Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

Diabetes effects start in utero and affect neonates, infants, children and adolescent. Gestational diabetes may have overwhelming effects on the embryonic heart as well as the infants born to diabetic mothers. The neonates and infants suffering this metabolic disease may have considerable cardiovascular effects [1]. Hypertrophic cardiomyopathy is a well known condition observed in infants of diabetic mothers and described for the first time in a stillborn infant of a diabetic mother by Maron et al. 1978 [2]. It occurred in about 30-40% of them. However, clinically manifest hypertrophic cardiomyopathy is present in 12% of cases with severity varies from an incidental finding on echocardiography to an infant with severe symptoms of congestive heart failure. Fatal cases of hypertrophic cardiomyopathy may occur in any infant of a diabetic mother [3]. It characterized by stiff, hypertrophied ventricular muscle, predominant thickening of the ventricular septum, impaired relaxation, and powerful but uncoordinated contraction. Functional subaortic obstruction may occur in severe cases (idiopathic hypertrophic subaortic stenosis) [4]. The exact mechanism of hypertrophic cardiomyopathy in infants of diabetic mothers is clear but it is suggested that fetal hyperinsulinism may trigger hyperplasia and hypertrophy of myocardial cells by increasing fat and protein synthesis [5]. Natural history of infant of diabetic mother related-hypertrophic cardiomyopathy appeared to be benign, with a resolution of symptoms within 2-4 weeks and a resolution of septal hypertrophy within 2-12 months [6].