Speckle Tracking and Myocardial Tissue Imaging in Infant of Diabetic Mother with Gestational and Pregestational Diabetes

Abstract

The aim of this study was to evaluate the myocardial changes in infants of diabetic mother either with gestational or pregestational diabetes and its relation to maternal diabetic control. The study included 45 infants of diabetic mother (IDMs) and 45 healthy newborn as a control group. IDMs were then categorized into 2 subgroups: twenty infants of mother with pregestational diabetes and twenty-five infants of mothers with gestational diabetes. The studied groups underwent measurement of the maternal and neonatal glycated Hb % (HbA1c), conventional echocardiography, tissue Doppler imaging (TDI) and two-dimensional speckle tracking imaging (STI). The weight, the rate of complications, and the rate of cesarean section were significantly higher in the IDMs group than in the control group. Significant positive correlation was present between the levels of HbA1c of IDMs and HbA1c of their mothers (P < 0.05). A significant deterioration of both systolic and diastolic functions measured by both conventional echocardiography and TDI was present in IDMs with both pre-gestational and gestational diabetes compared with the control group. Also, the septal/posterior wall ratio (SW/PW) was significantly higher in pregestational (1.86 ± 0.3) and gestational (2 ± 0.4) groups than in the control group (1 ± 0.06). Two-dimensional STI showed that the cardiac torsion was significantly impaired in pre-gestational (9.66 ± 2.5) and gestational (8.66 ± 3.9) groups when compared with the control group (5.4 ± 2.4) [P < 0.0001]. It also showed that the global strain was significantly impaired in pre-gestational (−10.4 ± 3.2) and gestational (−13.1 ± 4.7) groups when compared with the control group (−19 ± 2) [P < 0.0001]. However, no significant differences were present among the two patients’ subgroups in echocardiographic data except for a significant decrease of E’/A’ ratio and S wave at tricuspid annulus derived by TDI and impaired global strain derived by STI in infants of mothers with pre-gestational DM than those with gestational DM [P = 0.02]. SW/PW and cardiac torsion were significantly higher in infant of diabetic mother than the normal newborn and on the contrary systolic function and global strain were significantly lower in IDMs especially in infants of mother with pre-gestational diabetes. All the previous TDI findings did not show any significant correlation to neither maternal nor fetal HbA1c. Also, there was no significant correlation between cardiac torsion and the rest of TDI data neither in IDMs group nor in the control group. TDI and two-dimensional STI were efficient and sensitive tools able to early detect cardiac dysfunction in IDMs even in the absence of morphologic cardiac changes.