THE IMPACT OF SHORT-TERM HYPERGLYCEMIA AND OBESITY ON BIVENTRICULAR AND BIATRIAL MYOCARDIAL FUNCTION ASSESSED BY SPECKLE TRACKING ECHOCARDIOGRAPHY IN A POPULATION OF WOMEN WITH GESTATIONAL DIABETES MELLITUS

Background and aims: To compare biventricular and biatrial myocardial strain indices assessed by two-dimensional speckle tracking echocardiography (2D-STE) in women with gestational diabetes mellitus (GDM) and those with uncomplicated pregnancy at the third trimester of pregnancy and in post-partum.

Methods and results: 30 consecutive GDM women and 30 age-, ethnicity- and gestational week-matched controls without any comorbidity were examined in this prospective case-control study. All women underwent obstetric visit, blood tests and transthoracic echocardiography (TTE) implemented with 2D-STE analysis of all cardiac chambers at 36-38 weeks’ gestation. TTE and 2D-STE were repeated at 6–10 weeks after delivery.

At 36-38 weeks’ gestation, GDM women, compared to controls, had significantly higher body mass index (BMI), blood pressure values and inflammatory markers. TTE showed increased left ventricular (LV) mass and impaired LV diastolic function in GDM women, whereas there was no significant difference between the groups in ejection fraction. 2D-STE revealed that biventricular global longitudinal strain (GLS) and biatrial reservoir strain indices were significantly lower in GDM women than controls. Third trimester BMI was inversely correlated with LV-GLS (r=–0.86) and was independently associated with reduced LV-GLS (less negative than –20%) in GDM women in post-partum (OR 1.81, 95%CI 1.14-2.89). A BMI value ≥30 Kg/m² had 100% sensitivity and 99.5% specificity for identifying GDM women with impaired LV-GLS in post-partum (AUC=0.97).

Conclusion: Women with GDM, compared to women with uncomplicated pregnancy, have significantly lower biventricular and biatrial myocardial deformation indices. These abnormalities may be persistent in post-partum in GDM women with obesity.