Influence of chest conformation on ventricular‐arterial coupling during normal pregnancy

Abstract

Purpose There is still controversy regarding the changes of ventricular‐arterial coupling (VAC) during normal pregnancy. The possible influence of chest shape on VAC during normal pregnancy has never been investigated. Methods Between October 2019 and June 2020, 59 healthy pregnant women (33.7 ± 4.4 years/old) were consecutively included. They underwent obstetric visit, modified Haller index (MHI) assessment, and complete echocardiographic evaluation with blood pressure measurement to assess arterial elastance (Ea), end‐systolic elastance (Ees), and Ea/Ees as an index of VAC, at 12‐14 weeks and 36‐38 weeks gestation, then 6‐9 weeks after delivery. Results VAC progressively increased from the first to the third trimester of pregnancy, then decreased in the postpartum (P < 0.0001) in the whole study population. Women with concave‐shaped chest wall (MHI >2.5, n = 31) but not women with normal chest shape (MHI ≤2.5, n = 28) showed a progressive increase in VAC during normal pregnancy. Women with MHI >2.5 showed a significantly less pronounced increase in stroke volume index (SVi) from the first to the third trimester of pregnancy. There was a strong linear correlation between third trimester MHI and VAC (r = 0.93). Conclusions Anatomical and/or extrinsic mechanical factors rather than impaired arterial elastance or reduced left ventricular contractility may contribute to changes in VAC during normal pregnancy in women with concave‐shaped chest wall.

Does chest wall conformation influence myocardial strain parameters in infants with pectus excavatum?

“…MHI has been developed in our echo lab in the last decade and has been validated in 2018 13 . In the last few years, we have employed this non‐radiological method to assess the possible influence of a concave‐shaped chest wall on cardiac kinetics and function in different clinical settings 12,28–33 …”

“…In our previous studies, which were mostly conducted in middle‐aged healthy adults, we demonstrated that the anterior chest wall deformity is a decisive factor in determining an impairment of myocardial strain parameters in different patient populations, 12,28,29 in influencing stroke volume and ventricular‐arterial coupling (VAC) parameters in healthy pregnant women 30 and finally in affecting stress echocardiographic results and outcome 31–33 . The impairment in 2D‐STE derived myocardial strain indices, the modification in VAC parameters and the exercise‐induced left ventricular regional wall motion abnormalities were all strongly associated to MHI, in absence of any intrinsic myocardial dysfunction.…”

Highlights of the November/December issue

“…The Italian study that involved 16 infants with pes excavatum and 44 infants with normal chest shape revealed significantly deteriorated values of left and right ventricular mechanics in infants with chest abnormality in comparison with controls. 3 The authors revealed that abnormal chest anatomy progressively deteriorated myocardial strain parameters in infants with pes excavatum and this impairment is probably the consequence of intraventricular dyssynchrony due to compressive phenomena than intrinsic myocardial dysfunction.…”