Morphofunctional cardiac changes in pregnant women: associations with biomarkers

Abstract

ObjectiveThis longitudinal study was performed to determine changes in echocardiography parameters in association with various biomarker levels in pregnancy/postpartum.MethodsFifty-one healthy pregnant women underwent echocardiography with simultaneous determination of blood levels of five biomarkers at each of the first, second and third trimesters of pregnancy, immediately postpartum within 1 week after childbirth and approximately 1 month postpartum. Data on 255 echocardiography scans (five times per woman) and biomarkers were analysed.ResultsLeft ventricular end-diastolic dimension, left atrial (LA) volume index and left ventricular (LV) mass index increased with advancing gestation and reached the maximum immediately postpartum concomitant with the highest brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI) and creatine kinase MB levels. The inferior vena cava diameter was significantly reduced in the third trimester compared with that in the first trimester and the peak occurred immediately after childbirth. In 255 paired measurements, hs-TnI level was significantly positively correlated with LA volume index and LV mass index; BNP and NT-proBNP were significantly positively correlated with LA volume index and estimated glomerular filtration rate (eGFR) was significantly positively correlated with the average of early diastolic septal and lateral mitral annular velocity (e′).ConclusionsMaximal cardiac changes in morphology occurred postpartum within 1 week after childbirth, not during pregnancy. BNP/NT-proBNP, hs-TnI and eGFR reflected cardiac changes in pregnancy.

Morphofunctional Cardiac Changes in Singleton and Twin Pregnancies

“…Of 701 women with singleton and 61 with twin pregnancies who gave birth at the Hokkaido University Hospital during the 2-year study period, 151 and 41, respectively, participated in this project undergoing simultaneous echocardiographies and blood samplings ( Fig.1). This study was conducted as an additional examination of our previous studies [11,22].…”

“…Participants (Fig. 1) [11,22] To compare longitudinal changes in echocardiographic ndings between normotensive women with either singleton or twin pregnancy, we selected 22 twin pregnancies eligible participants meeting all of the following four criteria: (1) absence of preexisting hypertension or development of hypertension during the current pregnancy; (2) absence of preexisting diseases, including conditions involving hematological or endocrinological systems and connective tissue diseases; (3) uneventful clinical course during the current pregnancy; and (4) simultaneous echocardiography and blood sampling at least three times during the four stages of pregnancy/postpartum including the 2 nd , 3 rd , PP1, and PP2 timepoints. We selected two women with singleton pregnancies whose delivery date was closest to that of each woman with twin pregnancy meeting the above four criteria to serve as controls (44 women with singleton pregnancies in total).…”

“…Echocardiographic evaluations [11,22] A single trained operator (TU) performed all the bedside transthoracic echocardiography with pregnant women in the left lateral decubitus position using the same machine (ProSound α7; Hitachi, Tokyo, Japan) according to the European Association of Cardiovascular Imaging guidelines [23]. We calculated the stroke volume as the product of the aortic valve area and the aortic ow velocity time integral.…”

“…Biochemical procedures [11,22] Serum and plasma samples were stored at −20°C until assays of hs-TnI, NT-proBNP, BNP, and creatinine were ready to be performed. We used the following equation to obtain the estimated glomerular ltration rate (eGFR): 0.739 × 194 × serum creatinine -1.094 × age [years] -0.287 [24].…”

“…The blood volume increases physiologically in pregnancy [1], and this volume expansion is associated with cardiac morphofunctional changes during pregnancy [7][8][9][10][11]. 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.…”