac dysfunction, even without hypertrophy. Pulsed wave tissue Doppler imaging (TDI) reveals impaired systolic and diastolic function in these newborns compared to infants of non-diabetic mothers.
Area of Science:
- Cardiology
- Neonatology
- Pediatric Cardiology
Background:
- Infants of diabetic mothers (IDMs) are known to have impaired myocardial performance, particularly those with hypertrophic cardiomyopathy.
- Ventricular function in IDMs without cardiac hypertrophy is less understood.
- Early detection of subclinical cardiac changes is crucial for timely intervention.
Purpose of the Study:
- To investigate subclinical cardiac function in asymptomatic newborns of diabetic mothers (IDMs) without hypertrophy.
- To compare myocardial performance between IDMs and infants of non-diabetic mothers (nIDMs) using pulsed wave tissue Doppler imaging (TDI).
- To identify potential early indicators of cardiac dysfunction in IDMs.
Main Methods:
- Retrospective cohort study of asymptomatic neonates (≥36 weeks gestation, 0-7 days old) with normal echocardiograms.
- Pulsed wave tissue Doppler imaging (TDI) measured mitral annular systolic (S'), early diastolic (E'), and late diastolic (A') velocities.
- Variables compared included gestational age, birth weight, body surface area, maternal age, obesity, hypertension, and TDI parameters.
Main Results:
- IDMs (n=75) had significantly higher birth weight and BSA, lower gestational age, older maternal age, and higher rates of maternal obesity and hypertension than nIDMs (p<0.001).
- Multivariable analysis revealed significantly lower S' (p≤0.03) and E' (p<0.001) velocities, and higher E/E' ratios (p<0.001) at the mitral valve, interventricular septum, and tricuspid valve in IDMs.
- These findings suggest subclinical systolic and diastolic myocardial dysfunction in asymptomatic newborn IDMs without cardiac hypertrophy.
Conclusions:
- Pulsed wave TDI can detect subclinical myocardial dysfunction in asymptomatic newborn infants of diabetic mothers even in the absence of cardiac hypertrophy.
- IDMs exhibit impaired systolic and diastolic cardiac function compared to nIDMs, detectable by TDI.
- TDI is a valuable tool for assessing early cardiac changes in IDMs, potentially guiding future preventative strategies.
