Left ventricular remodelling and vascular adaptation to pregnancy in women with type 1 diabetes.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-09-05 DOI:10.1136/openhrt-2025-003427

Ása Wraae Olsen, Anne Nødgaard Weidemann Sørensen, Sidsel Linneberg Rathcke, Trine Tang Christensen, Jens Brøndum Frøkjær, Peter Søgaard, Tomas Zaremba

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Abstract

Background: Evidence regarding cardiovascular adaptation to pregnancy in women with pregestational diabetes is limited. Our study aimed to describe left ventricular (LV) remodelling and vascular adaptation to pregnancy in women with type 1 diabetes.

Methods: In this prospective cohort study, three consecutive cardiac MRI scans were conducted on age-matched and BMI-matched pregnant women with pregestational type 1 diabetes and pregnant women without diabetes. The scans were performed at gestational weeks 15-20, 26-30 and 34-37 from November 2020 to April 2023. Data collection and analysis included LV imaging results, brachial blood pressure and stroke volume derived functional vascular parameters.

Results: The study included 24 women with pregestational type 1 diabetes and 39 controls. Compared with controls, women with type 1 diabetes had significantly reduced LV end-diastolic volume index: 64.2±11.1 mL/m² vs 77.6±13.9 mL/m² (p<0.001), reduced end-systolic volume index: 26.0±7.3 mL/m² vs 33.5±7.7 mL/m² (p=0.003), increased concentricity: 0.84±0.13 g/mL vs 0.68±0.10 g/mL (p<0.001), reduced stroke volume index: 38.2±7.2 mL/m² vs 44.1±8.4 mL/m² (p=0.008), reduced cardiac index: 3.37±0.55 L/min/m² vs 3.62±0.51 L/min/m² (p=0.046), reduced global longitudinal strain: -13.5±2.3% vs -15.2±2.1% (p=0.04), increased myocardial T1 values: 998±28 ms vs 983±25 ms (p=0.03), increased systolic blood pressure: 128.1±7.8 mmHg vs 117.4±11.1 mmHg (p=0.007), increased mean arterial pressure: 94.8±6.7 mmHg vs 88.1±9.7 mmHg (p=0.03), increased total peripheral vascular resistance: 28.9±5.3 mmHg·min·m²/L vs 24.7±4.0 mmHg·min·m²/L (p=0.001), and reduced total arterial compliance: 0.79±0.19 mL/m²/mmHg vs 1.02±0.21 mL/m²/mmHg (p<0.001).

Conclusion: Our study provides evidence of impaired LV remodelling and suboptimal vascular adaptation to pregnancy in women with type 1 diabetes when compared to women without diabetes. The clinical implications of these findings, particularly their association with the development of later cardiovascular disease, require further investigation.

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1型糖尿病妇女妊娠左心室重构和血管适应。

背景：关于妊娠期糖尿病患者心血管适应妊娠的证据有限。我们的研究旨在描述1型糖尿病女性左心室（LV）重构和血管对妊娠的适应。方法：在这项前瞻性队列研究中，对年龄匹配和bmi匹配的妊娠期1型糖尿病孕妇和未患糖尿病的孕妇进行连续三次心脏MRI扫描。扫描于2020年11月至2023年4月在妊娠15-20周、26-30周和34-37周进行。数据收集和分析包括左室成像结果、肱血压和卒中容积衍生的功能血管参数。结果：该研究包括24名妊娠期1型糖尿病妇女和39名对照组。与对照组相比，1型糖尿病女性左室舒张末期容积指数显著降低：64.2±11.1 mL/m2 vs 77.6±13.9 mL/m2 (p2 vs 33.5±7.7 mL/m2 (p=0.003)，同心度增加：0.84±0.13 g/mL vs 0.68±0.10 g/mL (p2 vs 44.1±8.4 mL/m2 (p=0.008)，心脏指数降低：3.37±0.55 L/min/m2 vs 3.62±0.51 L/min/m2 (p=0.046)，整体纵向应变降低：-13.5±2.3% vs -15.2±2.1% (p=0.04)，心肌T1值升高：998±28 ms vs 983±25 ms (p=0.03)，收缩压升高：128.1±7.8 mmHg vs 117.4±11.1 mmHg (p=0.007)，平均动脉压升高：94.8±6.7 mmHg vs 88.1±9.7 mmHg (p=0.03)，外周血管总阻力升高：28.9±5.3 mmHg·min·m2/L vs 24.7±4.0 mmHg·min·m2/L (p=0.001)，动脉总依从性降低：0.79±0.19 mL/m2/mmHg vs 1.02±0.21 mL/m2/mmHg （p=0.03）。我们的研究提供了证据，证明与没有糖尿病的女性相比，1型糖尿病女性的左室重构受损和血管适应妊娠的次优。这些发现的临床意义，特别是它们与后期心血管疾病发展的关系，需要进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.