Comprehensive assessment of biventricular myocardial function by two-dimensional speckle tracking echocardiography in infants of gestational diabetic mothers

• Published in: Acta diabetologica Vol. 59; no. 9; pp. 1145 - 1156
• Main Authors: Sonaglioni, Andrea, Braga, Marta, Villa, Maria Cristina, Ferrulli, Anna, Nicolosi, Gian Luigi, Lombardo, Michele, Migliori, Claudio, Luzi, Livio
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.09.2022; Springer Nature B.V
• Subjects: Birth; Body mass index; Diabetes; Diabetes mellitus; Echocardiography; Heart; Hemoglobin; Infants; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Original Article; Pregnancy and diabetes; Ventricle; Radial strain; Body mass index; Longitudinal strain; Gestational diabetes mellitus; Glycosylated hemoglobin; Infants; Circumferential strain
• ISSN: 1432-5233; 0940-5429; 1432-5233
• DOI: 10.1007/s00592-022-01906-y

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.