The impact of maternal diabetes on fetal left atrial size and function

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Pathan ◽  
P Lam ◽  
S Sivapathan ◽  
S Orde ◽  
R Nanan ◽  
...  
Keyword(s):  
Gestational Age ◽  
Left Atrial ◽  
Smoking Status ◽  
Region Of Interest ◽  
Maternal Diabetes ◽  
Left Atrial Strain ◽  
Endocardial Border ◽  
And Function ◽  
The Impact ◽  
Diabetic Mothers

Abstract Introduction The developmental impact of maternal diabetes on the fetal left atrium (LA) is unclear. Purpose To determine if maternal diabetes mellitus (DM) impacts fetal LA size and function (fetal LA strain (LAS)). Methods We evaluated LA area (LAA) and LAS on fetuses of diabetic and control mothers who attended a mandated 24 week fetal morphology scan. Participants were excluded from the study if: there was a history of pre-eclampsia or if the fetus did not have adequate images for LAS analysis We used fetal cardiac 4-chamber view for analysis. A region of interest was drawn along the LA endocardial border for tracking and was used for assessment of maximum LAA. Baseline variables were compared using Student t test or Mann-Whitney U test and are presented as Mean ± Standard Deviation or Median (Interquartile range (IQR)). Body mass index (BMI), maternal age, gestational age, fetal heart rate (FHR), smoking status, estimated fetal weight (EFW) and Maternal DM were analysed in univariate and multivariate models with respect to LAA and LAS. Results 160 pregnant women (50 controls, 110 diabetics) were scanned. 9 were excluded due to poor image quality, resulting in 104 mothers with diabetes (T1DM 9, T2DM 8, and gestational DM 87) and 47 controls without diabetes. The mothers were well matched for age, blood pressure, smoking prevalence and gestational age. The diabetic mothers had a significantly higher BMI: Median (IQR) ((30.4 kg/m2 (25.1–34.8) vs 20.8 kg/m2 (21.4–27.4), p<0.001) and had higher weight (77 kg (65–93) vs 64 kg (62–68), p<0.001). FHR was higher in fetuses of diabetic mothers (147±10 vs 144±8, p 0.04). Maternal DM resulted in larger LAA 1.68 cm2±0.39 cm2 vs 1.56 cm2±0.36 cm2; p=0. 08, however the result was not significant. The LAS was significantly lower in fetuses with maternal DM compared to fetuses of controls: 28.8% ± 8.8% vs 32.3% ± 9.2%; p 0.033. On multivariate analysis (Table 1), the predictors of LAS were Maternal DM and FHR and predictors of LAA were EFW and Maternal DM. Conclusions Maternal diabetes modulates both LA size and LA function. The association between LA function and FHR may provide an explanation for fetal tachycardia in Maternal DM. Fetal left atrial strain Funding Acknowledgement Type of funding source: None

scholarly journals Maternal Diabetes Mellitus as a Risk Factor for High Blood Pressure in Late Childhood

Hypertension ◽  
2019 ◽  
Vol 73 (1) ◽  
Author(s):  
Joana Oliveira Miranda ◽  
Rui João Cerqueira ◽  
Henrique Barros ◽  
José Carlos Areias
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Body Mass ◽  
Cardiovascular Effects ◽  
Maternal Diabetes ◽  
Diabetes Mellitus Group ◽  
The Impact ◽  
Maternal Diabetes Mellitus ◽  
Diabetic Mothers

Intrauterine fetal conditions can have lifelong cardiovascular effects. The impact of maternal diabetes mellitus on children’s cardiovascular profile is not well established. The goal of this study was to explore the association between maternal diabetes mellitus and offspring’s blood pressure (BP) ≤10 years of age. Generation XXI is a prospective birth cohort, which enrolled 8301 mother-offspring pairs, including 586 (7.1%) children of diabetic mothers. The associations between maternal diabetes mellitus and BP at 4, 7, and 10 years of age was modeled using linear regression. A mixed-effects model was built to assess differences in BP variation over time. Path analysis was used to quantify effects of potential mediators. Maternal diabetes mellitus was associated with higher BP in offspring at the age of 10 (systolic: β, 1.48; 95% CI, 0.36–2.59; and diastolic: β, 0.86; 95% CI, 0.05–1.71). This association was independent of maternal perinatal characteristics, and it was mediated by child’s body mass index and, to a lesser extent, by gestational age, type of birth, and birth weight (indirect effect proportion, 73%). No significant differences in BP were found at 4 and 7 years of age. Longitudinal analysis showed an accelerated systolic BP increase on maternal diabetes mellitus group (β, 1.16; 95% CI, 0.03–2.28). These finding were especially relevant in males, suggesting sex differences in the mechanisms of BP prenatal programing. Our results provide further evidence that maternal diabetes mellitus is associated with high BP late in childhood, demonstrating a significant role of child’s body mass in the pathway of this association.

scholarly journals Left atrial strain evaluation and prognostic value in constrictive pericarditis patients undergoing pericardiectomy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Lo Presti ◽  
N Chan ◽  
Y Saijo ◽  
T Wang ◽  
A Klein
Keyword(s):  
Constrictive Pericarditis ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Time Interval ◽  
Clinical Tool ◽  
Left Atrial Strain ◽  
Endocardial Border ◽  
Valvular Surgery ◽  
All Cause Mortality

Abstract Background Left Atrial (LA) phasic volumes analyses is flawed with geometrical assumption requiring high endocardial border definition. LA strain analysis is an emergent technique that overcome some of these technical limitations. Prior studies of LA mechanics in pericardiectomy patients found improvement in LA strain at follow-up and manifested as symptomatic improvement, however their relationships with survival have not been investigated. Purpose We assessed LA strain before and after pericardiectomy and its association with all- cause mortality. Methods Consecutive patients with constrictive pericarditis who underwent pericardiectomy from 2000–2017 were retrospectively analyzed, analyzing pre-operative and post-operative (at 12 months) echocardiography. Exclusion criteria included atrial fibrillation, previous left sided valve surgery, concomitant valvular surgery at the index pericardiectomy, more than mild left sided valvulopathy and poor echocardiographic windows. Strain analyses was performed with Vector velocity imaging independent software. Univariate and multivariable analyses were utilized to identify factors associated with reduced survival. Results Amongst 190 patients included in the analyses, mean age was 58.5±12.7 years and 37 (19.5%) were female. The etiology of constriction was deemed idiopathic in 61.6% of the cases, median time interval surgery-postoperative echo was 67 days (IQR 6, 312 days). During median follow up of 3.3 years (IQR 0.73, 5.9 years) there were 37 deaths. After surgery, there was a significant decrease in LA reservoir, conduit and regional wall strains. (Table 1). Multivariable analysis demonstrated that postoperative 4C AL strain reservoir was independently associated with all-cause mortality (Table 2). Conclusions In pericardiectomy patients, postoperative 4C LA strain reservoir is independently associated with all-cause mortality. Perhaps, compensatory changes of septal and antero-posterior walls during constriction explain why after surgery these walls become less dynamic, negatively impacting the overall function. Overall, LA quantification and strains may become a useful clinical tool for risk stratification in pericardiectomy patients FUNDunding Acknowledgement Type of funding sources: None. Table 1. Left atrial variables. Table 2. All-cause mortality predictors

scholarly journals The Impact of Diabetes on Hippocampus

2021 ◽  
Author(s):  
Saeed Vafaei-Nezhad ◽  
Masood Vafaei-Nezhad ◽  
Mehri Shadi ◽  
Samira Ezi
Keyword(s):  
Central Nervous System ◽  
Developing Countries ◽  
Nervous System ◽  
Child Mortality ◽  
Maternal Diabetes ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
The Impact ◽  
Diabetic Mothers ◽  
Lines Of Evidence

Maternal Diabetes is one of the most common metabolic disorders resulting an increased risk of abnormalities in the developing fetus and offspring. It is estimated that the prevalence of diabetes during pregnancy among women in developing countries is approximately 4.5 percent and this range varies between 1 to 14 percent in different societies. According to earlier studies, diabetes during pregnancy is associated with an increased risk of maternal and child mortality and morbidity as well as major congenital anomalies including central nervous system (CNS) in their offspring. Multiple lines of evidence have suggested that infants of diabetic women are at risk of having neurodevelopmental sequelae. Previous studies reveal that the offspring of diabetic mothers exhibit disturbances in behavioral and intellectual functioning. In the examination of cognitive functioning, a poorer performance was observed in the children born to diabetic mothers when compared with the children of non-diabetic mothers. Therefore, it is important to study the possible effects of maternal diabetes on the hippocampus of these infants.

scholarly journals The impact of catheter ablation of atrial fibrillation on the left atrial volume and function: study using three-dimensional echocardiography

2019 ◽  
Vol 57 (1) ◽  
pp. 87-95
Author(s):  
Jongmin Hwang ◽  
Hyoung-Seob Park ◽  
Seongwook Han ◽  
Seung-Woon Jun ◽  
Na-Young Kang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Three Dimensional ◽  
Left Atrial Volume ◽  
Volumetric Assessment ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography ◽  
And Function ◽  
The Impact

Abstract Purpose The exact correlation between the baseline left atrial (LA) volume (LAV) and atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) outcomes and changes to the LA after AF RFCA has not yet been fully understood. We sought to evaluate the serial changes in the LAV and LA function after RFCA using 3D echocardiography. Methods Consecutive patients who received RFCA of paroxysmal (PAF) or persistent AF (PeAF) at our center between January 2013 and March 2016 were included. Real-time 3D apical full-volume images were acquired, and a 3D volumetric assessment was performed using an automated three-beat averaging method. The LAV index (LAVI) was calculated and the LA ejection fraction (LAEF) was calculated as [LAVmax − LAVmin]/LAVmax. Results Ninety-nine total patients were enrolled, and the mean age was 58.0 ± 8.2 years and 75 (74.7%) were male. There were 59 (59.6%) PAF patients and the remaining 40 (40.4%) had PeAF. AF recurred in 5 of 59 (8.5%) PAF and in 10 of 40 (25%) PeAF patients. The LAVImax increased on 1 day, decreased at 3 months, and then increased again at 1 year but was lower than that at baseline. The LAEF changes were similar to the volume changes but were more prominent in PeAF than PAF patients. The baseline 3D LAVImax was an independent predictor of AF recurrence after RFCA and the cut-off value was 44.13 ml/m2. Conclusion In our study, even after 3 months of scar formation due to ablation, structural remodeling of the LA continued. The changes were more prominent in the non-recurrent, PeAF patients.

scholarly journals The impact of 6 weeks of atrial fibrillation on left atrial and ventricular structure and function

2015 ◽  
Vol 150 (6) ◽  
pp. 1602-1608.e1 ◽  
Author(s):  
Toshinobu Kazui ◽  
Mathew C. Henn ◽  
Yoshiyuki Watanabe ◽  
Sándor J. Kovács ◽  
Christopher P. Lawrance ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Structure And Function ◽  
Ventricular Structure ◽  
And Function ◽  
The Impact

scholarly journals P1378 Impact of maternal diabetes on fetal left atrial function

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Pathan ◽  
P Lam ◽  
S Sivapathan ◽  
S Orde ◽  
K Negishi ◽  
...  
Keyword(s):  
Image Quality ◽  
Left Atrial ◽  
Fetal Heart ◽  
Maternal Diabetes ◽  
Atrial Function ◽  
Left Atrial Function ◽  
Healthy Controls ◽  
Chamber View ◽  
Risk Pregnancy ◽  
The Impact

Abstract Background/Introduction: Diabetes impacts 12- 14% of pregnancies. Evaluating the impact of maternal diabetes on the fetal heart is challenging due to variable image quality and limited time for structural changes to manifest. Left atrial reservoir strain (ER) is a sensitive marker of early left atrial dysfunction which may elucidate fetal atrial dysfunction resulting from maternal diabetes. Purpose We sought to evaluate if fetal ER can detect impairment of left atrial function in the fetal heart as a result of maternal diabetes. Methods We performed a prospective observational study evaluating patients who were referred to the high risk pregnancy service as a result of maternal diabetes (pre-existing or gestational) and healthy controls. Patients were excluded if adequate imaging of the fetal myocardium was not possible. Baseline characteristics of the mother and cardio-metabolic risk factors were recorded. The fetal echocardiogram focused on the 4 chamber view. We used the 4 chamber view with closure of the mitral valve as the zero reference point (R-R) gating. The strain curves from 6 atrial segments were averaged. Normality of the data was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was used to compare ER between fetuses, whose mothers had diabetes versus those fetuses whose mothers were healthy controls. Results A total of 120 fetal scans were performed. 5 were excluded due to poor image quality, which prevented strain analysis. 115 fetal scans were analysed (87 with maternal diabetes and 27 healthy controls). The diabetic subjects and controls did not defer significantly in age Mean ± SD (31± 5 vs 30± 5, p= 0.81). The mothers with diabetes had a higher body mass index than controls (Median [IQR]) (30.5 kg/m2 [25.1, 35.3] vs 24.6 kg/m2 [22.1, 28.6] p < 0.001). The presence of maternal diabetes resulted in lower fetal ER (28.5% [22.1, 36.2] vs 33.4% [26.6, 41.6] P = 0.01). Figure 1 illustrates the Box-Whisker plot comparing Fetal ER between fetuses exposed to maternal diabetes and fetuses where mothers were healthy controls. Conclusion The presence of maternal diabetes results in impaired fetal left atrial function as measured by fetal left atrial strain (ER). Abstract P1378 Figure 1

HEMOGLOBIN F IN NEWBORN INFANTS OF DIABETIC MOTHERS

1974 ◽  
Vol 77 (3_Suppl) ◽  
pp. S73-S80 ◽  
Author(s):  
Otto Davidsen
Keyword(s):  
Gestational Age ◽  
Relative Concentration ◽  
Newborn Infants ◽  
Maternal Diabetes ◽  
Agar Gel ◽  
Diabetes Group ◽  
Hemoglobin F ◽  
Infants Of Diabetic Mothers ◽  
Agar Gel Electrophoresis ◽  
Diabetic Mothers

ABSTRACT The relative concentration of hemoglobin F was determined by use of agar gel electrophoresis in the cord blood from 38 infants of diabetic mothers and 94 infants with non-diabetic mothers. The relative concentration of hemoglobin F was found to be negatively correlated to the gestational age of the infants. In infants of diabetic mothers the concentration was insignificantly higher than would be expected from their gestational age, and comparable to that of infants of non-diabetic mothers of about 2 weeks lower gestational age. In the diabetes group hemoglobin F was correlated neither to the increased birth weight of the infants nor to the severity of the maternal diabetes.

Left atrial strain and function in pediatric hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Simone Jhaveri ◽  
Rukmini Komarlu ◽  
Sarah Worley ◽  
Doaa Shahbah ◽  
Manasa Gurumoorthi ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Atrial Strain ◽  
And Function

scholarly journals Left atrial strain rate estimates PCWP

2015 ◽  
Vol 1 (1) ◽  
pp. 25 ◽  
Author(s):  
Michael Henein ◽  
Erik Tossavainen ◽  
Stefan Söderberg ◽  
Christer Grönlund ◽  
Manuel Gonzalez ◽  
...  
Keyword(s):  
Left Atrial ◽  
Tissue Doppler ◽  
Right Heart Catheterization ◽  
Structure And Function ◽  
Heart Catheterization ◽  
Left Atrial Strain ◽  
Filling Fraction ◽  
Atrial Strain ◽  
And Function ◽  
Atrial Systole

<p><span>Objective: </span>Raised left atrial (LA) pressure is a common pathway for many pathologies and is known for its complications. It has a direct effect on LA cavity size and potentially also its function. We hypothesized that raised LA pressure, as shown by pulmonary capillary wedge pressure (PCWP), correlates with severity of global LA deformation abnormalities during atrial systole (LASRa).</p><p>Design and Patients: We prospectively studied 46 consecutive patients, mean age 61 +/-13 years, 17 males, of various etiologies who underwent right heart catheterization and simultaneous Doppler echocardiography using spectral, tissue Doppler and speckle tracking echocardiography techniques for assessing LA structure and function.</p><p><span>Results: </span>PCWP correlated with direct measurements of LA structure and function: LA volume (r= 0.43, p&lt;0.01) and LASRa (r=0.79, p&lt;0.001). PCWP correlated also with other indirect measures of LA pressure such as E/A (r=0.65, p&lt;0.001), E wave deceleration time (r=0.54, p&lt;0.001), E/e’ (r=0.49, p&lt;0.001) and LA systolic filling fraction (r=0.52, p&lt;0.001). However, LASRa together with LA systolic filling fraction, had the highest areas under the curve (0.83 and 0.87, respectively) for identifying patients with PCWP &gt; 15 mmHg.</p><p><span>Conclusion: </span>PCWP correlates with LA deformation rate during atrial systole and to a higher extent than conventional Doppler measures of raised LA pressures. These findings should have significant clinical implications in correctly identifying breathless patients due to raised LA pressure.</p><p> </p>

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