Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

Sebastian Imre Sarvari; Merida Rodriguez-Lopez; Marta Nuñez-Garcia; Marta Sitges; Alvaro Sepulveda-Martinez; Oscar Camara; Constantine Butakoff; Eduard Gratacos; Bart Bijnens; Fatima Crispi

doi:10.1161/CIRCIMAGING.116.005270

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

Circ Cardiovasc Imaging. 2017 Jan;10(1):e005270. doi: 10.1161/CIRCIMAGING.116.005270.

Affiliations

¹ From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
² From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.). fcrispi@clinic.ub.es.

PMID: 28093413
DOI: 10.1161/CIRCIMAGING.116.005270

Abstract

Background: Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. We evaluated whether prenatal cardiovascular changes previously demonstrated in FGR persist into preadolescence.

Methods and results: A cohort study of 58 FGR (defined as birth weight below 10th centile) and 94 normally grown fetuses identified in utero and followed-up into preadolescence (8-12 years of age) by echocardiography and 3-dimensional shape computational analysis. Compared with controls, FGR preadolescents had a different cardiac shape, with more spherical and smaller hearts. Left ventricular ejection fraction was similar among groups, whereas FGR had decreased longitudinal motion (decreased mitral annular systolic peak velocities: control median, 0.11 m/s [interquartile range, 0.09-0.12] versus FGR median 0.09 m/s [interquartile range, 0.09-0.10]; P<0.01) and impaired relaxation (isovolumic relaxation time: control, 0.21 ms [interquartile range, 0.12-0.35] versus FGR, 0.35 ms [interquartile range, 0.20-0.46]; P=0.04). Global longitudinal strain was decreased (control mean, -22.4% [SD, 1.37] versus FGR mean, -21.5% [SD, 1.16]; P<0.001) compensated by an increased circumferential strain and with a higher prevalence of postsystolic shortening in FGR as compared with controls. These differences persisted after adjustment for parental ethnicity and smoking, prenatal glucocorticoid administration, preeclampsia, gestational age at delivery, days in intensive care unit, sex, age, and body surface area at evaluation.

Conclusions: This study provides evidence that cardiac remodeling induced by FGR persists until preadolescence with findings similar to those reported in their prenatal life and childhood. The findings support the hypothesis of primary cardiac programming in FGR for explaining the association between low birth weight and cardiovascular risk in adulthood.

Keywords: adult; birth weight; cardiovascular disease; echocardiography; pregnancy.

MeSH terms

Age Factors
Cardiovascular Diseases / diagnostic imaging
Cardiovascular Diseases / etiology
Cardiovascular Diseases / physiopathology*
Case-Control Studies
Child
Echocardiography, Doppler
Echocardiography, Three-Dimensional
Female
Fetal Growth Retardation / diagnostic imaging
Fetal Growth Retardation / physiopathology*
Fetal Heart / diagnostic imaging
Fetal Heart / physiopathology*
Humans
Image Interpretation, Computer-Assisted
Male
Myocardial Contraction
Predictive Value of Tests
Prognosis
Prospective Studies
Puberty
Risk Factors
Stroke Volume
Ultrasonography, Prenatal / methods
Ventricular Function, Left*
Ventricular Remodeling*