Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy (original) (raw)
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Altered maternal left ventricular contractility and function during normal pregnancy
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To evaluate maternal left ventricular (LV) systolic and diastolic function during normal pregnancy by non-invasive measures of LV contractility incorporating loading conditions. Sixty-five women were examined using echocardiography, including tissue Doppler and two-dimensional speckle tracking, and subclavian artery pulse trace recordings at gestational weeks 14-16, 22-24 and 36, and at 6 months postpartum. The mean ± SD age of the women was 32.0 ± 4.6 years. Cardiac output and LV end-diastolic volume were on average 20% and 23% higher, respectively, during pregnancy, compared to that at 6 months postpartum (both, P < 0.01). LV ejection fraction, global peak systolic strain and rate-corrected LV velocity of circumferential fiber shortening (Vcfc) were 11%, 6% and 6% lower, respectively, at 36 weeks' gestation compared to at 6 months postpartum (all, P < 0.01). Afterload, measured as LV end-systolic wall stress (ESWS) increased by 10% between 14-16 and 36 weeks' gestati...
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.
Maternal Cardiac Dysfunction and Remodeling in Women With Preeclampsia at Term
Preeclampsia is a disease associated with significant cardiovascular morbidity during pregnancy and in later life. This study was designed to evaluate cardiac function and remodeling in preeclampsia occurring at term. This was a prospective case– control study of 50 term preeclampsia and 50 normal pregnancies assessed by echocardiography and tissue Doppler analysis. Global diastolic dysfunction was observed more frequently in preeclampsia versus control pregnancies (40% versus 14%, P0.007). Increased cardiac work and left ventricular mass indices suggest that left ventricular remodeling was an adaptive response to maintain myocardial contractility with preeclampsia at term. Approximately 20% of patients with preeclampsia at term have more evident myocardial damage. Diastolic dysfunction usually precedes systolic dysfunction in the evolution of ischemic or hypertensive cardiac diseases and is of prognostic value in the prediction of long-term cardiovascular morbidity. The study findings also have significant implications for the acute medical management of preeclampsia. (Hypertension. 2011;57:00-00.)
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.
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 ...
Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy
Journal of the American Society of Echocardiography, 2013
Background: The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy. Methods: Forty-four healthy fetuses were examined prospectively during the second-trimester and thirdtrimester ultrasound examinations (20-24 and 30-34 weeks, respectively). Clips with high frame rates (mean, 120 frames/sec) of two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses of global and regional walls and segments (basal, mid, and apical) of myocardial strain and strain rate as well as T2P global strain in the longitudinal direction. Results: There were statistically significant decreases in global and regional strain of the right ventricle between the second and third trimesters. No statistically significant changes were observed in global and regional strain of the left ventricle. Global and regional strain rates of both ventricles decreased in a similar way during pregnancy. The mean T2P longitudinal left ventricular global strain (adjusted for heart rate) increased mildly during fetal life. Whereas T2P longitudinal strain of the left ventricle at 20 to 24 weeks was statistically significantly shorter than that of the right ventricle, no difference in T2P longitudinal strain was found at 30 to 34 weeks of gestation between both ventricles. Conclusions: The establishment of these changes between the second-trimester and third-trimester twodimensional speckle-tracking echocardiography-derived reference values is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.
Maternal left ventricular and endothelial functions in preeclampsia
Acta Obstetricia et Gynecologica Scandinavica, 2012
Objective. To compare maternal left ventricular and endothelial functions in preeclampsia and normal pregnancy, during pregnancy and after delivery. Design. Observational study with follow-up. Setting. University hospital and midwife-led antenatal care center. Samples. Twenty untreated women with preeclampsia and 20 women with normal pregnancy, matched for gestational age and parity. Methods. The women were examined during pregnancy and three months after delivery. Left ventricular function was assessed by echocardiography, including tissue-Doppler imaging. Endothelial function was assessed by measuring flow-mediated dilation of the brachial artery. Main outcome measures. Early diastolic mitral annular tissue velocity, "e", peak systolic tissue velocity, "S", and flow-mediated dilation. Results. The diastolic function was reduced in preeclampsia, with lower "e", and there was a higher ratio of early diastolic mitral inflow velocity and early diastolic mitral annular velocity, "E/e". Early diastolic mitral inflow deceleration time and isovolumetric relaxation time were similar between the groups, suggesting pseudonormalization and increased filling pressures in preeclampsia. "S" was lower in the preeclampsia group during pregnancy. Both diastolic and systolic left ventricular functions normalized postpartum. The flow-mediated dilation was impaired in the preeclampsia group both during pregnancy and three months after delivery. Conclusions. The maternal left ventricular function was impaired during preeclampsia but had normalized three months after delivery. The endothelial function, measured by flow-mediated dilation, was impaired in the preeclampsia group as compared with the normal pregnancy group both during pregnancy and three months after delivery.
Circulation: Cardiovascular Imaging, 2012
Background— Patients with preeclampsia are at risk for cardiovascular disease. Changes in cardiac function are subtle in preeclampsia and are difficult to quantify with conventional imaging. Strain measurements using speckle-tracking echocardiography have been used to sensitively quantify abnormalities in other disease settings. Methods and Results— We evaluated the feasibility and sensitivity of strain imaging using speckle-tracking echocardiography in women with preeclampsia. Forty-seven women were enrolled in this pilot study and 39 were analyzed: 11 with preeclampsia, 17 without a hypertensive disorder, and 11 with nonproteinuric hypertension. Echocardiographic ejection fraction and global peak longitudinal, radial, and circumferential strain were measured. Longitudinal strain was significantly worsened in women with preeclampsia compared with women without a hypertensive disorder ( P =0.0001). Similar results were observed for radial strain ( P =0.006) and circumferential strai...
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.