Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction

M Rodríguez-López; M Cruz-Lemini; B Valenzuela-Alcaraz; L Garcia-Otero; M Sitges; B Bijnens; E Gratacós; F Crispi

doi:10.1002/uog.17365

Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction

Ultrasound Obstet Gynecol. 2017 Aug;50(2):207-214. doi: 10.1002/uog.17365. Epub 2017 Jul 6.

Authors

M Rodríguez-López^{1

2}, M Cruz-Lemini^{1

2

3

4}, B Valenzuela-Alcaraz^{1

2}, L Garcia-Otero^{1

2}, M Sitges⁵, B Bijnens^{6

7}, E Gratacós^{1

2}, F Crispi^{1

2}

Affiliations

¹ BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.
² Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
³ Fetal Medicine and Surgery Research Unit, Children and Women's Hospital of Querétaro, Querétaro, Mexico.
⁴ Neurodevelopmental Research Unit 'Dr. Augusto Fernández Guardiola', Neurobiology Institute, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, Mexico.
⁵ Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
⁶ ICREA, Barcelona, Spain.
⁷ Universitat Pompeu Fabra, Barcelona, Spain.

PMID: 27859818
DOI: 10.1002/uog.17365

Abstract

Objective: To identify different cardiac phenotypes among cases of fetal growth restriction (FGR).

Methods: Echocardiography was performed in 126 cases with FGR (birth weight < 10^th centile) and 64 appropriate-for-gestational-age (AGA) fetuses. Principal component and cluster analyses were performed to identify different cardiac phenotypes among FGR cases.

Results: Three different cardiac phenotypes were identified among the FGR group: globular in 54% of cases, elongated in 29% of cases and hypertrophic in 17% of cases. Those with a globular heart had the lowest median left-ventricular sphericity index (controls, 1.78 (interquartile range (IQR), 1.62-1.97); FGR elongated, 1.92 (IQR, 1.78-2.09); FGR globular, 1.44 (IQR, 1.36-1.52); FGR hypertrophic, 1.65 (IQR, 1.42-1.77); P = 0.001). FGR cases with an elongated left ventricle had nearly normal cardiac dimensions. FGR cases with a hypertrophic phenotype had the highest median left-ventricular wall thickness (controls, 1.22 (IQR, 1.10-1.67) mm/kg; FGR elongated, 1.52 (IQR, 1.28-1.86) mm/kg; FGR globular, 1.65 (IQR, 1.39-1.99) mm/kg; FGR hypertrophic, 3.68 (IQR, 3.45-4.71) mm/kg; P = 0.001) and cardiac dimensions. Globular and elongated phenotypes showed a fetoplacental profile of late-onset FGR, while the hypertrophic phenotype showed signs of early-onset FGR. The hypertrophic group also had the poorest perinatal results, having the lowest birth-weight centile, gestational age at delivery and Apgar score and the highest postnatal blood pressure and aorta intima-media thickness.

Conclusions: FGR induces at least three different cardiac phenotypes, with early-onset FGR cases being associated with a hypertrophic response and worse perinatal outcomes. This cardiac phenotypic classification may improve identification of FGR cases with the highest perinatal and long-term cardiovascular risks. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Keywords: echocardiography; fetal growth restriction; phenotype; ventricular cardiac remodeling.

MeSH terms

Case-Control Studies
Cohort Studies
Echocardiography
Female
Fetal Growth Retardation / diagnostic imaging*
Gestational Age
Heart / diagnostic imaging*
Humans
Phenotype
Pregnancy
Prospective Studies
Ultrasonography, Prenatal