Cardiovascular Remodeling and Dysfunction Across a Range of Growth Restriction Severity in Small for Gestational Age Infants　- Implications for Fetal Programming.

Background: The purpose of this study was to clarify cardiovascular structure and function in small for gestational age (SGA) infants across a range of intrauterine growth restriction (IUGR) severity. Methods and Results: This prospective study included 38 SGA infants and 30 appropriate for gestational age (AGA) infants. SGA infants were subclassified into severe and mild SGA according to the degree of IUGR. Cardiovascular structure and function were evaluated using echocardiography at 1 week of age. Compared with the AGA infants, both the severe and mild SGA infants showed increased left ventricular diastolic dimensions (severe SGA 10.2+/-2.4, mild SGA 8.2+/-1.3, and AGA 7.3+/-0.7 mm/kg, P<0.05 for all) and decreased global longitudinal strain (severe -21.1+/-1.6, mild -22.5+/-1.8, and AGA -23.8+/-1.8%, P<0.05 for all). Severe SGA infants showed a decreased mitral annular early diastolic velocity (severe 5.6+/-1.4 vs. AGA 7.0+/-1.3 cm/s, P<0.01) and increased isovolumic relaxation time (severe 51.3+/-9.2 vs. AGA 42.7+/-8.2 ms, P<0.01). Weight-adjusted aortic intima-media thickness and arterial wall stiffness were significantly greater in both SGA infant groups. These cardiovascular parameters tended to deteriorate with increasing IUGR severity. Conclusions: SGA infants, including those with mild SGA, showed cardiovascular remodeling and dysfunction, which increased with IUGR severity.