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Du B, Wang H, Wu Y, Li Z, Niu Y, Wang Q, Zhang L, Chen S, Wu Y, Huang J, Sun K, Wang J. The association of gestational age and birthweight with blood pressure, cardiac structure, and function in 4 years old: a prospective birth cohort study. BMC Med 2023; 21:103. [PMID: 36941582 PMCID: PMC10029264 DOI: 10.1186/s12916-023-02812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Current evidence relating birthweight and gestational age to cardiovascular risk is conflicting. Whether these factors have independent or interactive impacts on cardiovascular parameters during early childhood remains unclear. The goal of this study was to explore whether there were any independent and interactive effects of gestational age and birthweight on blood pressure, left ventricle (LV) structure, and function in 4 years old. METHODS This study included 1194 children in the Shanghai Birth Cohort from 2013 to 2016. Information about the mothers and children was recorded at time of birth using a questionnaire. Follow-up measurements, including anthropometric, blood pressure, and echocardiography, were taken between 2018 and 2021, when the children were 4 years old. Multiple linear or logistic regressions and restricted cubic spline were used to explore the association of birthweight and gestational age with cardiovascular measurements. RESULTS Gestational age had a significant negative correlation with both systolic blood pressure [β = - 0.41, 95% CI: (- 0.76, - 0.07)] and mean arterial pressure [β = - 0.36, 95%CI: (- 0.66, - 0.07)]. The risk of prehypertension decreased with increased gestational age [OR = 0.54, 95% CI: (0.32, 0.93)]. The relationship between birthweight with blood pressure was U-shape (P for non-linear < 0.001). The wall thickness, volume, mass, and cardiac output of LV increased with birthweight, though the ejection fraction [β = - 1.02, 95% CI: (- 1.76, - 0.27)] and shorten fraction [β = 0.72, 95% CI: (- 1.31, - 0.14)] decreased with birthweight. The risk of LV hypertrophy was not associated with birthweight [OR = 1.59, 95% CI: (0.68, 3.73)]. CONCLUSIONS In this study, we found different associations of birthweight and gestational age with cardiovascular measurements in the offspring at 4 years old. Gestational age influenced blood pressure independent of birthweight. Heart size and function at 4 years old was influenced mostly by birthweight and not by gestational age.
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Affiliation(s)
- Bowen Du
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Hualin Wang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yujian Wu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Zhuoyan Li
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yiwei Niu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Qianchuo Wang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Lin Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Jihong Huang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Yangpu District, No.1665, Kongjiang Road, Shanghai, 200092, China.
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Li Z, Wu Y, Du B, Yu X, Wang H, Niu Y, Wang J, Chen S, Sun K. Associations of maternal gestational diabetes mellitus with alterations in cardiovascular system in early childhood. Diabetes Metab Res Rev 2022; 38:e3551. [PMID: 35638862 DOI: 10.1002/dmrr.3551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/07/2022]
Abstract
AIMS The association of maternal gestational diabetes mellitus (GDM) with childhood cardiovascular alterations is not well established. This study aims to test the hypothesis that prenatal exposure to GDM is associated with vascular and cardiac alterations in early childhood. METHODS In a population-based prospective cohort among 1094 mothers and their offspring, GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups criteria. Childhood blood pressure (BP) measurement, echocardiography and vascular ultrasound were performed using standardised methods at 4 years old. The associations between maternal GDM and childhood cardiovascular outcomes were modelled using linear regression and binary logistic regression. Mediation analysis was conducted to test the potential mediators. RESULTS Maternal GDM was associated with higher systolic BP (SBP; β, 1.20; [0.11, 2.28]), lower left ventricular end-diastolic diameter (LVEDD; β, -0.36; [-0.71, -0.01]), lower end-diastolic volume (EDV; β, -1.42; [-2.71, -0.13]) and increased risk of high blood pressure (HBP, OR = 1.522; 95% CI, 1.023 to 2.264) in offspring at the age of 4 years. After stratification by sex, the association remained strong only in male offspring (SBP: β, 1.94; [0.37, 3.51]; LVEDD: β, -0.60; [-1.09, -0.12]; EDV: β, -2.09; [-3.86, -0.31]; HBP: OR = 1.797; 95% CI, 1.063 to 3.037) and was independent of maternal and child characteristics. However, carotid intima-media thickness (cIMT) was not associated with maternal GDM. Mediation analysis showed that the effects on childhood cardiovascular alterations were attributable mostly to the direct effects of maternal GDM. CONCLUSIONS Our results provide evidence that maternal GDM is associated with offspring cardiovascular adaptations at preschool age. Further studies are needed to replicate our results and the long-term effect of these adaptations on later cardiovascular risks needs further investigation.
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Affiliation(s)
- Zhuoyan Li
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujian Wu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bowen Du
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodan Yu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education, Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Hualing Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Niu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bongers-Karmaoui MN, Jaddoe VW, Roest AA, Helbing WA, Steegers EA, Gaillard R. Associations of maternal angiogenic factors during pregnancy with alterations in cardiac development in childhood at 10 years of age. Am Heart J 2022; 247:100-111. [PMID: 35123935 DOI: 10.1016/j.ahj.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine whether maternal angiogenic factors in the first half of pregnancy are associated with offspring left and right cardiac development. METHODS In a population-based prospective cohort among 2,415 women and their offspring, maternal first and second trimester plasma PlGF and sFlt-1 concentrations were measured. Cardiac MRI was performed in their offspring at 10 years. RESULTS Maternal angiogenic factors were not associated with childhood cardiac outcomes in the total population. In children born small-for-their-gestational-age, higher maternal first trimester PlGF concentrations were associated with a lower childhood left ventricular mass (-0.24 SDS [95%CI -0.42, -0.05 per SDS increase in maternal PlGF]), whereas higher sFlt-1 concentrations were associated with higher childhood left ventricular mass (0.22 SDS [95%CI 0.09, 0.34 per SDS increase in maternal sFlt-1]). Higher second trimester maternal sFlt-1 concentrations were also associated with higher childhood left ventricular mass (P-value <.05). In preterm born children, higher maternal first and second trimester sFlt-1/PlGF ratio were associated with higher childhood left ventricular mass (0.30 SDS [95%CI 0.01, 0.60], 0.22 SDS [95%CI -0.03, 0.40]) per SDS increase in maternal sFlt-1/PlGF ratio in first and second trimester respectively). No effects on other childhood cardiac outcomes were present within these higher-risk children. CONCLUSIONS In a low-risk population, maternal angiogenic factors are not associated with childhood cardiac ventricular structure, and function within the normal range. In children born small for their gestational age or preterm, an imbalance in maternal angiogenic factors in the first half of pregnancy was associated with higher childhood left ventricular mass only.
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Toemen L, Santos S, Roest AAW, Vernooij MW, Helbing WA, Gaillard R, Jaddoe VWV. Pericardial adipose tissue, cardiac structures, and cardiovascular risk factors in school-age children. Eur Heart J Cardiovasc Imaging 2021; 22:307-313. [PMID: 32154869 PMCID: PMC7899276 DOI: 10.1093/ehjci/jeaa031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
Aims We examined the associations of pericardial adipose tissue with cardiac structures and cardiovascular risk factors in children. Methods and results We performed a cross-sectional analysis in a population-based cohort study among 2892 children aged 10 years (2404 normal weight and 488 overweight/obese). Pericardial adipose tissue mass was estimated by magnetic resonance imaging (MRI) and indexed on height3. Left ventricular mass (LVM) and left ventricular mass-to-volume ratio (LMVR) were estimated by cardiac MRI. Cardiovascular risk factors included android adipose tissue percentage obtained by Dual-energy X-ray absorptiometry, blood pressure and glucose, insulin, cholesterol, and triglycerides concentrations. Adverse outcomes were defined as values above the 75 percentile. Median pericardial adipose tissue index was 3.6 (95% range 1.6–7.1) among normal weight and 4.7 (95% range 2.0–8.9) among overweight children. A one standard deviation (1 SD) higher pericardial adipose tissue index was associated with higher LMVR [0.06 standard deviation scores, 95% confidence interval (CI) 0.02–0.09], increased odds of high android adipose tissue [odd ratio (OR) 2.08, 95% CI 1.89–2.29], high insulin concentrations (OR 1.17, 95% CI 1.06–1.30), an atherogenic lipid profile (OR 1.22, 95% CI 1.11–1.33), and clustering of cardiovascular risk factors (OR 1.56, 95% CI 1.36–1.79). Pericardial adipose tissue index was not associated with LVM, blood pressure, and glucose concentrations. The associations showed largely the same directions but tended to be weaker among normal weight than among overweight children. Conclusion Pericardial adipose tissue is associated with cardiac adaptations and cardiovascular risk factors already in childhood in both normal weight and overweight children.
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Affiliation(s)
- Liza Toemen
- Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands
| | - Susana Santos
- Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands
| | - Arno A W Roest
- Department of Pediatrics, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands
| | - Romy Gaillard
- Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, PO Box 22040, 3000 CA Rotterdam, The Netherlands
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Clarke GD, Li J, Kuo AH, Moody AJ, Nathanielsz PW. Cardiac magnetic resonance imaging: insights into developmental programming and its consequences for aging. J Dev Orig Health Dis 2021; 12:203-219. [PMID: 33349289 PMCID: PMC7987688 DOI: 10.1017/s2040174420001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiovascular diseases (CVD) are important consequences of adverse perinatal conditions such as fetal hypoxia and maternal malnutrition. Cardiac magnetic resonance imaging (CMR) can produce a wealth of physiological information related to the development of the heart. This review outlines the current state of CMR technologies and describes the physiological biomarkers that can be measured. These phenotypes include impaired ventricular and atrial function, maladaptive ventricular remodeling, and the proliferation of myocardial steatosis and fibrosis. The discussion outlines the applications of CMR to understanding the developmental pathways leading to impaired cardiac function. The use of CMR, both in animal models of developmental programming and in human studies, is described. Specific examples are given in a baboon model of intrauterine growth restriction (IUGR). CMR offers great potential as a tool for understanding the sequence of dysfunctional adaptations of developmental origin that can affect the human cardiovascular system.
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Affiliation(s)
- G D Clarke
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - J Li
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - A H Kuo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - A J Moody
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - P W Nathanielsz
- Department of Animal Science, University of Wyoming, Laramie, WY, USA
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6
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van Genuchten WJ, Toemen L, Roest AAW, Vernooij MW, Gaillard R, Helbing WA, Jaddoe VWV. Ethnic differences in childhood right and left cardiac structure and function assessed by cardiac magnetic resonance imaging. Eur J Pediatr 2021; 180:1257-1266. [PMID: 33170364 PMCID: PMC7940261 DOI: 10.1007/s00431-020-03869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
Ethnic differences in cardiovascular risk factors and disease are well-known and may originate in early-life. We examined the ethnic differences in cardiac structure and function in children using cardiac magnetic resonance imaging in a European migrant population, and whether any difference was explained by early life factors. We used a prospective population-based cohort study among 2317 children in Rotterdam, the Netherlands. We compared children from Dutch (73%), Cape Verdean (3.5%), Dutch Antillean (3.3%), Moroccan (6.1%), Surinamese-Creoles (3.9%), Surinamese-Hindustani (3.4%), and Turkish (6.4%) background. Main outcomes were cMRI-measured cardiac structures and function. Cardiac outcomes were standardized on body surface area. Cape Verdean, Surinamese-Hindustani, and Turkish children had smaller right ventricular end-diastolic volume and left ventricular end-diastolic volume relative to their body size than Dutch children (p < 0.05). These results were not fully explained by fetal and childhood factors. Right ventricular ejection fraction and left ventricular ejection fraction did not differ between ethnicities after adjustment for fetal and childhood factors.Conclusion: Right ventricular end-diastolic volume and left ventricular end-diastolic volume differ between ethnic subgroups in childhood, without affecting ejection fraction. Follow-up studies are needed to investigate whether these differences lead to ethnic differences in cardiac disease in adulthood. What is Known: • Ethnic differences in cardiovascular risk factors and disease are well-known and may originate in early-life. • The prevalence of cardiovascular disease differs between ethnic groups. What is New: • We examined ethnic differences in left and right cardiac structure and function in children using cMRI. • Right and left cardiac dimensions differ between ethnic groups in childhood and are only partly explained by fetal and childhood factors.
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Affiliation(s)
- Wouter J. van Genuchten
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Liza Toemen
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Arno A. W. Roest
- grid.10419.3d0000000089452978Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Meike W. Vernooij
- grid.5645.2000000040459992XDepartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Willem A. Helbing
- grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent W. V. Jaddoe
- grid.5645.2000000040459992XThe Generation R Study Group (Na 2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Wahab RJ, Jaddoe VWV, Roest AAW, Toemen L, Gaillard R. Associations of Maternal Glycemia in the First Half of Pregnancy With Alterations in Cardiac Structure and Function in Childhood. Diabetes Care 2020; 43:2272-2280. [PMID: 32661110 PMCID: PMC7613757 DOI: 10.2337/dc19-2580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus has been associated with offspring cardiac congenital malformations, ventricular hypertrophy, and diastolic dysfunction in large observational cohort studies and experimental animal models. We assessed the associations of maternal random glucose concentrations across the full range with childhood cardiac ventricular structure and function. RESEARCH DESIGN AND METHODS In a population-based prospective cohort among 1,959 women and their offspring, maternal random glucose concentrations were measured at a median 13.1 weeks' gestation (95% range 10.5-16.8 weeks). We obtained offspring cardiac outcomes, relative to body size, through cardiac MRI at 10 years. RESULTS The mean maternal random glucose concentration was 4.4 mmol/L (SD 0.8). The highest quintile of maternal glucose concentrations, compared with the lowest quintile, was associated with a lower childhood left ventricular mass (-0.19 SD score [SDS]; 95% CI -0.31, -0.07) and left ventricular end-diastolic volume (-0.17 SDS; 95% -0.28, -0.05). Also, higher maternal glucose concentrations across the full range per 1 mmol/L increase were associated with a lower childhood left ventricular mass and left ventricular end-diastolic volume (P values ≤0.05). Adjustment for maternal prepregnancy BMI, gestational age, and weight at birth or childhood BMI and blood pressure did not influence the effect estimates. Maternal glucose concentrations were not significantly associated with childhood right ventricular end-diastolic volume or left and right ventricular ejection fraction. CONCLUSIONS Higher maternal random glucose concentrations in the first half of pregnancy are associated with a lower childhood left ventricular mass and left ventricular end-diastolic volume, with the strongest associations for childhood left ventricular mass. These associations were not explained by maternal, birth, or childhood characteristics. Further studies are needed to replicate these findings using repeated maternal glucose measurements throughout pregnancy and offspring cardiac outcomes throughout childhood and adulthood.
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Affiliation(s)
- Rama J Wahab
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arno A W Roest
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Liza Toemen
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands .,Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
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8
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Toemen L, Santos S, Roest AA, Jelic G, van der Lugt A, Felix JF, Helbing WA, Gaillard R, Jaddoe VWV. Body Fat Distribution, Overweight, and Cardiac Structures in School-Age Children: A Population-Based Cardiac Magnetic Resonance Imaging Study. J Am Heart Assoc 2020; 9:e014933. [PMID: 32567454 PMCID: PMC7670529 DOI: 10.1161/jaha.119.014933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Adiposity is associated with larger left ventricular mass in children and adults. The role of body fat distribution in these associations is not clear. We examined the associations of body fat distribution and overweight with cardiac measures obtained by cardiac magnetic resonance imaging in school‐age children. Methods and Results In a population‐based cohort study including 2836 children, 10 years of age, we used anthropometric measures, dual‐energy X‐ray absorptiometry, and magnetic resonance imaging to collect information on body mass index, lean mass index, fat mass index, and abdominal visceral adipose tissue index. Indexes were standardized by height. Cardiac measures included right and left ventricular end‐diastolic volume, left ventricular mass, and mass‐to‐volume ratio as a marker for concentricity. All body fat measures were positively associated with right and left ventricular end‐diastolic volumes and left ventricular mass, with the strongest associations for lean mass index (all P<0.05). Obese children had a 1.12 standard deviation score (95% CI, 0.94–1.30) larger left ventricular mass and a 0.35 standard deviation score (95% CI, 0.14–0.57) higher left ventricular mass‐to‐volume ratio than normal weight children. Conditional on body mass index, higher lean mass index was associated with higher right and left ventricular end‐diastolic volume and left ventricular mass, whereas higher fat mass measures were inversely associated with these cardiac measures (all P<0.05). Conclusions Higher childhood body mass index is associated with a larger right and left ventricular size. This association is influenced by higher lean mass. In childhood, lean mass may be a stronger determinant of heart growth than fat mass. Fat mass may influence cardiac structures at older ages.
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Affiliation(s)
- Liza Toemen
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands.,Pediatrics Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Susana Santos
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands.,Pediatrics Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Arno A Roest
- Department of Pediatrics Leiden University Medical Center Leiden The Netherlands
| | - Gavro Jelic
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Aad van der Lugt
- Radiology Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Janine F Felix
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Willem A Helbing
- Pediatrics Erasmus MC, University Medical Center Rotterdam The Netherlands.,Radiology Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Romy Gaillard
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands.,Pediatrics Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands.,Pediatrics Erasmus MC, University Medical Center Rotterdam The Netherlands
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Cho SKS, Darby JRT, Saini BS, Lock MC, Holman SL, Lim JM, Perumal SR, Macgowan CK, Morrison JL, Seed M. Feasibility of ventricular volumetry by cardiovascular MRI to assess cardiac function in the fetal sheep. J Physiol 2020; 598:2557-2573. [PMID: 32378201 DOI: 10.1113/jp279054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
KEY POINTS The application of fetal cardiovascular magnetic resonance imaging (CMR) to assess fetal cardiovascular physiology and cardiac function through the quantification of ventricular volumes has previously been investigated, but the approach has not yet been fully validated. Ventricular output measurements calculated from heart rate and stroke volumes (SV) of the right and left ventricles measured by ventricular volumetry (VV) exhibited a high level of agreement with phase-contrast (PC) blood flow measurements in the main pulmonary artery and ascending aorta, respectively. Ejection fraction of the right ventricle, which is lower than that of the left ventricle in postnatal subjects, was similar to the left ventricular ejection fraction in the fetus; probably due to the different loading conditions present in the fetal circulation. This study provides evidence to support the reliability of VV in the sheep fetus, providing evidence for its use in animal models of human diseases affecting the fetal circulation. ABSTRACT The application of ventricular volumetry (VV) by cardiovascular magnetic resonance imaging (CMR) in the fetus remains challenging due to the small size of the fetal heart and high heart rate. The reliability of this technique in utero has not yet been established. The aim of this study was to assess the feasibility and reliability of VV in a fetal sheep model of human pregnancy. Right and left ventricular outputs by stroke volume (SV) measured using VV were compared with 2D phase-contrast (PC) CMR measurements of blood flow in the main pulmonary artery (MPA) and ascending aorta (AAo). At 124-140 days (d) gestation, singleton bearing Merino ewes underwent CMR under general anaesthesia using fetal femoral artery catheters, implanted at 109-117d, to trigger cine steady state free precession acquisitions of ventricular short-axis stacks. The short-axis cine stacks were segmented at end-systole and end-diastole, yielding right and left ventricular SV, ejection fraction, and cardiac outputs (SV × heart rate). PC cine acquisitions of MPA and AAo were analysed to measure blood flow, which served as comparators for the right and left cardiac outputs by VV. There was good correlation and agreement between VV and PC measures of ventricular outputs with no significant bias (r2 = 0.926; P < 0.0001; Bias = -4.7 ± 10.5 ml min-1 kg-1 ; 95% limits of agreement: -15.9 to 25.2 ml min-1 kg-1 ). This study validates fetal VV by CMR in a large animal model of human pregnancy and provides preliminary reference values of fetal sheep right and left ventricles in late gestation.
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Affiliation(s)
- Steven K S Cho
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia.,Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Brahmdeep S Saini
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Jessie Mei Lim
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Sunthara Rajan Perumal
- Preclinical, Imaging & Research Laboratories, South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Christopher K Macgowan
- Translational Medicine, Hospital for Sick Children, Toronto, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Mike Seed
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Nikolaidou C, Karamitsos T. The shape of our hearts: The impact of early stages in life on cardiac development. Eur J Prev Cardiol 2019; 27:60-62. [PMID: 31408369 DOI: 10.1177/2047487319869579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Theodoros Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
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