Jana Brodszki

Impaired Vascular Growth in Late Adolescence After Intrauterine Growth Restriction

Background—Abnormal blood flow in a fetus small for gestational age indicates true fetal intrauterine growth restriction (IUGR). We tested the hypothesis that IUGR with abnormal fetal blood flow is associated with long-term abnormal vascular morphology and function in adolescence. Methods and Results—In a prospective study, vascular mechanical properties of the common carotid artery (CCA), abdominal aorta, and popliteal artery (PA) were assessed by echo-tracking sonography in 21 adolescents with IUGR and abnormal fetal aortic blood flow and in 23 adolescents with normal fetal growth and normal fetal aortic blood flow. Endothelium-dependent and -independent vasodilatation of the brachial artery was measured by high-resolution ultrasound. After adjustment for body surface area and sex, the IUGR group had significantly smaller end-diastolic vessel diameters than the referents in the abdominal aorta and PA (mean difference, 1.7 mm [95% CI, 0.62 to 2.74] and 0.6 mm [95% CI, 0.25 to 1.02], respectively) (P=0.003 and P=0.002, respectively), with a similar trend in the CCA (P=0.09). A higher resting heart rate was observed in the IUGR group (P=0.01). No differences were found in stiffness or in endothelium-dependent and -independent vasodilatation between the 2 groups. Conclusions—IUGR caused by placental insufficiency appears to be associated with impaired vascular growth persisting into young adulthood in both men and women. The smaller aortic dimensions and the higher resting heart rate seen in adolescents with previous IUGR may be of importance for future cardiovascular health.

Early intervention in management of very preterm growth-restricted fetuses: 2-year outcome of infants delivered on fetal indication before 30 gestational weeks

To describe the outcome of growth‐restricted fetuses with absent or reversed end‐diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.

Increased aortic pulse wave velocity in middle aged women with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a connective tissue disease where inflammatory activity affects several organ systems. An increased risk of cardiovascular disease has been identified in these patients, even after correction for traditional risk factors. The aim of the present study was to evaluate arterial stiffness and central hemodynamics in women with SLE in comparison to controls. Arterial tonometry was used to measure aortic (carotid-femoral) and arm (carotid-radial) pulse wave velocity (PWV), reflected pressure waves, and aortic augmentation index (AIx) in 27 women with SLE (52 to 68 years) and 27 controls. Aortic PWV was higher in women with SLE than controls, 9.8 m/s versus 8.2 m/s (P 0.01), after correction for mean arterial pressure and body mass index, 9.5 m/s versus 8.5 m/s (P 0.05). Other parameters were similar, arm PWV, 8.4 versus 8.5 m/s, AIx 34 versus 33% and calculated central aortic pulse pressure 48 versus 43 mmHg, in SLE and controls, respectively (NS). Aortic PWV was positively associated to C-reactive protein (CRP) and complement factor 3 (C3). Women with SLE have increased stiffness of their elastic central arteries. This may be one factor contributing to the increased cardiovascular risk seen in this cohort.

Vascular mechanical properties and endothelial function in pre-eclampsia with special reference to bilateral uterine artery notch

Objectives. To assess whether women with pre‐eclampsia (PE) have different properties of the blood vessel wall compared to healthy pregnant controls. Further, to evaluate endothelial function and vascular mechanical properties in women with PE with special regard to its association with bilateral uterine artery notch and placental histopathology. Participants. Some 57 Caucasian pregnant women: 23 with uncomplicated pregnancies and normal uterine artery Doppler, and 34 with PE, the PE group comprising 2 subgroups according to the presence (n = 20) or absence (n = 14) of bilateral uterine artery notches. Methods. Ultrasonic echo‐tracking assessed the elastic properties of the common carotid artery, abdominal aorta and popliteal artery. Flow‐mediated dilatation (FMD) of the brachial artery was measured by ultrasonography. Histopathological examination of the placenta was carried out in 46 pregnancies: 18 uncomplicated pregnancies, 15 with PE with bilateral notch, and 13 with PE without bilateral notch. Results. There were no significant differences in carotid, aortic or popliteal vessel wall stiffness either between women with PE and controls or within the PE group. FMD was significantly lower in women with PE than in controls (p = 0.03). The lowest FMD was observed in pre‐eclamptic women with bilateral uterine artery notches 9.5% (SD: 5.3) compared to 11.6% (SD: 5.4) in pre‐eclamptic women without bilateral uterine artery notch, and 13.4% (SD: 4.0) in controls (p = 0.01). Bilateral uterine artery notching was significantly associated with a lower FMD (OR: 0.87; 95% CI: 0.77–0.98). There were significantly more placentas with high ischaemic score in the bilateral notch group than in the group with PE and normal circulation. Conclusions. There were no differences in vessel wall stiffness between women with PE and healthy controls. Women with PE showed signs of endothelial dysfunction, significantly more pronounced in women with bilateral uterine artery notch. Bilateral uterine artery notch was associated with ischaemic pathology of the placenta. Notwithstanding, a significant number of placentas in the PE group failed to show noteworthy ischaemic or other morphological changes that could explain the role of the placenta in the development of PE.

Abnormal mechanical properties of larger arteries in postmenopausal women with systemic lupus erythematosus.

There is limited knowledge of potential defects in arterial wall properties in female systemic lupus erythematosus (SLE) patients without manifest cardiovascular disease (CVD) and significant atherosclerotic lesions. The aim of the present study was to investigate the mechanical properties of larger vessels in these patients and to compare them with healthy controls. B-mode ultrasound was used to assess vessel wall structure and to exclude presence of plaque. The ankle/brachial pressure index was measured to exclude occlusive arterial disease. An ultrasound echo-tracking system was used to determine stiffness of the abdominal aorta, common carotid artery (CCA) and popliteal artery (PA) in 39 female patientswith SLE and 55 female, healthy controls. SLE had an independent effect on stiffening of the CCA (P = 0.01) and PA (P = 0.005). In addition, larger vessel diameters were observed in the CCA (P = 0.002) after adjustments for the effects of mean arterial pressure and age. Thus, this investigation demonstrated an increased arterial stiffness and signs of premature vascular ageing in the SLE patients without manifest cardiovascular disease and without significant atherosclerotic lesions. The results of this study indicate that other mechanisms besides atherosclerosis might be involved in the pathogenesis of arterial stiffening in SLE patients.

Lung function in children born after foetal growth restriction and very preterm birth.

Aims:  To assess lung function at early school age in children delivered at very early gestation owing to intrauterine growth restriction and abnormal foetal blood flow (IUGR).

Cardiovascular function in adulthood following intrauterine growth restriction with abnormal fetal blood flow

To examine whether intrauterine growth restriction (IUGR) is associated with increased cardiovascular risk later in life.

VOLUME BLOOD FLOW ESTIMATION IN THE NORMAL AND GROWTH-RESTRICTED FETUS

The objective was to compare volume blood flow (VBF) in the descending aorta (DAo) of gestational age and weight-matched growth restricted (GR) and normal (N) fetuses. A longitudinal study of 20 N was compared with 11 GR in two analyses matched for weight and gestation. DAo dimensions and flow velocity were measured simultaneously using a new technique combining an ultrasonic phase-locked echo-tracking system synchronized with a pulsed Doppler velocimeter. Cardiac output was estimated using standard echocardiographic views. DAo and semilunar valve diameters increased linearly in N and indexed cardiac output was similar in N and GR, although GR showed reduced DAo relative pulse amplitude, mean flow velocity and VBF. This synchronized technique permits calculation of VBF in human fetuses. Growth restriction is associated with reduced aortic wall pulsations and lower mean blood flow velocities and VBF in DAo secondary to increased placental impedance.

Ventriculo-vascular interaction in the normal development of the fetal circulation

OBJECTIVES To examine cardiovascular physiology in the healthy fetus during normal development. DESIGN Twenty normal fetuses were studied longitudinally from 20 weeks to term. Serial echocardiography was performed, and arterial and venous diameter pulse wave characteristics and aortic pulse wave propagation velocity (PWV) were examined in the thoracic descending aorta (AoD) and inferior caval vein (IVC) using an ultrasonic phase-locked echo-tracking system. Statistical analyses included ANOVA, paired t-test and logistic regression where appropriate. RESULTS Aortic PWV, maximum incremental and late decremental velocities increased with gestation while the relative pulse amplitude decreased, reflecting falling distal impedance. There was a linear increase in cardiac preload and relative pulse amplitude in the IVC with gestation that correlated significantly with the presence of end-diastolic flow in the pulmonary artery and improvement in right ventricular diastolic function. CONCLUSIONS Non-invasive concurrent assessment of preload, ventricular function and impedance are possible in the fetus and may prove useful in the longitudinal study of fetal adaptation to pathophysiological changes.

Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches

Objectives To assess endothelial function and vascular mechanical properties in normotensive pregnant women with high resistance in the uteroplacental circulation.