Altered maternal left ventricular contractility and function during normal pregnancy. (28th May 2013)

• Record Type: Journal Article
• Authors: Estensen, M. E.; Beitnes, J. O.; Grindheim, G.; Aaberge, L.; Smiseth, O. A.; Henriksen, T.; Aakhus, S.
• Is Part Of: Ultrasound in obstetrics & gynecology. Volume 41:Number 6(2013:Jun.)
• Page Start: 659
• Page End: 666
• Publication Date: 2013-05-28
• Subjects: Ultrasonics in obstetrics -- Periodicals; Generative organs, Female -- Diseases -- Diagnosis -- Periodicals; Diagnosis, Ultrasonic -- Periodicals; Genital Diseases, Female -- ultrasonography -- Periodicals; Ultrasonography, Prenatal -- Periodicals; 618.047543
• DOI: 10.1002/uog.12296
• Languages: English
• ISSNs: 0960-7692

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <sec id="uog12296-sec-0001" sec-type="section"> <title>Objectives</title> <p>To evaluate maternal left ventricular (LV) systolic and diastolic function during normal pregnancy by non‐invasive measures of LV contractility incorporating loading conditions.</p> </sec> <sec id="uog12296-sec-0002" sec-type="section"> <title>METHODS</title> <p>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.</p> </sec> <sec id="uog12296-sec-0003" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> < 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, <italic>P</italic> < 0.01). Afterload, measured as LV end‐systolic wall stress (ESWS) increased by 10% between 14–16 and 36 weeks' gestation (<italic>P</italic> < 0.01). Analysis of the relationship between Vcfc and ESWS revealed that LV contractility was lower during pregnancy than at 6 months postpartum. Changes in diastolic function were demonstrated by 11% lower mitral early diastolic (E) wave velocity, 8% lower tissue Doppler early diastolic velocity (e′) and 13% higher left atrial area (all <italic>P</italic> < 0.01) during pregnancy. Tissue Doppler E/e′ remained unaltered (<italic>P</italic> = 0.78).</p> </sec> <sec id="uog12296-sec-0004" sec-type="section"> <title>Conclusions</title> <p>During normal pregnancy, LV contractility is lower than it is at 6 months postpartum. This is associated with increased LV and left atrial area, whereas filling pressures are unchanged. These findings suggest that pregnancy exerts a larger load on the cardiovascular system than previously assumed. Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd.</p> </sec> </abstract>