Depressed left and right ventricular cardiac output in fetuses of diabetic mothers

Jennifer Winter, Aparna Kulkarni, Mary Craft, Ling Li, Lisa K. Hornberger, David A. Danford, Shelby Kutty

Research output: Contribution to journalArticle

Abstract

Introduction: We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) with a large normal cohort. Methods: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters such as semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD) and stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO were calculated. These were normalized using non-linear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z scores and 95% confidence limits (CL) were calculated and compared to zero. Results: LVCO, RVCO and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z −1.679, 95% CL −2.404, −0.955, P<0.001), and AVVTI, LVOTD and AVSV were significantly lower than normal. Similarly, RVCO (mean Z=−1.119, CL −1.839, −0.400, P=0.003), RVOTD (mean −2.085, CL −3.077, −1.093, P<0.001) and PVSV (mean −1.184, CL −1.921, −0.446, P=0.003) were lower than normal, however, PVVTI was not different (mean Z 0.078, CL −0.552, +0.707, P=0.803). Conclusion: Normal biventricular stroke volumes and outputs follow a non-linear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalEcho Research and Practice
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Cardiac Output
Fetus
Fetal Weight
Stroke Volume
Cardiac Volume
Carbon Monoxide
Weights and Measures

Keywords

  • F fetus f cardiac output f Z scores f diabetes mellitus

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Advanced and Specialized Nursing

Cite this

Winter, J., Kulkarni, A., Craft, M., Li, L., Hornberger, L. K., Danford, D. A., & Kutty, S. (2018). Depressed left and right ventricular cardiac output in fetuses of diabetic mothers. Echo Research and Practice, 5(1), 19-26. https://doi.org/10.1530/ERP-17-0063

Depressed left and right ventricular cardiac output in fetuses of diabetic mothers. / Winter, Jennifer; Kulkarni, Aparna; Craft, Mary; Li, Ling; Hornberger, Lisa K.; Danford, David A.; Kutty, Shelby.

In: Echo Research and Practice, Vol. 5, No. 1, 01.01.2018, p. 19-26.

Research output: Contribution to journalArticle

Winter, J, Kulkarni, A, Craft, M, Li, L, Hornberger, LK, Danford, DA & Kutty, S 2018, 'Depressed left and right ventricular cardiac output in fetuses of diabetic mothers', Echo Research and Practice, vol. 5, no. 1, pp. 19-26. https://doi.org/10.1530/ERP-17-0063
Winter J, Kulkarni A, Craft M, Li L, Hornberger LK, Danford DA et al. Depressed left and right ventricular cardiac output in fetuses of diabetic mothers. Echo Research and Practice. 2018 Jan 1;5(1):19-26. https://doi.org/10.1530/ERP-17-0063
Winter, Jennifer ; Kulkarni, Aparna ; Craft, Mary ; Li, Ling ; Hornberger, Lisa K. ; Danford, David A. ; Kutty, Shelby. / Depressed left and right ventricular cardiac output in fetuses of diabetic mothers. In: Echo Research and Practice. 2018 ; Vol. 5, No. 1. pp. 19-26.
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abstract = "Introduction: We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) with a large normal cohort. Methods: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters such as semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD) and stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO were calculated. These were normalized using non-linear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z scores and 95{\%} confidence limits (CL) were calculated and compared to zero. Results: LVCO, RVCO and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z −1.679, 95{\%} CL −2.404, −0.955, P<0.001), and AVVTI, LVOTD and AVSV were significantly lower than normal. Similarly, RVCO (mean Z=−1.119, CL −1.839, −0.400, P=0.003), RVOTD (mean −2.085, CL −3.077, −1.093, P<0.001) and PVSV (mean −1.184, CL −1.921, −0.446, P=0.003) were lower than normal, however, PVVTI was not different (mean Z 0.078, CL −0.552, +0.707, P=0.803). Conclusion: Normal biventricular stroke volumes and outputs follow a non-linear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.",
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AU - Winter, Jennifer

AU - Kulkarni, Aparna

AU - Craft, Mary

AU - Li, Ling

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AU - Danford, David A.

AU - Kutty, Shelby

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N2 - Introduction: We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) with a large normal cohort. Methods: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters such as semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD) and stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO were calculated. These were normalized using non-linear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z scores and 95% confidence limits (CL) were calculated and compared to zero. Results: LVCO, RVCO and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z −1.679, 95% CL −2.404, −0.955, P<0.001), and AVVTI, LVOTD and AVSV were significantly lower than normal. Similarly, RVCO (mean Z=−1.119, CL −1.839, −0.400, P=0.003), RVOTD (mean −2.085, CL −3.077, −1.093, P<0.001) and PVSV (mean −1.184, CL −1.921, −0.446, P=0.003) were lower than normal, however, PVVTI was not different (mean Z 0.078, CL −0.552, +0.707, P=0.803). Conclusion: Normal biventricular stroke volumes and outputs follow a non-linear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.

AB - Introduction: We compared right and left ventricular cardiac output (RVCO and LVCO) in fetuses of diabetic mothers (FDM) with a large normal cohort. Methods: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters such as semilunar valve velocity time integrals (AVVTI, PVVTI), ventricular outflow diameters (LVOTD, RVOTD) and stroke volumes (AVSV, PVSV) were measured, and LVCO and RVCO were calculated. These were normalized using non-linear regression to estimated fetal weight (EFW) to provide means and standard deviations. Among FDMs, mean Z scores and 95% confidence limits (CL) were calculated and compared to zero. Results: LVCO, RVCO and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z −1.679, 95% CL −2.404, −0.955, P<0.001), and AVVTI, LVOTD and AVSV were significantly lower than normal. Similarly, RVCO (mean Z=−1.119, CL −1.839, −0.400, P=0.003), RVOTD (mean −2.085, CL −3.077, −1.093, P<0.001) and PVSV (mean −1.184, CL −1.921, −0.446, P=0.003) were lower than normal, however, PVVTI was not different (mean Z 0.078, CL −0.552, +0.707, P=0.803). Conclusion: Normal biventricular stroke volumes and outputs follow a non-linear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.

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