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Morphological and Functional Adaptation of the Maternal Heart during Pregnancy.
MedLine Citation:
PMID:  22455877     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Pregnancy provides a unique model to study the adaptation of the heart in a physiological situation of transient load changes. This study aimed at assessing the performance of the left ventricle (LV) in normal uncomplicated pregnancies considering the actual LV load and shape. METHODS AND RESULTS: -Serial echocardiographic examinations were performed in 51 women in each pregnancy trimester and 3-6 months after delivery. Data from 10 nulliparous age-matched women were used as control. Conventional parameters of LV function (ejection fraction, EF) as well as myocardial deformation (strain, S) were interpreted considering maternal hemodynamics and LV shape. Cardiac output increased during pregnancy due to a higher stroke volume in early pregnancy and a late increase in heart rate, while total vascular resistance decreased. Progressive development of eccentric hypertrophy was observed, which subsequently recovered postpartum. Sphericity index decreased from the first towards the third trimester (1.92±0.17 versus 1.71±0.17) and returned postpartum to values comparable to the control. While higher LV stroke work was noted towards the third trimester (5.9±1.1 vs. 5.3±1.0 Nm, p<0.001), EF showed no significant changes. Left ventricular strain (S) decreased significantly in late pregnancy (from -19.5±2% to -17.6±1.6%, p<0.001) and returned to baseline values after delivery (-19.5±2%). CONCLUSIONS: -Pregnancy is a physiological process associated with increased cardiac performance and progressive left ventricular remodeling. These changes are not directly reflected by parameters traditionally considered to describe systolic function such as ejection fraction and longitudinal deformation. While ejection fraction was insensitive to the functional changes, the transient decrease in longitudinal deformation becomes only plausible considering the changes in LV geometry.
Authors:
Oana Savu; Ruxandra Jurcut; Sorin Giusca; Tim van Mieghem; Ilinca Gussi; Bogdan A Popescu; Carmen Ginghina; Frank Rademakers; Jan Deprest; Jens-Uwe Voigt
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-28
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  -     ISSN:  1942-0080     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Catholic University Leuven, Belgium and Institute for Emergency in Cardiovascular Diseases, Romania;
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