title: Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction.
abstract: BACKGROUND
  Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. We evaluated whether prenatal cardiovascular changes previously demonstrated in FGR persist into preadolescence.
  
  
  RESULTS
  A cohort study of 58 FGR (defined as birth weight below 10th centile) and 94 normally grown fetuses identified in utero and followed-up into preadolescence (8-12 years of age) by echocardiography and 3-dimensional shape computational analysis. Compared with controls, FGR preadolescents had a different cardiac shape, with more spherical and smaller hearts. Left ventricular ejection fraction was similar among groups, whereas FGR had decreased longitudinal motion (decreased mitral annular systolic peak velocities: control median, 0.11 m/s [interquartile range, 0.09-0.12] versus FGR median 0.09 m/s [interquartile range, 0.09-0.10]; P<0.01) and impaired relaxation (isovolumic relaxation time: control, 0.21 ms [interquartile range, 0.12-0.35] versus FGR, 0.35 ms [interquartile range, 0.20-0.46]; P=0.04). Global longitudinal strain was decreased (control mean, -22.4% [SD, 1.37] versus FGR mean, -21.5% [SD, 1.16]; P<0.001) compensated by an increased circumferential strain and with a higher prevalence of postsystolic shortening in FGR as compared with controls. These differences persisted after adjustment for parental ethnicity and smoking, prenatal glucocorticoid administration, preeclampsia, gestational age at delivery, days in intensive care unit, sex, age, and body surface area at evaluation.
  
  
  CONCLUSIONS
  This study provides evidence that cardiac remodeling induced by FGR persists until preadolescence with findings similar to those reported in their prenatal life and childhood. The findings support the hypothesis of primary cardiac programming in FGR for explaining the association between low birth weight and cardiovascular risk in adulthood.
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Sebastian Imre
authors.initials: SI
authors.lastname: Sarvari
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Merida
authors.initials: M
authors.lastname: Rodriguez-Lopez
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Marta
authors.initials: M
authors.lastname: Nuñez-Garcia
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sepulveda-Martinez
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Oscar
authors.initials: O
authors.lastname: Camara
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Constantine
authors.initials: C
authors.lastname: Butakoff
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacos
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.). fcrispi@clinic.ub.es.
authors.forename: Fatima
authors.initials: F
authors.lastname: Crispi
mesh_terms: D000367:Age Factors; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011627:Puberty; D012307:Risk Factors; D013318:Stroke Volume; D016216:Ultrasonography, Prenatal / Q000379:methods; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: adult; birth weight; cardiovascular disease; echocardiography; pregnancy