title: Assessment of diastolic ventricular function in fetuses of diabetic mothers using tissue Doppler.
abstract: OBJECTIVE
  To identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers.
  
  
  METHODS
  A contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil. We analysed variance with the Student-Neumann-Keuls post hoc test. An alfa of 0.05 was considered significant for statistical analysis.
  
  
  RESULTS
  The mean myocardial velocities of the E'and A' waves at the mural mitral annulus, in fetuses of diabetic mothers with myocardial hypertrophy, were, respectively, 7.00 plus or minus 1.6 centimetres per second, and 10.24 plus or minus 3.3 centimetres per second. In the fetuses of diabetic mothers group without myocardial hypertrophy, the comparable values were 7.19 plus or minus 2.4 centimetres per second and 10.77 plus or minus 3.77 centimetres per second, respectively. In the control group, they were 4.81 plus or minus 0.85 centimetres per second and 8.01 plus or minus 2.2 centimetres per second. The difference between the velocities in fetuses of diabetic mothers and in fetal normal mothers was statistically significant (p less than 0.05). Statistically significant differences were also observed in E' and A' diastolic waves at the aortic mitral annulus, as well as for the tricuspid annulus when tissue Doppler assessment was carried out in the same sample. The mean ratio between the E and E' of mitral and tricuspid waves in the control fetuses of normal mothers was significantly higher than in fetuses of diabetic mothers.
  
  
  CONCLUSIONS
  Pulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.
authors.affiliation: Fetal Cardiology Unit, Institute of Cardiology of Rio Grande do Sul/Universitary Cardiology Foundation, Porto Alegre, Brazil.
authors.forename: Maria Amélia Bulhões
authors.initials: MA
authors.lastname: Hatém
authors.forename: Paulo
authors.initials: P
authors.lastname: Zielinsky
authors.forename: Domingos Mohamad
authors.initials: DM
authors.lastname: Hatém
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: Nicoloso
authors.forename: João Luiz
authors.initials: JL
authors.lastname: Manica
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Piccoli
authors.forename: Juliana
authors.initials: J
authors.lastname: Zanettini
authors.forename: Vinicius
authors.initials: V
authors.lastname: Oliveira
authors.forename: Fernanda
authors.initials: F
authors.lastname: Scarpa
authors.forename: Rafaella
authors.initials: R
authors.lastname: Petracco
mesh_terms: D016640:Diabetes, Gestational / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005318:Fetal Heart / Q000503:physiopathology*; D005333:Fetus / Q000503:physiopathology*; D006801:Humans; D009206:Myocardium / Q000473:pathology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D016276:Ventricular Function / Q000502:physiology*