title: A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction.
abstract: OBJECTIVE
  Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants.
  
  
  METHODS
  One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of >95th percentile together with aortic intima-media thickness of >75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes.
  
  
  RESULTS
  Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P < .001).
  
  
  CONCLUSIONS
  Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Cruz-Lemini
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
authors.forename: Fátima
authors.initials: F
authors.lastname: Crispi
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
authors.forename: Brenda
authors.initials: B
authors.lastname: Valenzuela-Alcaraz
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Figueras
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Gómez
authors.affiliation: Department of Cardiology, Institut Clínic del Tòrax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: ICREA-Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain. Electronic address: gratacos@clinic.ub.es.
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D002319:Cardiovascular System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005333:Fetus / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
keywords: cardiovascular risk; fetal echocardiography; hypertension; intrauterine growth restriction; programming