Quantifying fetal heart health in gestational diabetes: a new approach with fetal heart quantification technology

Abstract

Objective: This study aimed to assess the impact of gestational diabetes mellitus (GDM) on fetal heart structure and function using a technique called fetal heart quantification (Fetal HQ), with a focus on mitochondrial dynamics, which employs advanced imaging technology for comprehensive analysis.

Methods: A total of 180 fetuses with normal heart structures, aged 24-40 weeks of gestation, were examined. A 2-3 s cine loop in the standard four-chamber oblique view was captured and analyzed using the speckle-tracking technique with Fetal HQ. Various echocardiographic parameters were evaluated, including four-chamber view (4CV), global spherical index (GSI), global longitudinal strain (GLS), 24-segment spherical index (SI), ventricular fractional area change (FAC), cardiac output (CO), and stroke volume (SV). These parameters were compared between the GDM group and the control group during two gestational periods: 24⁺⁰ to 28⁺⁰ weeks and 28⁺¹ to 40⁺¹ weeks. Statistical analysis was performed using independent samples t-tests and Mann-Whitney U tests to identify significant differences.

Results: Twenty fetuses from mothers with GDM and 40 from the control group were recruited at 24⁺⁰ to 28⁺⁰ weeks. At 28⁺¹ to 40⁺¹ weeks, 40 fetuses from mothers with GDM and 80 from the control group were recruited. The fetal left ventricular global longitudinal function was similar between the GDM and control groups. However, compared to the controls, right ventricular function in the GDM group was lower only at 28⁺¹ to 40⁺¹ weeks. In the GDM group, the global spherical index (GSI) was lower than in the control group at 28⁺¹ to 40⁺¹ weeks (1.175 vs. 1.22; p = 0.001). There were significant decreases in ventricular FAC (38.74% vs. 42.83%; p < 0.0001) and 4CV GLS for the right ventricle (-22.27% vs. -26.31%; p = 0.005) at 28⁺¹ to 40⁺¹ weeks.

Conclusion: Our findings suggest that GDM is associated with decreased right ventricular function in the fetal heart, particularly during the later stages of pregnancy (28⁺¹ to 40⁺¹ weeks), compared to fetuses from healthy pregnancies. The Fetal HQ technique represents a valuable tool for evaluating the structure and function of fetal hearts affected by GDM during the advanced stages of pregnancy.

Keywords: cardiac function; echocardiography; fetal cardiac morphology; fetal heart quantification; gestational diabetes mellitus (GDM).

FIGURE 1

Schematic diagram for the evaluation of fetal four-chamber morphology. The diagram shows the maximum longitudinal transverse diameter of the heart, the global spherical index (GSI), and the area of the four-chamber view.

FIGURE 2

Determination of the cardiac cycle. This figure shows the determination of the right ventricular cardiac cycle, including the end-diastole and end-systole. Anatomical M-mode was drawn in the direction of the apical segment to the basal segment with the sampling line placed at the tricuspid valve to determine a single cardiac cycle, where points A and B represent end-diastole, the first frame of atrioventricular valve closure, and point C represents end-systole, the first frame of atrioventricular valve opening.

FIGURE 3

Endocardial tracing of the left and right ventricles and calculation of global longitudinal strain. The upper left image shows a four-chamber view projected obliquely for optimal tracking of endocardial borders. Strain measurements of the left and right ventricles are shown in the upper right.

FIGURE 4

Comparison of the ventricular 24-segment spherical index (SI) between the control and GDM groups at 24+0–40+1 week.(A) Left ventricular 24-segment SI values in the GDM and control groups at 24–28⁺⁰ week (p > 0.05). (B) Right ventricular (RV) 24-segment SI values in the GDM and control groups at 24–28⁺⁰ week (p > 0.05). (C) Left ventricular 24-segment SI values in the GDM and control groups at 28–40⁺¹ weeks (p > 0.05). (D) Right ventricular (RV) 24-segment SI values in the GDM and control groups at 28–40⁺⁰ weeks (p < 0.05).

FIGURE 5

Box plots of global longitudinal strain (GLS) and fractional area change (FAC) in the fetal endocardium. (A) Changes in the LV-GLS in the control and GDM groups at 24⁺⁰ to 28⁺⁰ and 28⁺¹ to 40⁺¹ weeks. (B) Changes in RV-GLS in the control and GDM groups at 24⁺⁰ to 28⁺⁰ and 28⁺¹ to 40⁺¹ week. (C) Changes in the LV-FAC in the control and GDM groups at 24⁺⁰ to 28⁺⁰ and 28⁺¹ to 40⁺¹ week. (D) Changes in RV-FAC in the control and GDM groups at 24⁺⁰ to 28⁺⁰ and 28⁺¹ to 40⁺¹ week. Boxes indicate medians and interquartile ranges; whiskers indicate ranges.

FIGURE 6

Bland–Altman plots for interobserver and intraobserver variability. The Bland–Altman analysis of the inter- and intraobserver variability of the LV- GLS (A), RV-GLS (C), LV-FAC (E), RV-FAC (G), and GSI (I) in 24⁺⁰-28⁺⁰ weeks. The Bland–Altman analysis of the inter- and intraobserver variability of the LV- GLS (B), RV-GLS (D), LV-FAC (F), RV-FAC (H), and GSI (J) in 28⁺¹-40⁺¹ weeks. This results demonstrated that the mean variability in the inter- and intraobserver results was acceptable. LV, left ventricle; GLS, global longitudinal strain; RV, right ventricle; FAC, fractional area change; GSI, global spherical index.