Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society (original) (raw)
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Structural and Functional Changes in Maternal Heart during Pregnancy: An Echocardiographic Study
Indian Journal of Cardiovascular Disease in Women WINCARS
Background Pregnancy is associated with profound physiologic alterations in the maternal cardiovascular system. This study aimed to investigate maternal cardiac performance during normal pregnancy by two-dimensional echocardiography parameters and various functional and structural alterations. Methods This was a cross-sectional study of 100 normal pregnant women who attended the antenatal clinic, and all participants had clinical history, physical examination, and 12-lead electrocardiogram. Two-dimensional, M-mode, and Doppler echocardiography was done. Echocardiographic parameters were compared with normal age-matched controls from previously published studies. Results The mean age of the study group was 23.35 ± 3.05 years, mean systolic blood pressure was 110.5 ± 8.69 mm Hg, and mean diastolic blood pressure was 71.6 ± 6.77 mm Hg. There was an increase in left atrial (LA) diameter, left ventricular end diastolic diameter, and interventricular septum (IVS) thickness as gestational ...
Echocardiography in Pregnancy: Part 2
Current Cardiology Reports, 2016
The prevalence of pregnant women with cardiovascular heart disease is increasing. Transthoracic echocardiography is safe during pregnancy, and it is an important diagnostic tool in pregnant women with established heart disease in order to monitor ventricular and valvular anatomy and function. In addition, it can be used to delineate cardiac anatomy in complex congenital heart disease and help stratify maternal risk during pregnancy. This review will focus on the use of echocardiography in the diagnosis and management of pregnant women with common congenital lesions and with prosthetic valves.
Normal Echocardiographic Measurements in Uncomplicated Pregnancy, a Single Center Experience
Journal of Cardiovascular Disease Research, 2014
Background: Cardiovascular changes of pregnancy are well-known; however, parameters for accurately assessing these changes have not been refi ned as measurement tools have advanced. We sought to examine the range of echocardiographic parameters during normal pregnancy using current echocardiographic imaging modalities. Methods: We performed a retrospective analysis of normal echocardiograms in 121 women (97 pregnant, 24 non-pregnant) without evidence of cardiovascular disease. Linear, area, and Doppler fl ow measurements were made of commonly reviewed cardiac structures. Height-indexed measurements were compared between pregnant women and controls and between trimesters of pregnancy. Results: Compared to non-pregnant patients, all four cardiac chambers showed signifi cant enlargement in the pregnant patients. The left atrium was the fi rst chamber to enlarge. LV mass also increased in the third trimester (134.5 ± 31 vs. 112.3 ± 28.2 g, P < 0.01), with preservation of LV mass to volume ratio. LV ejection fraction was signifi cantly larger (68% vs. 63%, P < 0.036) in the second trimester patients, but decreased into the third trimester (64.1% ± 6.8%, P < 0.006). When pulmonary artery systolic pressure (PASP) was calculated from the pulmonary artery acceleration time, observed pressures were signifi cantly greater in the third trimester than second trimester (40.1 ± 10.3 vs. 45.5 ± 10.1 mmHg, P = 0.029). PASP calculated conventionally from tricuspid regurgitation gradient did not show similar signifi cance. There was no signifi cant change in diastolic parameters throughout pregnancy. Conclusions: This study provides data on echocardiographic parameters during normal pregnancy and is one of the largest sample sizes in the literature. The results will contribute to the current literature by helping to distinguish between normal and abnormal echocardiograms during pregnancy.
Cardiac structure and function in normal pregnancy
Current Opinion in Obstetrics & Gynecology, 2012
Purpose of review To review the published data on maternal cardiac adaptation to pregnancy. Recent findings Normal pregnancy is characterized by significant changes in the cardiovascular system. Studies on systemic arterial system and heart remodelling in pregnancy provide somewhat uniform results. In normal pregnancy, left ventricle mass, cardiac output and arterial compliance increase, whereas total vascular resistance decreases. In contrast, findings on left ventricular systolic and diastolic chamber and myocardial function are conflicting.
Cardiac Dimensions in Normal Pregnancy: A Prospective Study
Cureus
Background: Pregnancy, a unique physiologic state, is associated with several changes in the various body systems. The cardiovascular system is one of the systems affected, with chronic volume overload being one of the characteristic changes experienced during pregnancy. Cardiovascular disease in pregnancy is the leading cause of non-obstetric maternal death worldwide. Aim: This study aims to determine and describe the changes in left and right ventricular and atrial sizes in systole and diastole in the course of normal pregnancy. Methods and materials: A cohort study was conducted among healthy pregnant women between the age of 18 and 40 who attended the antenatal clinic of Federal Medical Centre (FMC), Yenagoa, Bayelsa State. Fifty women were recruited during the first trimester (T1) of pregnancy and followed up until six weeks postpartum. Ethical approval was obtained from the Research Ethics Committee of Federal Medical Centre, Yenagoa, with approval number FMCY/REC/ECC/2019/JAN/150. Clinical evaluation, hematologic, biochemical, and anthropometric assessments, and two-dimensional M-mode and Doppler echocardiography were done for the participants in each trimester of pregnancy and at six weeks postpartum. The clinical and echocardiographic parameters were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA). Results: The mean trend of left ventricular posterior wall thickness in diastole (LVPWd) and left ventricular posterior wall thickness in systole (LVPWs) increased progressively from the first to third trimester (T3) (not statistically significant) but dropped toward initial values in postpartum to the level that was statistically significant for LVWPd alone when compared to baseline first trimester values. The left atrial diameter in systole (LADs) was largest in the third trimester, and the left atrial volume index (LAVI) and right ventricular basal diameter (RVD1) also showed a similar trend. The left ventricular internal diameter (LVID) in both systole and diastole increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). The right atrial diameter (RAD) and right atrial volume (RAV) also increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). Conclusion: Changes were noticed in the cardiac chamber sizes during pregnancy. However, this reversed back to levels similar to the first trimester during the postpartum period. To aid in the early detection and treatment of cardiovascular disorders in pregnancy, screening of apparently healthy pregnant women who later developed complaints is advised as cardiovascular changes could be significant during pregnancy.
Proceedings of the International Congress on Cardiovascular Technologies, 2013
The hyperkinetic hemodynamic pattern and the low viscosity of the blood are typical during pregnancy and cause a number of auscultatory changes. The main goal of this study was to describe hemodynamic and auscultatory changes in normal pregnant women and compare them to those of non-pregnant women. Digital heart auscultation and Doppler echocardiography tests were performed in 29 pregnant and 27 nonpregnant women, both healthy. Changes in the digital stethoscope auscultation and Doppler echocardiographic findings were compared between the groups. The low-intensity systolic murmur was statistically more frequent in the pregnant group (69.0% x 40.7%, p=0.034), as well as B1 Hyperphonesis (51.7% x 7.4%, p<0.001), B2 Hyperphonesis (69% x 18.5%, p<0.001) and B1 Split (89.7% x 29.6%, p<0.001). In pregnant women, no associations were found between auscultation findings and Doppler echocardiogram changes (mitral-murmur x mitral-regurgitation, p=0.675; tricuspid-murmur x tricuspidregurgitation, p=1.000; pulmonary-murmur x pulmonary-regurgitation, p=1.000). The digital heart auscultation of healthy pregnant subjects was able to detect frequent and numerous alterations, confirming the importance of knowing the physiological changes of pregnancy. The normal Doppler echocardiogram in all healthy pregnant women with heart murmur indicates that such test has limited applicability for healthy pregnant subjects, only in cases of suspicion of a heart disease or when it does occur.
IOSR Journals , 2019
Background Cardiac disease is being the leading non obstetric cause of death in pregnancy and puerperium. Hypertensive disorders constitute 5-10% of all pregnancies, being one of the components of deadly triad with hemorrhage and infection. Preeclampsia is a pregnancy complication of placental etiology with acute onset of predominantly cardiovascular manifestations and constitutes 2-7% of medical disorders in pregnancies. In India, preeclampsia accounts for approximately 8-14% of maternal deaths. There is limited knowledge with respect to parameters of cardiac function in pregnancy and even less in the presence of pregnancy complications such as preeclampsia. In preeclampsia mean arterial pressure and total vascular resistance are increased resulting in increased afterload on heart. Transthoracic echocardiography is frequently considered the reference standard for cardiovascular system monitoring. It is a non-invasive, precise device and is validated in pregnancy. Aim & Objective:- To compare the echocardiography parameters in pregnant women with new onset hypertension and normotensive pregnant women after 28 weeks of gestational age. Methods:- This is a hospital based observational case control study carried out in the departments of obstetrics and gynecology and cardiology at Gandhi hospital during the study period. Patients were enrolled in the study after applying the inclusion and exclusion criteria. On admission subjects are assessed clinically, appropriate biochemical tests done. • The subjects were studied by standard 2 – dimensional and Doppler transthoracic echocardiography in the left lateral decubitus position and data acquired at end expiration from standard parasternal/apical views. Results:- In the present study, it is observed mean heart rate is 82.9bpm in cases and 84 bpm in controls. It is observed that mean stroke volume index in cases is 39.05 and in controls is 39.06. Cardiac work index (CWI) is increased in cases compared to controls. Mean CWI in cases is 385 and in controls are 288.89.Mean E wave velocity in cases is 0.79 m/s and in controls are 0.82 m/s. A wave is increased in cases which is statistically significant. Mean A wave velocity in cases is 0.65 m/s and in controls is 0.60 m/s. E/A ratio is reduced in cases which is statistically significant. Mean E/A ratio in cases is 1.22 and in controls is 1.35.In the present study it is observed Left ventricular mass index (LVMI) is increased in cases compared to controls. Mean LVMI in cases is 75.26 gm/m² and in controls is 70.48 gm/m². Conclusion:- Preeclampsia is a multisystem disease complicating 5-10% of pregnancies and remains in the top three causes of maternal morbidity and mortality globally. In women with preeclampsia cardiac work index ,left ventricular mass index,left ventricular posterior wall diameter and interventricular septal thickness are increased as a result of increased workload on heart to maintain cardiac output against increased after load.Systolic function is well preserved. Diastolic function is reduced and those with global diastolic dysfunction are at increased risk of developing pulmonary edema.
Cardiac function at term in human pregnancy
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
Objectives: We have previously demonstrated deterioration in cardiac function at term in human pregnancy. To explore further, we investigated central arterial hemodynamics and association with maternal weight during gestation. Study design: Primiparous women (n = 32) were recruited in a tertiary referral obstetric hospital and a longitudinal cohort study with analyses at median 16 and 37 weeks gestation undertaken. Subgroups of normal body mass index, <25 kg/m 2 , and overweight, P25 kg/m 2 , at 16 weeks were created. Main outcome measures: We performed 2D speckle tracking echocardiography strain analysis and tonometric measures of central arterial pressures, waveforms and pulse wave velocity. Results: A reduction in cardiac strain (2P = 0.002) from 16 to 37 weeks gestation was associated with increased systemic vascular resistance (2P = 0.008), reduced arterial compliance (2P = 0.004) and increased central arterial pressures (2P < 0.001) and augmentation index (2P = 0.001). Conclusions: By 37 weeks, compared with values in earlier pregnancy, overweight women had higher systemic vascular resistance (2P < 0.05). Additionally, their central diastolic pressure was higher (2P < 0.05) and their ventricular strain was lower (2P < 0.05) than in normal weight pregnant women. An increase in systemic vascular resistance and central arterial pressures by term may contribute to the observed deterioration in cardiac function. This appears more prominent in overweight women.
Obstetrics & Gynecology, 1997
Objective: To investigate the hemodynamic changes occurring in normal pregnancy and to see if these changes were associated with an increase in myocardial contractility. Methods: In a longitudinal study, primigravidas were studied with echocardiography in early (15 + 1.8 weeks), mid (26 rt 1.2 weeks), and late (36 f 1.0 weeks) gestation, as well as at 6 weeks postpartum. Cardiac dimensions were measured with two-dimensional and M-mode echocardiography and hemodynamic indices were calculated. All measurements were made with subjects in the left lateral decubitus position. Statistical analysis was performed with repeated measures analysis of variance. Results: Seventy-six women with normal pregnancy outcomes completed all four studies. From the baseline study to late gestation, an increase in cardiac output of 27% (from [mean f standard error] 4.2 f 0.1 to 5.8 f 0.2 L/min, P = .OOl), and a decrease in total peripheral resistance of 33% (from 1356-C 69 to 941 f 37 dynes/second cmm5, P = .OOl) occurred. Over this same time period, left ventricular function, while demonstrating a small and non-significant increase in velocity of circumferential fiber shortening (from 1.25 f 0.02 to 1.27-C 0.02 cm/second), revealed a 12% decrease in wall stress (from 36.3 + 1.0 to 31.9 + 1.0 g/cm', P = .OOl) and a 13% decrease in the load-independent wall stress to velocity of circumferential fiber shortening ratio (from 30.0 f 1.2 to 26.1 f 1.0, P = .Ol), implying enhanced intrinsic myocardial contractility. Conclusion: Normal pregnancy is characterized by enhanced myocardial performance.
2014
Background: Cardiovascular disease in pregnancy is the leading cause of maternal mortality in North America. Although transthoracic echocardiography (TTE) is the most widely used imaging modality for the assessment of cardiovascular function during pregnancy, little is known on the role of cardiovascular magnetic resonance (CMR). The objective of the Cardiac Hemodynamic Imaging and Remodeling in Pregnancy (CHIRP) study was to compare TTE and CMR in the non-invasive assessment of maternal cardiac remodeling during the peripartum period. Methods: Between 2010-2012, healthy pregnant women aged 18 to 35 years were prospectively enrolled. All women underwent TTE and CMR during the third trimester and at least 3 months postpartum (surrogate for non-pregnant state). Results: The study population included a total of 34 women (mean age 29 ± 3 years). During the third trimester, TTE and CMR demonstrated an increase in left ventricular end-diastolic volume from 95 ± 11 mL to 115 ± 14 mL and 98 ± 6 mL to 125 ± 5 mL, respectively (p < 0.05). By TTE and CMR, there was also an increase in left ventricular (LV) mass during pregnancy from 111 ± 10 g to 163 ± 11 g and 121 ± 5 g to 179 ± 5 g, respectively (p < 0.05). Although there was good correlation between both imaging modalities for LV mass, stroke volume, and cardiac output, the values were consistently underestimated by TTE. Conclusion: This CMR study provides reference values for cardiac indices during normal pregnancy and the postpartum state.