Deterioration in cardiac systolic and diastolic function late in normal human pregnancy

Abstract

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 left ventricular mass (two-tailed P value=0.002) were associated with a significant increase in ventricular wall stress (two-tailed P value<0.001), and reductions in septal systolic (two-tailed P value=0.004) and septal and lateral early diastolic (two-tailed P value<0.001) myocardial velocities. The diastolic velocities at 37 weeks correlated inversely with maternal weight and age. In conclusion, by term pregnancy, an increase in ventricular wall stress is accompanied by a deterioration in cardiac function.

Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery

“…[1][2][3]10,[19][20][21][22][23][24][25] When examining the literature regarding CO changes in pregnancy, the strength and weaknesses of the various techniques and characteristics of the study group should be considered. CO may be artificially elevated in healthy women by invasive techniques, even though validated against non-invasive techniques.…”

Morphological and Functional Adaptation of the Maternal Heart During Pregnancy

“…Based on such velocity and displacement measurements, a contractile dysfunction in late pregnancy and postpartum has been discussed in previous studies. 15,38 Based on our data, however, we suggest that the remodeling of the LV needs to be considered. Figure 6 shows that mitral annulus systolic excursion parallels the course of strain if adjusted for LV length.…”

Does Pregnancy Contribute to Systemic Right Ventricular Dysfunction in Adults with an Atrial Switch Operation?

“…We have previously demonstrated measurable deterioration in maternal cardiac function at term in well women [12]. Although the mechanism remains open to speculation, proposed putative pathological pathways during normal pregnancy are the insulin resistance, sympathetic stimulation and weight increase that accompany pregnancy.…”