Changes in hemodynamics, ventricular remodeling, and ventricular contractility during normal pregnancy: A longitudinal study (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...
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.
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.
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.
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 ...
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.
Deterioration in cardiac systolic and diastolic function late in normal human pregnancy
Clinical Science, 2009
The aim of the present study was to undertake a longitudinal study of systolic and diastolic cardiac function during normal pregnancy. At a median of 16 weeks of gestation, 100 primiparous women underwent echocardiography, including tissue Doppler imaging, determining left ventricular mass, cardiac output, systolic and diastolic velocities, and wall stress. A total of 32 were assessed again at a median of 37 weeks of gestation. Non-pregnant control estimates (n=9) were obtained by averaging four separate measures over two menstrual cycles. Initially, the pregnant women had significantly higher pulse rates than controls, associated with greater ventricular wall stress (two-tailed P value=0.015), and systolic (two-tailed P value=0.005) and diastolic (two-tailed P value=0.018) lateral wall myocardial velocities, but no differences in systolic blood pressure, left ventricular mass or cardiac output. By 37 weeks of gestation, increased blood pressure (two-tailed P value <0.001) and le...
Maternal left ventricular transverse and long-axis systolic function during pregnancy
Ultrasound in Obstetrics and Gynecology, 2001
Objectives Circumferential fiber shortening has been the dominant basis for conventional analysis by echocardiography of left ventricular systolic function during pregnancy. Results in the literature have been conflicting due mainly to the fact that geometric assumptions for the calculation of these indices are made that may not be valid due to changes in left ventricular shape during pregnancy. Left ventricular long-axis displacement is expected to be a useful index of systolic function, independent of the changes in left ventricular geometry. The aim of this study was to compare circumferential to long-axis shortening during left ventricular contraction in pregnant women. Methods This was a cross-sectional study of 125 pregnant women at 9 -42 weeks of gestation and 19 non-pregnant female controls. Two-dimensional and M-mode echocardiography of the left ventricle was performed including measurement of left ventricular long-axis displacement and activation time on the lateral, septal, anterior and inferior sides of the mitral annulus. Activation time was assessed as the time from the start of the Q-wave of the electrocardiogram to the onset of left ventricular long-axis shortening. Results Mean arterial pressure and activation time decreased during pregnancy, reaching a nadir at about 19 weeks' gestational age of 4% and 13%, respectively, below non-pregnant values; they subsequently increased towards term. Left ventricular long-axis displacement mirrored the changes in mean arterial pressure and activation time and increased with gestational age at all four sites of the atrioventricular plane reaching a peak at about 23 weeks (+ 12% compared to nonpregnant levels). The ejection fraction and fractional shortening remained stable until 30 and 32 weeks, respectively, and then decreased towards term. Conclusion Changes in left ventricular long-axis performance during pregnancy occur earlier than do measures of transverse function. Left ventricular long-axis function during pregnancy Kametas et al.
Ultrasound in Obstetrics & Gynecology, 2012
Objectives Most studies during pregnancy have assessed maternal left ventricular (LV) function by load-dependent indices, assessing only chamber function. The aim of this study was to assess afterload-adjusted LV myocardial and chamber systolic function at 24 weeks' gestation and 6 months postpartum in high-risk normotensive pregnant women. Methods A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks' gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled. Results The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks' gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001, respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05). In the uncomplicatedoutcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicatedoutcome group, it was lower during pregnancy than it was postpartum (P < 0.05). Conclusions Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications.
Left Ventricular Torsional Mechanics in Uncomplicated Pregnancy
Clinical Cardiology, 2011
Background: Alterations in left ventricular (LV) twist (torsion) and untwist have been described for a variety of physiologic and pathologic conditions. Little information is available regarding changes in these parameters during normal pregnancy. Hypothesis: Pregnancy is associated with significant changes in LV torsional mechanics. Methods: Left ventricular twist and untwist was measured in 32 pregnant females (mean gestation 199 ± 48 d) and 23 nonpregnant controls using speckle-tracking echocardiography. Results: Left ventricular ejection fraction (68 ± 5% vs 66 ± 5%) was similar between the groups (P not significant). There was a significant increase in peak LV twist from nonpregnant controls (9.4 ± 3.7 degrees) to second-trimester (12.0 ± 4.2 degrees) and third-trimester subjects (12.6 ± 5.9 degrees, all P < 0.05). Peak LV twist velocity was also increased in second-and third-trimester groups compared with controls (94 ± 24 degrees/sec and 93 ± 30 vs 64 ± 21 degrees/sec, respectively, both P < 0.05). Both peak untwist velocity and time to peak untwist velocity were not significantly different between groups (P not significant). Multiple regression analysis indicate that only systolic blood pressure (r = 0.394, P = 0.005) was an independent predictor for increased LV torsion. Conclusions: There are significant changes in LV torsional indices during the course of pregnancy, whereas untwist parameters remain unchanged. Blood pressure is independently associated with increased torsion during pregnancy.