Three-dimensional echocardiography and cardiac strain imaging in women with gestational diabetes mellitus

A. M. Company Calabuig; E. Nunez; A. Sánchez; K. H. Nicolaides; M. Charakida; C. De Paco Matallana

doi:10.1002/uog.23666

Three-dimensional echocardiography and cardiac strain imaging in women with gestational diabetes mellitus

A. M. Company Calabuig, E. Nunez, A. Sánchez, K. H. Nicolaides^*, M. Charakida, C. De Paco Matallana

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Objectives: Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional changes in the left ventricle have been reported during pregnancy in women with GDM using conventional echocardiography, but results are inconsistent. The aims of the current study were to assess whether GDM is associated with biventricular systolic dysfunction in the mother and whether these cardiac changes can be detected using the novel echocardiographic modalities of strain imaging and three-dimensional (3D) echocardiography. Methods: This was a cross-sectional study in women with GDM and controls examined at 26–40 weeks of gestation. All women underwent echocardiography, and 3D volumes of the left and right ventricles and left atrium were collected. Ejection fraction and left ventricular mass were measured using 3D echocardiography. Left ventricular mass was indexed to body surface area. Speckle-tracking echocardiography was used to assess global longitudinal strain of the left and right ventricles and strain of the left atrium. Results: The study population included 123 women with GDM and 246 controls. Women with GDM, compared to controls, were older (35.1 ± 5.2 vs 32.4 ± 5.5 years; P < 0.001), had higher body mass index (30.6 (interquartile range (IQR), 26.2–35.2) vs 27.5 (IQR, 24.7–30.7) kg/m²; P < 0.001) and had higher systolic blood pressure (119.9 ± 11.2 vs 116.4 ± 12.0 mmHg; P = 0.007). In all women with GDM, there was good glycemic control. In women with GDM, compared to controls, there was lower global longitudinal strain of the left ventricle (−19.3% (IQR, −21.4 to −17.6%) vs −20.1% (IQR, −22.1 to −18.7%); P = 0.002) and right ventricle (−22.2% (IQR, −26.1 to −19.8%) vs −24.1% (IQR, −27.0 to −21.9%); P < 0.001). There was no significant difference between the groups in ejection fraction, left ventricular mass, diastolic function assessed by left atrial strain, or 3D functional indices. Conclusions: Women with GDM, compared to women with uncomplicated pregnancy, have lower left and right ventricular myocardial deformation. Volumetric assessment using 3D echocardiography does not provide additional information about maternal cardiac function. Strain imaging is a sensitive echocardiographic modality to detect early cardiac functional changes in women with GDM. Further studies are needed to assess the pattern of deterioration of cardiac function with advancing age in women with a history of GDM.

Original language	English
Pages (from-to)	278-284
Number of pages	7
Journal	Ultrasound in Obstetrics and Gynecology
Volume	58
Issue number	2
Early online date	5 Jul 2021
DOIs	https://doi.org/10.1002/uog.23666
Publication status	Published - Aug 2021

Keywords

deformation
ejection fraction
three-dimensional echocardiography

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/uog.23666

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@article{6e3ef0b30378435f938ff92fef22d88b,

title = "Three-dimensional echocardiography and cardiac strain imaging in women with gestational diabetes mellitus",

abstract = "Objectives: Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional changes in the left ventricle have been reported during pregnancy in women with GDM using conventional echocardiography, but results are inconsistent. The aims of the current study were to assess whether GDM is associated with biventricular systolic dysfunction in the mother and whether these cardiac changes can be detected using the novel echocardiographic modalities of strain imaging and three-dimensional (3D) echocardiography. Methods: This was a cross-sectional study in women with GDM and controls examined at 26–40 weeks of gestation. All women underwent echocardiography, and 3D volumes of the left and right ventricles and left atrium were collected. Ejection fraction and left ventricular mass were measured using 3D echocardiography. Left ventricular mass was indexed to body surface area. Speckle-tracking echocardiography was used to assess global longitudinal strain of the left and right ventricles and strain of the left atrium. Results: The study population included 123 women with GDM and 246 controls. Women with GDM, compared to controls, were older (35.1 ± 5.2 vs 32.4 ± 5.5 years; P < 0.001), had higher body mass index (30.6 (interquartile range (IQR), 26.2–35.2) vs 27.5 (IQR, 24.7–30.7) kg/m2; P < 0.001) and had higher systolic blood pressure (119.9 ± 11.2 vs 116.4 ± 12.0 mmHg; P = 0.007). In all women with GDM, there was good glycemic control. In women with GDM, compared to controls, there was lower global longitudinal strain of the left ventricle (−19.3% (IQR, −21.4 to −17.6%) vs −20.1% (IQR, −22.1 to −18.7%); P = 0.002) and right ventricle (−22.2% (IQR, −26.1 to −19.8%) vs −24.1% (IQR, −27.0 to −21.9%); P < 0.001). There was no significant difference between the groups in ejection fraction, left ventricular mass, diastolic function assessed by left atrial strain, or 3D functional indices. Conclusions: Women with GDM, compared to women with uncomplicated pregnancy, have lower left and right ventricular myocardial deformation. Volumetric assessment using 3D echocardiography does not provide additional information about maternal cardiac function. Strain imaging is a sensitive echocardiographic modality to detect early cardiac functional changes in women with GDM. Further studies are needed to assess the pattern of deterioration of cardiac function with advancing age in women with a history of GDM.",

keywords = "deformation, ejection fraction, three-dimensional echocardiography",

author = "{Company Calabuig}, {A. M.} and E. Nunez and A. S{\'a}nchez and Nicolaides, {K. H.} and M. Charakida and {De Paco Matallana}, C.",

note = "Funding Information: This study was funded by a grant from The Fetal Medicine Foundation (charity No: 1037116). The ultrasound machines for fetal echocardiography and the software for speckle‐tracking analysis were provided free‐of‐charge by Philips, Bothell, WA, USA. These bodies had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021 International Society of Ultrasound in Obstetrics and Gynecology. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = aug,

doi = "10.1002/uog.23666",

language = "English",

volume = "58",

pages = "278--284",

journal = "Ultrasound in Obstetrics and Gynecology",

issn = "0960-7692",

publisher = "John Wiley and Sons Ltd",

number = "2",

}

TY - JOUR

T1 - Three-dimensional echocardiography and cardiac strain imaging in women with gestational diabetes mellitus

AU - Company Calabuig, A. M.

AU - Nunez, E.

AU - Sánchez, A.

AU - Nicolaides, K. H.

AU - Charakida, M.

AU - De Paco Matallana, C.

N1 - Funding Information: This study was funded by a grant from The Fetal Medicine Foundation (charity No: 1037116). The ultrasound machines for fetal echocardiography and the software for speckle‐tracking analysis were provided free‐of‐charge by Philips, Bothell, WA, USA. These bodies had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. Publisher Copyright: © 2021 International Society of Ultrasound in Obstetrics and Gynecology. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/8

Y1 - 2021/8

N2 - Objectives: Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional changes in the left ventricle have been reported during pregnancy in women with GDM using conventional echocardiography, but results are inconsistent. The aims of the current study were to assess whether GDM is associated with biventricular systolic dysfunction in the mother and whether these cardiac changes can be detected using the novel echocardiographic modalities of strain imaging and three-dimensional (3D) echocardiography. Methods: This was a cross-sectional study in women with GDM and controls examined at 26–40 weeks of gestation. All women underwent echocardiography, and 3D volumes of the left and right ventricles and left atrium were collected. Ejection fraction and left ventricular mass were measured using 3D echocardiography. Left ventricular mass was indexed to body surface area. Speckle-tracking echocardiography was used to assess global longitudinal strain of the left and right ventricles and strain of the left atrium. Results: The study population included 123 women with GDM and 246 controls. Women with GDM, compared to controls, were older (35.1 ± 5.2 vs 32.4 ± 5.5 years; P < 0.001), had higher body mass index (30.6 (interquartile range (IQR), 26.2–35.2) vs 27.5 (IQR, 24.7–30.7) kg/m2; P < 0.001) and had higher systolic blood pressure (119.9 ± 11.2 vs 116.4 ± 12.0 mmHg; P = 0.007). In all women with GDM, there was good glycemic control. In women with GDM, compared to controls, there was lower global longitudinal strain of the left ventricle (−19.3% (IQR, −21.4 to −17.6%) vs −20.1% (IQR, −22.1 to −18.7%); P = 0.002) and right ventricle (−22.2% (IQR, −26.1 to −19.8%) vs −24.1% (IQR, −27.0 to −21.9%); P < 0.001). There was no significant difference between the groups in ejection fraction, left ventricular mass, diastolic function assessed by left atrial strain, or 3D functional indices. Conclusions: Women with GDM, compared to women with uncomplicated pregnancy, have lower left and right ventricular myocardial deformation. Volumetric assessment using 3D echocardiography does not provide additional information about maternal cardiac function. Strain imaging is a sensitive echocardiographic modality to detect early cardiac functional changes in women with GDM. Further studies are needed to assess the pattern of deterioration of cardiac function with advancing age in women with a history of GDM.

AB - Objectives: Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional changes in the left ventricle have been reported during pregnancy in women with GDM using conventional echocardiography, but results are inconsistent. The aims of the current study were to assess whether GDM is associated with biventricular systolic dysfunction in the mother and whether these cardiac changes can be detected using the novel echocardiographic modalities of strain imaging and three-dimensional (3D) echocardiography. Methods: This was a cross-sectional study in women with GDM and controls examined at 26–40 weeks of gestation. All women underwent echocardiography, and 3D volumes of the left and right ventricles and left atrium were collected. Ejection fraction and left ventricular mass were measured using 3D echocardiography. Left ventricular mass was indexed to body surface area. Speckle-tracking echocardiography was used to assess global longitudinal strain of the left and right ventricles and strain of the left atrium. Results: The study population included 123 women with GDM and 246 controls. Women with GDM, compared to controls, were older (35.1 ± 5.2 vs 32.4 ± 5.5 years; P < 0.001), had higher body mass index (30.6 (interquartile range (IQR), 26.2–35.2) vs 27.5 (IQR, 24.7–30.7) kg/m2; P < 0.001) and had higher systolic blood pressure (119.9 ± 11.2 vs 116.4 ± 12.0 mmHg; P = 0.007). In all women with GDM, there was good glycemic control. In women with GDM, compared to controls, there was lower global longitudinal strain of the left ventricle (−19.3% (IQR, −21.4 to −17.6%) vs −20.1% (IQR, −22.1 to −18.7%); P = 0.002) and right ventricle (−22.2% (IQR, −26.1 to −19.8%) vs −24.1% (IQR, −27.0 to −21.9%); P < 0.001). There was no significant difference between the groups in ejection fraction, left ventricular mass, diastolic function assessed by left atrial strain, or 3D functional indices. Conclusions: Women with GDM, compared to women with uncomplicated pregnancy, have lower left and right ventricular myocardial deformation. Volumetric assessment using 3D echocardiography does not provide additional information about maternal cardiac function. Strain imaging is a sensitive echocardiographic modality to detect early cardiac functional changes in women with GDM. Further studies are needed to assess the pattern of deterioration of cardiac function with advancing age in women with a history of GDM.

KW - deformation

KW - ejection fraction

KW - three-dimensional echocardiography

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U2 - 10.1002/uog.23666

DO - 10.1002/uog.23666

M3 - Article

AN - SCOPUS:85109029699

SN - 0960-7692

VL - 58

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JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

IS - 2

ER -

Three-dimensional echocardiography and cardiac strain imaging in women with gestational diabetes mellitus

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Keywords

UN SDGs

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