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Myocardial function in fetuses with lower urinary tract obstruction: Is there a cardiac remodeling effect due to renal damage?
Author(s) -
Graupner Oliver,
Enzensberger Christian,
Götte Malena,
Wolter Aline,
Müller Vera,
Kawecki Andreea,
Weber Stefanie,
Degenhardt Jan,
Herrmann Johannes,
AxtFliedner Roland
Publication year - 2019
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5453
Subject(s) - medicine , urinary tract obstruction , urinary system , gestation , fetus , gestational age , isovolumetric contraction , cardiology , doppler imaging , urology , endocrinology , pregnancy , diastole , biology , blood pressure , genetics
Objectives Cardiac remodeling due to renal dysfunction may have an impact on myocardial function (MF) of fetuses with lower urinary tract obstruction (LUTO). The aim was to identify possible differences in MF in LUTO fetuses compared with healthy controls and to look for interactions between urine biochemistry and MF indices. Methods This is a cohort study consisting of 31 LUTO fetuses and 45 healthy controls. Subgroups were generated according to intrauterine therapy (group 1: LUTO after therapy, group 2: LUTO without therapy at the time of examination, and group 3: controls). MF indices were measured using pulsed wave tissue Doppler imaging and M‐mode. Furthermore, results of fetal urine biochemistry were gathered retrospectively. Results Among other findings, right ventricular (RV) e’/a’ ratio was lower in group 1 compared with group 3 ( p = .050). According to gestational age (GA) level‐dependent analysis, RV isovolumetric relaxation time was significantly longer in group 2 compared with group 1 and group 3 at GA level 1 (19 wk of gestation). A significant positive correlation between RV e’/a’ ratio and β‐2‐microglobulin as well as α‐1‐microglobulin and potassium could be observed. Conclusion We observed differences in MF and an association between ventricular filling pattern and renal protein secretion in LUTO fetuses. This can be interpreted as a sign of intrauterine cardiac remodeling.