Journal
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Volume 50, Issue 2, Pages 207-214Publisher
WILEY
DOI: 10.1002/uog.17365
Keywords
echocardiography; fetal growth restriction; phenotype; ventricular cardiac remodeling
Funding
- Erasmus+ Programme of the European Union [2013-0040]
- Instituto de Salud Carlos III and Ministerio de Economia y Competitividad [PI12/00801, PI14/00226, SAF2012-37196, TIN2014-52923-R]
- cofinanciado por el Fondo Europeo de Desarrollo Regional de la Union Europea 'Una manera de hacer Europa'
- 'la Caixa' Foundation
- Cerebra Foundation
- Programa de Ayudas Postdoctorales from Agencia de Gestio d'Ajuts Universitaris i de Recerca [2013FI_B 00667]
- Mexican National Council of Science and Technology (CONACyT, Mexico City, Mexico)
- Agencia de Gestio d'Ajuts Universitaris i de Recerca [SGR_928]
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Objective To identify different cardiac phenotypes among cases of fetal growth restriction (FGR). Methods Echocardiography was performed in 126 cases with FGR (birth weight < 10th 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 (C) 2016 ISUOG. Published by John Wiley & Sons Ltd.
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