Maternal Cardiac Evaluation During Uncomplicated Twin Pregnancy With Emphasis on the Diastolic Function

Ghi, T.; Esposti, D. Degli; Montaguti, Elisa; Rosticci, Martina; Tancredi, S.; Youssef, A.; Giovanni, Martinelli; Pilu, Gianluigi; Borghi, Claudio; Rizzo, Nicola

doi:10.1097/01.aoa.0000489482.52898.30

Cited by 10 publications

(24 citation statements)

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“…More significant changes have been reported in twin compared to singleton pregnancies, including higher maternal cardiac output (CO) and lower total vascular resistance (TVR) across gestation [2][3][4][5][6][7][8]. In a recent study focusing on maternal haemodynamics in uncomplicated twin gestations, significant changes in systolic and diastolic function were documented from the first to third trimester [9]. Nevertheless, in that study echocardiographic findings were not assessed according to chorionicity due to the small number of monochorionic (MC) gestations included.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

et al. 2018

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Objective: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. Methods: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dichorionic (DC) pregnancies. Results: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). Conclusions: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

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Section: Introductionmentioning

confidence: 99%

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

et al. 2018

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“…Thus, it is evident that even in uncomplicated pregnancies, the maternal cardiovascular system is pushed to its maximum functional limits at the edge of decompensation. This is evident when assessing cardiovascular condition in obese women, advanced maternal age or multiple gestation, where the prevalence and severity of maternal cardiovascular dysfunction at term is significantly increased (Ghi et al 2015;Budderberg et al 2018b). As maternal cardiovascular dysfunction occurs acutely and at the end of pregnancy, late preeclampsia is only infrequently associated with fetal growth restriction -placental dysfunction is short lived and rarely results in fetal growth restriction (Verlohren et al 2014).…”

Section: Pregnancy-induced Cardiovascular Dysfunction Predisposing Tomentioning

confidence: 99%

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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“…Twin pregnancy differs from singleton pregnancy in many respects like the greater physiological increase in circulating blood volume [1], greater gestational weight gain and newborn weight (sum for twins) [2], shorter pregnancy length [3], persistent systolic dysfunction after delivery [4], and greater risk of peripartum cardiomyopathy in women with twin pregnancies than in those with singleton pregnancies [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…In a classical study by Pritchard [1], the mean net increases in circulating blood volume in singleton and twin pregnancies were 1570 mL and 1960 mL, respectively. This causes signi cant differences between singleton and twin pregnancy women in echocardiographic ndings [12][13][14][15][16] and in blood levels of cardiac biomarkers, such as B-type natriuretic peptide (BNP), N-terminal precursor protein BNP fragment (NT-proBNP), and high-sensitivity troponin I (hs-TnI) [17]. Kuleva et al revealed a higher cardiac output in twin than in singleton pregnancies [15], and Ghi et al showed changes in maternal systolic and diastolic function from the rst to the third trimester and a persisting decreased systolic function after delivery [16].…”

Section: Introductionmentioning

confidence: 99%

“…This causes signi cant differences between singleton and twin pregnancy women in echocardiographic ndings [12][13][14][15][16] and in blood levels of cardiac biomarkers, such as B-type natriuretic peptide (BNP), N-terminal precursor protein BNP fragment (NT-proBNP), and high-sensitivity troponin I (hs-TnI) [17]. Kuleva et al revealed a higher cardiac output in twin than in singleton pregnancies [15], and Ghi et al showed changes in maternal systolic and diastolic function from the rst to the third trimester and a persisting decreased systolic function after delivery [16]. The BNP levels increase with heart failure severity, and their measurements are used widely to assess the presence, severity, and prognosis of heart failure [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Morphofunctional Cardiac Changes in Singleton and Twin Pregnancies

Umazume

Yamada

Furuta

et al. 2020

Preprint

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Objectives To compare heart echocardiographic changes between women with singleton and twin pregnanciesMethods We enrolled pregnant and postpartum women for this longitudinal cohort study in a tertiary center from 2014 through 2016. We analyzed 166 and 83 prospectively collected longitudinal data on simultaneously determined echocardiography parameters and blood variables in 44 and 22 normotensive women with either singleton or twin pregnancies, respectively. We tested mixed effect models for echocardiographic parameters and cardiac biomarkers.Results The mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies during the 3rd trimester and immediately postpartum (within 1 week after childbirth). The 2nd trimester inferior vena cava diameters were significantly smaller and the 3rd trimester creatinine levels were significantly higher in women with twin pregnancies than in those with singleton pregnancies. BNP was positively correlated with left atrial volume index (β=0.49, p<0.01) and with the ratio of early diastolic transmitral to mitral annular velocity (E/e') (β=0.41, p<0.01). BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum were negatively correlated with the later E/e', at 1 month postpartum in women with singleton pregnancies (r=−0.33, p=0.02 and r=−0.36, p<0.01, respectively).Conclusions The intravascular cardiac load at postpartum within 1 week after childbirth was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP was significantly positively correlated with LA volume index and E/e', BNP may be secreted to reduce the volume and pressure overload on the myocardial wall by diuretic action and may have improved the diastolic functions 1 month after childbirth. Our results provide evidence to deepen the understanding of the pathophysiological hemodynamic changes after delivery.

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Maternal Cardiac Evaluation During Uncomplicated Twin Pregnancy With Emphasis on the Diastolic Function

Cited by 10 publications

References 0 publications

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

Preeclampsia: a gestational cardiorenal syndrome

Morphofunctional Cardiac Changes in Singleton and Twin Pregnancies

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