Tei Index Derived From Doppler Tissue Imaging Combining With Other Multiple Fetal Echocardiographic Indices For Evaluation Of Fetal Cardiac Function In Women With Gestational Diabetes Mellitus

Background:Diabetes mellitus is a common condition, affecting approximately7%of pregnant women. Gestational diabetes mellitus is defined as glucose intolerance with onset or first recognition during pregnancy. The incidence of gestational diabetes mellitus in China is about1.31～3.75%, and the prevalence is keeping increasing. Pregnancies complicated by gestational diabetes are at high risk of adverse outcome, including congenital anomaly, premature delivery and perinatal mortality. Conventional echocardiographic parameters including atrioventricular inflow velocities, ejection fraction have limitations in evaluating fetal cardiac function because of various influence factors. Doppler Tissue Imaging(DTI) evaluation of the fetal heart is feasible and reproducible and can quantitative assessment of myocardial performance precisely. By incorporating only time intervals, the Tei index is less dependent on anatomy, independent of both heart rate and ventricular geometry. The Tei index can be used as a measure of global myocardial function in fetuses.Objectives:To evaluate fetal cardiac function in women with gestational diabetes mellitus (GDM) by using myocardial performance index (Tei Index) measured by DTI and other multiple fetal echocardiographic parameters, and compared DTI derived Tei index and other echocardiographic indices with those of control fetuses.Methods:Echocardiographic examinations were performed in106women with well controlled gestational diabetes mellitus at25-38weeks of gestation admitted to Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and133gestational age-matched controls. Detailed fetal echocardiographic measurements including M-mode,2-dimensional and Doppler echocardiography were performed for both groups. The following variables were studied:the thickness of the fetal interventricular septum, tricuspid annular displacement, mitral annular displacement, left atrial shortening fraction, left ventricular ejection fraction, and DTI-derived Tei index was calculated. Measurements were made in3consecutive cardiac cycles and averaged. Data were expressed as mean values±tandard deviations (SD). All analyses were performed using SPSS17.0. A P-value<0.05was considered significant.Results:There were no significant differences in interventricular septum thickness, velocity of mitral and tricuspid annulus, tricuspid annular displacement, mitral annular displacement, left atrial shortening fraction and left ventricular ejection fraction between study and control groups (P>0.05). The left and right ventricular Tei index increased significantly in the fetuses of study group throughout gestation (P<0.05) and were significantly higher than those of the control group (P<0.05).Conclusions:Fetuses of women with well-controlled gestational diabetes mellitus lack the ventricular hypertrophy, significant diastolic and systolic dysfunction compared with non-diabetic controls, but they have an increased MPI late in gestation.