title: Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction.
abstract: OBJECTIVE
  To identify different cardiac phenotypes among cases of fetal growth restriction (FGR).
  
  
  METHODS
  Echocardiography was performed in 126 cases with FGR (birth weight < 10thcentile) and 64 appropriate-for-gestational-age (AGA) fetuses. Principal component and cluster analyses were performed to identify different cardiac phenotypes among FGR cases.
  
  
  RESULTS
  Three different cardiac phenotypes were identified among the FGR group: globular in 54% of cases, elongated in 29% of cases and hypertrophic in 17% of cases. Those with a globular heart had the lowest median left-ventricular sphericity index (controls, 1.78 (interquartile range (IQR), 1.62-1.97); FGR elongated, 1.92 (IQR, 1.78-2.09); FGR globular, 1.44 (IQR, 1.36-1.52); FGR hypertrophic, 1.65 (IQR, 1.42-1.77); P = 0.001). FGR cases with an elongated left ventricle had nearly normal cardiac dimensions. FGR cases with a hypertrophic phenotype had the highest median left-ventricular wall thickness (controls, 1.22 (IQR, 1.10-1.67) mm/kg; FGR elongated, 1.52 (IQR, 1.28-1.86) mm/kg; FGR globular, 1.65 (IQR, 1.39-1.99) mm/kg; FGR hypertrophic, 3.68 (IQR, 3.45-4.71) mm/kg; P = 0.001) and cardiac dimensions. Globular and elongated phenotypes showed a fetoplacental profile of late-onset FGR, while the hypertrophic phenotype showed signs of early-onset FGR. The hypertrophic group also had the poorest perinatal results, having the lowest birth-weight centile, gestational age at delivery and Apgar score and the highest postnatal blood pressure and aorta intima-media thickness.
  
  
  CONCLUSIONS
  FGR induces at least three different cardiac phenotypes, with early-onset FGR cases being associated with a hypertrophic response and worse perinatal outcomes. This cardiac phenotypic classification may improve identification of FGR cases with the highest perinatal and long-term cardiovascular risks. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-8245-0811
authors.initials: M
authors.lastname: Rodríguez-López
authors.affiliation: BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.|Fetal Medicine and Surgery Research Unit, Children and Women's Hospital of Querétaro, Querétaro, Mexico.|Neurodevelopmental Research Unit 'Dr. Augusto Fernández Guardiola', Neurobiology Institute, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, Mexico.
authors.forename: M
authors.initials: M
authors.lastname: Cruz-Lemini
authors.affiliation: BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Valenzuela-Alcaraz
authors.affiliation: BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Garcia-Otero
authors.affiliation: Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sitges
authors.affiliation: ICREA, Barcelona, Spain.|Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: E
authors.identifier: http://orcid.org/0000-0002-7405-7224
authors.initials: E
authors.lastname: Gratacós
authors.affiliation: BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain.|Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-7422-5240
authors.initials: F
authors.lastname: Crispi
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D010641:Phenotype; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal
keywords: echocardiography; fetal growth restriction; phenotype; ventricular cardiac remodeling