A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction
A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction
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DOI：
10.1016/j.ajog.2013.12.031
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发表时间：
2014-06-01
影响因子：
9.8
通讯作者：
Gratacos, Eduard
中科院分区：
文献类型：
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作者：
Cruz-Lemini, Monica;Crispi, Fatima;Gratacos, Eduard
目的：宫内生长受限（IUGR）胎儿经历持续到婴儿期的心血管重塑，并与成年期心血管结局相关。婴儿期高血压已被证明是日后心血管疾病的一个重要危险因素。密切监测和饮食干预已显示可改善高血压儿童的心血管健康；然而，并不是所有IUGR婴儿都表现出血压升高。我们评估了胎儿超声心动图在预测6个月IUGR婴儿高血压和动脉重塑方面的潜力。研究设计：观察100例连续IUGR胎儿和100例对照胎儿至婴儿期。胎儿评估包括围产期多普勒成像、心脏形态测量、射血分数、心输出量、等容松弛时间（IVRT）、三尖瓣环面收缩偏移（TAPSE）和组织多普勒成像。婴儿高血压和动脉重塑的定义为6月龄时平均血压为>的第95个百分位，主动脉内膜-中膜厚度为>的第75个百分位。获得与婴儿结局相关的胎儿参数的优势比。结果：胎儿TAPSE、右球度指数、IVRT和脑胎盘比是产后血管重构的最强预测因子。基于胎儿TAPSE、脑胎盘比、右球度指数和IVRT的心血管风险评分可高度预测婴儿高血压和动脉重构（曲线下面积0.87；95%可信区间0.79-0.93;P < 0.001）。结论：胎儿超声心动图参数确定了IUGR胎儿中的高危人群，可以作为早期筛查血压和其他心血管危险因素的目标，并促进健康饮食和体育锻炼。
OBJECTIVE: Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants.STUDY DESIGN: One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of >95th percentile together with aortic intima-media thickness of >75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes.RESULTS: Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P < .001).CONCLUSION: Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.