Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
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DOI：
10.1161/circulationaha.110.937995
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发表时间：
2010-06-08
期刊：
影响因子：
37.8
通讯作者：
Gratacos, Eduard
中科院分区：
文献类型：
--
作者：
Crispi, Fatima;Bijnens, Bart;Gratacos, Eduard
背景 - 胎儿生长受限（FGR）影响5% - 10%的新生儿，并与成年期心血管疾病死亡率增加相关。最普遍被接受的假说是胎儿代谢程序化继而导致与心血管疾病相关的疾病，如肥胖、糖尿病和高血压。我们的主要目的是评估另一种假说，即FGR引发的心脏原发性改变会持续到儿童期。
方法与结果 - 在一组在胎儿期被确定为生长受限并随访至儿童期的胎儿队列中，我们随机选取了80名FGR患儿，并将他们与120名正常生长的胎儿进行比较，这些胎儿在性别、出生日期和出生时的胎龄上相匹配。在儿童期（平均年龄5岁）进行了心血管评估。与对照组相比，FGR患儿心脏形状不同，横向直径增加，心室更呈球形。尽管研究组之间左心室射血分数相似，但每搏输出量显著减少，在严重FGR中通过心率增加来代偿以维持心输出量。这与亚临床纵向收缩功能障碍（心肌峰值速度降低）和舒张功能改变（E/E'比值增加和E波减速时间延长）有关。FGR患儿还具有较高的血压和内膜 - 中层厚度增加。对于所评估的所有参数，都随着生长受限的严重程度呈线性增加。
结论 - 这些发现表明FGR引发心脏和血管的原发性改变，这可以解释成年期心血管疾病易感性增加的原因。如果这些结果得到证实，应该在FGR患儿中探索对心脏重构有有益影响的策略的作用。（《循环》2010年；121卷：2427 - 2436页）
Background-Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. The most commonly accepted hypothesis is that fetal metabolic programming leads secondarily to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension. Our main objective was to evaluate the alternative hypothesis that FGR induces primary cardiac changes that persist into childhood.Methods and Results-Within a cohort of fetuses with growth restriction identified in fetal life and followed up into childhood, we randomly selected 80 subjects with FGR and compared them with 120 normally grown fetuses, matched for gender, birth date, and gestational age at birth. Cardiovascular assessment was performed in childhood (mean age of 5 years). Compared with control subjects, children with FGR had a different cardiac shape, with increased transversal diameters and more globular cardiac ventricles. Although left ejection fraction was similar among the study groups, stroke volume was reduced significantly, which was compensated for by an increased heart rate to maintain output in severe FGR. This was associated with subclinical longitudinal systolic dysfunction (decreased myocardial peak velocities) and diastolic changes (increased E/E' ratio and E deceleration time). Children with FGR also had higher blood pressure and increased intima-media thickness. For all parameters evaluated, there was a linear increase with the severity of growth restriction.Conclusions-These findings suggest that FGR induces primary cardiac and vascular changes that could explain the increased predisposition to cardiovascular disease in adult life. If these results are confirmed, the impact of strategies with beneficial effects on cardiac remodeling should be explored in children with FGR. (Circulation. 2010; 121: 2427-2436.)