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Abstract Objective To investigate the relationship between parameters of diastolic function, loading conditions and remodeling of the left ventricle in the appropriate-for-gestational age and small-for-gestational age fetus. Methods Two-dimensional echocardiographic left ventricular images were digitized in 24 appropriate-for-gestational age and 14 small-for-gestational age fetuses. The maximal short axis and long axis were measured. The left ventricular contour was divided into 12 segments. The changes in whole left ventricular cavity area were calculated for ventricular global area change assessment. The coefficient of variation for segmental fractional area change was calculated for the evaluation of left ventricular regional wall motion non-uniformity. Results Mean left ventricular long axis/short axis ratio in the small-for-gestational age fetus (1.11 ± 0.08) was smaller (P < 0.01) than in the appropriate-for-gestational age fetus (1.75 ± 0.26). Mean fractional area change in the small-for-gestational age fetus was larger ( P < 0.01) than in the appropriate-for-gestational age fetus (37.8 ± 17.6% vs. 21.1 ± 9.9%). Mean left ventricular global area change in the small-for-gestational age fetus was smaller ( P < 0.05) than in the appropriate-for-gestational age fetus (53.2 ± 7.4% vs. 61.5 ± 10.3%). Mean ventricular isovolumic relaxation time in the appropriate-for-gestational age fetus was shorter ( P = 0.03) than in the small-for-gestational age fetus (37 ± 6 ms vs. 57 ± 9 ms). Mean transmitral E-wave/A-wave ratio in the small-for-gestational age fetus was smaller ( P < 0.01) than in the appropriate-for-gestational age fetus (0.69 ± 0.08 vs. 0.80 ± 0.08). A negative correlation ( P < 0.05) was demonstrated between: (i) fractional area change and global area change in both small-for-gestational age ( r = -0.62) and appropriate-for-gestational age fetuses ( r = -0.58); (ii) umbil-ical artery systolic/diastolic... [ABSTRACT FROM AUTHOR]

Objective To determine fetal left ventricular diastolic function as expressed by normalized left ventricular filling rate integral as well as conventional indices of transmitral blood flow in appropriate-for-gestational-age (AGA), small-for-gestational-age (SGA) and IDDM (insulin-dependent diabetes mellitus) fetuses during the third trimester of pregnancy. Design A cross-sectional study of fetal left ventricular filling using conventional parameters of transmitral blood flow. Subjects Twenty-five AGA fetuses (mean 32 weeks), 18 SGA fetuses (mean 32 weeks) and 15 fetuses associated with IDDM (mean 31 weeks). Methods Doppler measurements of mitral inflow velocity were converted to relative cumulative volume flow by integration at sequential time points along the velocity contour, producing a relative filling curve of the ventricle. The area under this curve was calculated to obtain the left ventricular filling rate integral. Results The left ventricular filling rate integral (I) for the complete diastole (E + A wave) was not significantly different between AGA and SGA fetuses but significantly lower in the IDDM fetus (p < 0.05) compared with the AGA fetus. Ie (E wave) was significantly lower and Ia (A wave) significantly higher in both SGA fetuses (p < 0.05) and IDDM fetuses (p < 0.01) compared with AGA fetuses. Conclusions There is a delay in left ventricular filling which may reflect changes in myocardial relaxation and possible reduction in passive ventricular filling as a result of chronic hypoxemia in the SGA fetus and altered in utero metabolic environment in the IDDM fetus. [ABSTRACT FROM AUTHOR]