DUCTUS VENOSUS FLOW, DIASTOLIC DYSFUNCTION AND MYOCARDIAL HYPERTROPHY IN FETUSES OF DIABETIC MOTHERS

Abstract

Infants of diabetic mothers have an established risk of developing myocardial hypertrophy even with adequate maternal metabolic control. The pulsatility index of ductus venosus flow may be a useful parameter for assessing the role of myocardial hypertrophy due to maternal diabetes in fetal diastolic ventricular function.
Aim of the work: To test the hypothesis that the pulsatility index of ductus venosus (PIDV) is higher and the mitral & tricuspid early diastolic/atrial systole velocity ratios (E/A ratios) are lower in the fetuses of diabetic mothers (FDM) with myocardial hypertrophy (MH) than in the FDM with no MH and in the control fetuses of non-diabetic mothers (FNDM).
Subjects and methods: Cross-sectional study included fetuses with gestational ages ranging from 20 to 36 weeks, divided into the following 3 groups: 10 FDM with MH (group I), 20 FDM with no MH (group II), and 30 FNDM (group III, control). The Doppler echocardiogram assessed the PIDV through the ratio (systolic velocity – pre-systolic velocity)/mean velocity. The mitral and tricuspid E/A ratios were also assessed.
Results: The mean PIDV in groups I, II, and III were 1.28 ± 0.5, 0.73 ± 0.09, and 0.59±0.09, respectively. Using ANOVA test, the mean pulsatility index was significantly higher in group I than in group II and III (P 0.001). Comparing the pulsatility index of ductus venosus in group II with that in group III, a statistically significant difference (P=0.02) was observed. The mean mitral E/A ratios in groups I, II and III were 0.68 ± 0.04, 0.73 ± 0.06 and 0.68 ± 0.1, respectively. When applying the ANOVA, the mitral E/A ratios were non significant between the three groups (P = 0.17). The mean tricuspid E/A ratios in groups I, II and III were 0.69 ± 0.05, 0.71 ± 0.03 and 0.68 ± 0.07, respectively. When applying the ANOVA, the tricuspid E/A ratios were non significant between the three groups (P = 0.19).
Conclusion: DV PI is significantly greater in FDM with MH than in FDM with no MH and in FNDM. It is a useful parameter than E/A ratios of the mitral and the tricuspid valves for assessing fetal diastolic function.
Key words: Ductus venosus, maternal diabetes; fetal myocardial hypertrophy, diastolic dysfunction.