1
|
Ferreira AF, Azevedo MJ, Morais J, Almeida-Coelho J, Leite-Moreira AM, Lourenço AP, Saraiva F, Diaz SO, Amador AF, Sousa C, Machado AP, Sampaio-Maia B, Ramalho C, Leite-Moreira A, Barros AS, Falcão-Pires I. Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors. Am J Physiol Heart Circ Physiol 2024; 326:H1193-H1203. [PMID: 38334973 DOI: 10.1152/ajpheart.00701.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
Pressure overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy's chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Thirty-seven women (1st trimester, 1stT) and a separate group of 31 (3rd trimester, 3rdT) women [healthy or with CVR factors (obesity and/or hypertension and/or with gestational diabetes)] underwent echocardiography determination of left ventricular end-diastolic volume (LVEDV) and E/e' before (T0), immediately after (T1), and 15 min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Acute leg elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1stT and 3rdT, confirming AVO. LVEDV and E/e' also increased immediately after AVO (T1) in both 1stT and 3rdT. SIC adaptation (T2, 15 min after AVO) significantly decreased E/e' in both trimesters, with additional expansion of LVEDV only in the 1stT. NT-pro-BNP increased slightly after AVO but only in the 1stT. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. A distinct functional response to SIC was observed between 1stT and 3rdT, which was influenced by CVR factors. The LV of 3rdT pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, whereas the lower LV filling pressure values suggest increased diastolic compliance.NEW & NOTEWORTHY The sudden increase of volume overload triggers an acute myocardial stretch characterized by an immediate rise in contractility by the Frank-Starling mechanism, followed by a progressive increase known as the slow force response. The present study is the first to characterize echocardiographically the stretch-induced compliance (SIC) mechanism in the context of physiological hypertrophy induced by pregnancy. A distinct functional adaptation to SIC was observed between first and third trimesters, which was influenced by cardiovascular risk factors.
Collapse
Affiliation(s)
- Ana Filipa Ferreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juliana Morais
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida-Coelho
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André M Leite-Moreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Filipa Amador
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Sousa
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Paula Machado
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Carla Ramalho
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Obstetrics, Gynaecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António S Barros
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
2
|
Aldo C, Martina Z, Alberto A, Mario P. Cardiovascular risk evaluation in pregnancy: focus on cardiac specific biomarkers. Clin Chem Lab Med 2024; 62:581-592. [PMID: 37942796 DOI: 10.1515/cclm-2023-0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
Despite the evidence demonstrating the clinical utility of cardiac specific biomarkers in improving cardiovascular risk evaluation in several clinical conditions, even the most recent reviews and guidelines fail to consider their measurement in order to enhance the accuracy of the evaluation of cardiovascular risk in pregnant women. The aim of this review article was to examine whether the assay of cardiac specific biomarkers can enhance cardiovascular risk evaluation in pregnant women, first by reviewing the relationships between the physiological state of pregnancy and cardiac specific biomarkers. The clinical relevance of brain natriuretic peptide (BNP)/NT-proBNP and high-sensitivity cardiac troponin I/high-sensitivity cardiac troponin T (hs-cTnI/hs-cTnT) assay in improving cardiovascular risk evaluation is examined based on the results of clinical studies on subjects with normal and those with complicated pregnancy. Finally, the analytical approaches and clinical objectives related to cardio specific biomarkers are advocated in order to allow an early and more accurate evaluation of cardiovascular risk in pregnant women.
Collapse
Affiliation(s)
- Clerico Aldo
- Coordinator of the Study Group on Cardiac Biomarkers from Italian Society of Biochemical Chemistry (SIBioC) and European Ligand Assay Society (ELAS), Milan, Italy
| | - Zaninotto Martina
- Department of Laboratory Medicine, University-Hospital Padova, Padova, Italy
| | - Aimo Alberto
- Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | - Plebani Mario
- Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Ferreira AF, Saraiva F, Diaz SO, Azevedo MJ, Sousa C, Leite-Moreira A, Sampaio-Maia B, Ramalho C, Barros AS, Falcão-Pires I. The impact of echocardiographic indexation to evaluate cardiac reverse remodeling throughout pregnancy and postpartum. Rev Port Cardiol 2024; 43:107-127. [PMID: 37495102 DOI: 10.1016/j.repc.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Echocardiography guidelines suggest normalizing left ventricular (LV) volumes and mass (LVM) to body size. During pregnancy, continuous weight variation impacts on body surface area (BSA) calculation, limiting the longitudinal analysis of cardiac remodeling (CR) and reverse remodeling (RR) variables. Our aim was to identify the most common indexing methodologies in the literature on pregnant populations through a systematic review; and, to compare four scaling methods: (i) none (absolute values); (ii) indexing to the BSA before pregnancy; (iii) allomeric indexing; and (iv) indexing to BSA measured at the same day of cardiac assessment, using an illustrative example. METHODS We performed a systematic review of CR and RR during pregnancy and post-partum, using two databases. We included studies reporting longitudinal echocardiographic analysis of cardiac chamber volumes in humans. We used a prospective cohort study of healthy pregnant women who underwent four echocardiographic evaluations during pregnancy and postpartum, as an illustrative example. RESULTS Twenty-seven studies were included, most studies indexed to BSA measured at each evaluation moment (n=21). Within-subjects design was the most reported to analyse longitudinal data (n=17). Indexation to the pre-pregnancy BSA or application of allometric indexes revealed a higher effect than BSA measured at each evaluation and an equal effect to not indexing using within-subjects design. The within-subjects designs also revealed a higher effect size value than the between-subjects design for longitudinal analysis of LVM adaptations during pregnancy and postpartum. CONCLUSION(S) This study concludes that indexation methods do not impact the clinical interpretation of longitudinal echocardiographic assessment but highlights the need to harmonize normalization procedures during pregnancy.
Collapse
Affiliation(s)
- Ana Filipa Ferreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sílvia Oliveira Diaz
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, The Netherlands
| | - Carla Sousa
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Carla Ramalho
- Center of Prenatal Diagnosis, Obstetrics Department, Centro Hospitalar de São João, Porto, Portugal; Obstetrics, Gynecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Portugal
| | - António Sousa Barros
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
| |
Collapse
|
4
|
Ferreira AF, Azevedo MJ, Morais J, Trindade F, Saraiva F, Diaz SO, Alves IN, Fragão-Marques M, Sousa C, Machado AP, Leite-Moreira A, Sampaio-Maia B, Ramalho C, Barros AS, Falcão-Marques I. Cardiovascular risk factors during pregnancy impact the postpartum cardiac and vascular reverse remodeling. Am J Physiol Heart Circ Physiol 2023; 325:H774-H789. [PMID: 37477690 DOI: 10.1152/ajpheart.00200.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
Pregnant women with cardiovascular risk (CVR) factors are highly prone to develop cardiovascular disease later in life. Thus, recent guidelines suggest extending the follow-up period to 1 yr after delivery. We aimed to evaluate cardiovascular remodeling during pregnancy and determine which CVR factors and potential biomarkers predict postpartum cardiac and vascular reverse remodeling (RR). Our study included a prospective cohort of 76 healthy and 54 obese and/or hypertensive and/or with gestational diabetes pregnant women who underwent transthoracic echocardiography, pulse-wave velocity (PWV), and blood collection at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy as well as at the 1st/6th/12th mo after delivery. Generalized linear mixed-effects models was used to evaluate the extent of RR and its potential predictors. Pregnant women develop cardiac hypertrophy, as confirmed by a significant increase in left ventricular mass (LVM). Moreover, ventricular filling pressure (E/e') and atrial volume increased significantly during gestation. Significant regression of left ventricular (LV) volume, LVM, and filling pressures was observed as soon as 1 mo postpartum. The LV global longitudinal strain worsened slightly and recovered at 6 mo postpartum. PWV decreased significantly from 1T to 3T and normalized at 1 mo postpartum. We found that arterial hypertension, smoking habits, and obesity were independent predictors of increased LVM during pregnancy and postpartum. High C-reactive protein (CRP) and low ST2/IL33-receptor levels are potential circulatory biomarkers of worse LVM regression. Arterial hypertension, age, and gestational diabetes positively correlated with PWV. Altogether, our findings pinpoint arterial hypertension as a critical risk factor for worse RR and CRP, and ST2/IL33 receptors as potential biomarkers of postpartum hypertrophy reversal.NEW & NOTEWORTHY This study describes the impact of cardiovascular risk factors (CVR) in pregnancy-induced remodeling and postpartum reverse remodeling (up to 1 yr) by applying advanced statistic methods (multivariate generalized linear mixed-effects models) to a prospective cohort of pregnant women. Aiming to extrapolate to pathological conditions, this invaluable "human model" allowed us to demonstrate that arterial hypertension is a critical CVR for worse RR and that ST2/IL33-receptors and CRP are potential biomarkers of postpartum hypertrophy reversal.
Collapse
Affiliation(s)
- Ana Filipa Ferreira
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- INEB-Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juliana Morais
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Fábio Trindade
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Sílvia Oliveira Diaz
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Inês Nuno Alves
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
- Department of Clinical Pathology, Centro Hospitalar de São João, Porto, Portugal
| | - Carla Sousa
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
- Department of Cardiology, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Paula Machado
- Center of Prenatal Diagnosis, Department of Obstetrics, Centro Hospitalar de São João, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- INEB-Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Carla Ramalho
- Center of Prenatal Diagnosis, Department of Obstetrics, Centro Hospitalar de São João, Porto, Portugal
- Department of Obstetrics, Gynaecology and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António Sousa Barros
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Inês Falcão-Marques
- Department of Surgery and Physiology, Cardiovascular R&D Centre-UnIC@RISE, Faculdade de Medicina, University of Porto, Porto, Portugal
| |
Collapse
|
5
|
Minhas AS, Echouffo-Tcheugui JB, Zhang S, Ndumele CE, McEvoy JW, Christenson R, Selvin E. High-Sensitivity Troponin T and I Among Pregnant Women in the US-The National Health and Nutrition Examination Survey, 1999-2004. JAMA Cardiol 2023; 8:406-408. [PMID: 36790770 PMCID: PMC9932939 DOI: 10.1001/jamacardio.2022.5601] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023]
Abstract
This cross-sectional study investigates the expected physiologic concentrations of high-sensitivity cardiac troponin in normal pregnancy.
Collapse
Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - J. William McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
6
|
Minhas AS, Rooney MR, Fang M, Zhang S, Ndumele CE, Tang O, Schulman SP, Michos ED, McEvoy JW, Echouffo-Tcheugui J, Christenson R, Selvin E. Prevalence and Correlates of Elevated NT-proBNP in Pregnant Women in the General U.S. Population. JACC. ADVANCES 2023; 2:100265. [PMID: 37168845 PMCID: PMC10168650 DOI: 10.1016/j.jacadv.2023.100265] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Physiologic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) across trimesters of pregnancy have not been well studied. OBJECTIVES The authors aimed to measure NT-proBNP in adult women, by pregnancy status and trimester, in a nationally representative sample from the National Health and Nutrition Examination Survey 1999 to 2004. METHODS We conducted a cross-sectional analysis of 2,134 women (546 pregnant) aged 20 to 40 years without a history of cardiovascular disease. RESULTS Among pregnant women in the first trimester, the prevalence of elevated NT-proBNP (>125 pg/mL) was 20.0% (SE, 6.6%) compared to 2.4% (SE, 0.8%) among women in the third trimester and 8.0% among nonpregnant women. After adjustment for demographics and cardiovascular risk factors, NT-proBNP was 44% higher (absolute difference 26.4 [95% CI: 11.2-41.6] pg/mL) in the first trimester of pregnancy compared to nonpregnant women. Among pregnant women only, adjusted NT-proBNP was 46% lower (absolute difference -22.2 [95% CI: -36.9 to -7.5] pg/mL) in women in the third trimester compared to women in the first trimester. NT-proBNP was inversely associated with body mass index and with systolic blood pressure. CONCLUSIONS Women in the first trimester of pregnancy had significantly higher NT-proBNP than those in the third trimester and compared to similarly aged nonpregnant women. The dynamic nature of NT-proBNP should be taken into consideration when ordering NT-proBNP lab tests in pregnant women.
Collapse
Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary R. Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olive Tang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven P. Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J. William McEvoy
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Justin Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Gabarre P, Ruiz P, Chenevier-Gobeaux C, Charpentier E, Soulat-Dufour L, Cohen A, Monnier-Cholley L, Chemali L, François H, Kerneis M, Lefèvre G, Boissan M. Inverted Takotsubo Syndrome With HELLP Syndrome: A Case Report. Front Cardiovasc Med 2022; 9:832098. [PMID: 35433851 PMCID: PMC9008274 DOI: 10.3389/fcvm.2022.832098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTakotsubo syndrome is an acute cardiac condition involving sudden, transient apical ballooning of the left ventricle of the heart that may be triggered by emotional stress and some non-cardiac conditions. Its diagnosis is based on clinical presentation, electrocardiogram, cardiac imaging and biomarkers.Case SummaryHere, we present a novel and original case report of a patient presenting very soon in the post-partum period with an unusual form of Takotsubo syndrome without clinical symptoms of cardiac disease and accompanied by HELLP syndrome. The overall dynamics of the changes in troponin I, troponin T and NT-proBNP levels after delivery were generally similar, but the amount of troponin I was much greater than that of troponin T and troponin I was already elevated before delivery. NT-proBNP levels peaked around the same time as the troponins and the peak concentration was within the same range as that of troponin I.DiscussionOur findings indicate that assaying circulating cardiac biomarkers, especially troponin I and NT-proBNP, may be a useful complement to non-invasive cardiac imaging including transthoracic echocardiography and cardiovascular magnetic resonance imaging, in the diagnosis of Takotsubo syndrome. They illustrate the importance of cardiac biomarkers in assisting diagnosis of this disease.
Collapse
Affiliation(s)
- Paul Gabarre
- AP-HP, Hôpital Tenon, Soins Intensifs Néphrologiques et Rein Aigu (SINRA), Paris, France
| | - Pablo Ruiz
- AP-HP, Hôpital Tenon, Laboratoire de Biochimie, Paris, France
| | - Camille Chenevier-Gobeaux
- AP-HP-Centre Université de Paris, Hôpital Cochin, Department of Automated Biological Diagnostic, Paris, France
| | - Etienne Charpentier
- AP-HP, Groupe Hospitalier Pitié Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique ICT, Institut de Cardiologie, Paris, France
| | - Laurie Soulat-Dufour
- AP-HP, Hôpital Saint-Antoine-Tenon, Service de Cardiologie, Paris, France
- Sorbonne Université, Inserm, Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Paris, France
| | - Ariel Cohen
- AP-HP, Hôpital Saint-Antoine-Tenon, Service de Cardiologie, Paris, France
- Sorbonne Université, Inserm, Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Paris, France
| | | | - Lotfi Chemali
- AP-HP, Hôpital Tenon, Laboratoire de Biochimie, Paris, France
| | - Hélène François
- AP-HP, Hôpital Tenon, Soins Intensifs Néphrologiques et Rein Aigu (SINRA), Paris, France
- Sorbonne Université, Inserm, UMR_S1155, Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France
| | | | - Mathieu Boissan
- AP-HP, Hôpital Tenon, Laboratoire de Biochimie, Paris, France
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, Paris, France
- *Correspondence: Mathieu Boissan
| |
Collapse
|
8
|
Giorgione V, O'Driscoll J, Coutinho CM, Di Fabrizio C, Sharma R, Khalil A, Thilaganathan B. Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:365-370. [PMID: 34309939 DOI: 10.1002/uog.23745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) are associated with significant myocardial dysfunction on echocardiography. The impact of hemodynamic changes related to volume redistribution following delivery on myocardial function in women with HDP has not been evaluated systematically. The aim of this study was to compare echocardiographic findings immediately before and after delivery in women with HDP. METHODS This was a prospective longitudinal study including 30 women with a diagnosis of HDP who underwent two consecutive transthoracic echocardiographic (TTE) examinations, before delivery and in the early postpartum period. Paired comparisons of the findings from the two assessments were performed. RESULTS Left-ventricular (LV) concentric remodeling or hypertrophy was detected in 21 (70%) patients. There was no significant difference in cardiac morphology indices such as LV mass index (78.9 ± 16.3 g/m2 vs 77.9 ± 15.4 g/m2 ; P = 0.611) or relative wall thickness (0.45 ± 0.1 vs 0.44 ± 0.1; P = 0.453) before vs after delivery. LV diastolic function did not demonstrate any peripartum variation, with similar left-atrial volume (52.4 ± 15.3 mL vs 51.0 ± 15.6 mL; P = 0.433), lateral E' (0.12 ± 0.03 m/s vs 0.12 ± 0.03 m/s; P = 0.307) and E/E' ratio (7.9 ± 2.2 vs 7.9 ± 1.7; P = 0.934) before vs after delivery. Systolic function indices, such as LV ejection fraction (57.5 ± 3.4% vs 56.4 ± 2.1%; P = 0.295) and global longitudinal strain (-15.3 ± 2.6% vs -15.1 ± 3.1%; P = 0.582), also remained unchanged between before vs after delivery. CONCLUSIONS Maternal hemodynamic changes associated with delivery did not influence significantly peripartum TTE indices in women with HDP. Suboptimal maternal echocardiographic findings in HDP are likely to be the consequence of chronic pregnancy cardiovascular load changes or pre-existing maternal cardiovascular impairment. Severity and persistence of myocardial dysfunction in the postpartum period may be related to the long-term maternal cardiovascular disease legacy of HDP. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- V Giorgione
- Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - C M Coutinho
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - C Di Fabrizio
- Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - R Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - B Thilaganathan
- Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| |
Collapse
|
9
|
Sahu AK, Harsha MM, Rathoor S. Cardiovascular Diseases in Pregnancy - A Brief Overview. Curr Cardiol Rev 2022; 18:e250821195824. [PMID: 34525935 PMCID: PMC9241116 DOI: 10.2174/1573403x17666210825103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Even though, there have been many advances in maternal medical care and fertility treatments, the presence of cardiovascular disease has a significant impact on pregnancy. In pregnant women, several heart conditions, such as valvular heart disease, chronic hypertension, congenital heart defects and non-ischemic cardiomyopathies are linked to increased risk of fetal as well as maternal morbidity and mortality. To date, the management of the co-existing conditions of pregnancy and heart disease has been challenging. Therefore, in-depth information may be beneficial to tackle a difficult case scenario. Towards this end, this paper provides an overview of the recent updated knowledge of pregnancy-related cardiovascular diseases in women.
Collapse
Affiliation(s)
- Ankit Kumar Sahu
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Mullusoge Mariappa Harsha
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR), Mysore, India
| | - Sonika Rathoor
- Physical Medicine & Rehabilitation, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| |
Collapse
|
10
|
Woo D, Jae S, Park S. U-shaped association between age at first childbirth and mortality: a prospective cohort study. Maturitas 2022; 161:33-39. [DOI: 10.1016/j.maturitas.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/15/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
|
11
|
Sheikh M, Ostadrahimi P, Salarzaei M, Parooie F. Cardiac Complications in Pregnancy: A Systematic Review and Meta-Analysis of Diagnostic Accuracy of BNP and N-Terminal Pro-BNP. Cardiol Ther 2021; 10:501-514. [PMID: 34213737 PMCID: PMC8555044 DOI: 10.1007/s40119-021-00230-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/12/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Serum brain-type natriuretic peptide (BNP) levels may be involved in detecting the breakdown of defense mechanisms in pregnant women. BNP and N-terminal pro-BNP (NT-proBNP) levels can be used in emergency settings as a biomarker to rule out or confirm cardiac complications. The present study was conducted as an attempt to evaluate the performance of BNP and NT-proBNP as diagnostic tools for cardiac complications, including heart failure and pre-eclampsia, in pregnant and recently-delivered women. Methods This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To extract the data, articles meeting the inclusion criteria were directly reviewed by two of the authors. Disputes were resolved through discussion with all authors before data mining. In cases of unresolved disagreement, a third reviewer was consulted to achieve consensus. A quantitative analysis of the total bias of publications was performed using Stata software version 14.0, using funnel plots and Deek’s test. Results Overall, 13 unique studies were included in this review. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women when BNP level was ≤ 100 ng/L, were determined to be 95, 62, 71 and 91%, respectively. The corresponding measures when the BNP levels were 100–500 ng/L were calculated to be 98, 92, 97 and 92%, respectively. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women using NT-proBNP were 78, 74, 20.5 and 97%, respectively. Conclusion Our results suggest that both BNP and NT-proBNP levels can be used as diagnostic tools among pregnant and newly-delivered women to diagnose cardiac complications, including heart failure and pre-eclampsia. While BNP showed a relatively better diagnostic accuracy compared to NT-proBNP, it must be noted that the number of studies evaluating NT-proBNP included in this meta-analysis was low and the studies were inconsistent in terms of cutoff value. Further studies are required to confirm the prospective use of BNP and NT-pro BNP in assessing common symptoms that indicate cardiac complications during labor. Moreover, the clinical use of the NT-proBNP test in this field requires further study.
Collapse
Affiliation(s)
- Mahboobeh Sheikh
- Department of Cardiology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Pouya Ostadrahimi
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.
| | - Morteza Salarzaei
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Fateme Parooie
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| |
Collapse
|
12
|
Umazume T, Yamada T, Furuta I, Iwano H, Morikawa M, Watari H, Minakami H. Morphofunctional cardiac changes in singleton and twin pregnancies: a longitudinal cohort study. BMC Pregnancy Childbirth 2020; 20:750. [PMID: 33267789 PMCID: PMC7709235 DOI: 10.1186/s12884-020-03452-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to compare the echocardiographic changes and cardiac biomarkers between women with singleton and twin pregnancies. Methods From April 2014 to March 2016, this longitudinal cohort study invited pregnant women who were scheduled to give birth at Hokkaido University Hospital. We analyzed prospectively collected data on simultaneously determined echocardiographic parameters and blood cardiac markers of 44 women with singleton and 22 women with twin pregnancies. Furthermore, we tested the mixed-effect models for echocardiographic parameters and cardiac biomarkers. Results During the third trimester and immediately postpartum (within 1 week after childbirth), 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. Women with twin pregnancies also had significantly smaller second-trimester inferior vena cava diameters and significantly higher third−trimester creatinine levels than those with singleton pregnancies. BNP positively correlated with the left atrial volume index (β = 0.49, p < 0.01) and the ratio of early diastolic transmitral to mitral annular velocity (E/e’) (β = 0.41, p < 0.01). At 1 month after childbirth in women with singleton pregnancies, BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum negatively correlated with the later E/e’ (r = − 0.33, p = 0.02 and r = − 0.36, p < 0.01, respectively). Conclusions The intravascular cardiac load reached maximum within 1 week after childbirth and was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP significantly positively correlated with LA volume index and E/e’. In women with singleton pregnancies, BNP secreted immediately after childbirth might improve the diastolic functions 1 month after childbirth.
Collapse
Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takahiro Yamada
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Itsuko Furuta
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hisanori Minakami
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| |
Collapse
|
13
|
Song L, Yu Z, Xu Y, Li X, Liu X, Liu D, Zhou T. Preliminary physiologically based pharmacokinetic modeling of renally cleared drugs in Chinese pregnant women. Biopharm Drug Dispos 2020; 41:248-267. [PMID: 32520400 DOI: 10.1002/bdd.2243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to build and verify a preliminary physiologically based pharmacokinetic (PBPK) model of Chinese pregnant women. The model was used to predict maternal pharmacokinetics (PK) of 6 predominantly renally cleared drugs. METHOD Based on SimCYP Caucasian pregnancy population dataset, the preliminary Chinese pregnant population was built by updating several key parameters and equations according to physiological parameters of Chinese (or Japanese) pregnant women. Drug-specific parameters of 6 renally cleared drugs were validated through PBPK modeling of Caucasian non-pregnant, Caucasian pregnant and Chinese non-pregnant population. The preliminary PBPK model of Chinese pregnant population was then developed by integrating the preliminary Chinese pregnant population and the drug-specific parameters. This model was verified by comparing the predicted maternal PK of these 6 drugs with the observed in vivo data from the literature. RESULTS The preliminary Chinese pregnant population PBPK model successfully predicted the PK of 6 target drugs for different pregnancy stages. The predicted plasma concentrations time profiles fitted the observed data well, and most predicted PK parameters were within 2-fold of observed data. CONCLUSIONS The preliminary Chinese pregnant population PBPK model provided a useful tool to predict the maternal PK of 6 predominantly renally cleared drugs in Chinese pregnant women.
Collapse
Affiliation(s)
- Ling Song
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Zhiheng Yu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China
| | - Yifan Xu
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, 100191, China
| | - Xiaobei Li
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Xuanlin Liu
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, 100191, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, China
| | - Tianyan Zhou
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| |
Collapse
|
14
|
Dynamic changes in cardiac function before and early postdelivery in women with severe preeclampsia. J Hypertens 2020; 38:1367-1374. [DOI: 10.1097/hjh.0000000000002406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
15
|
Kimura Y, Kato T, Miyata H, Sasaki I, Minamino-Muta E, Nagasawa Y, Numao S, Nagano T, Higuchi T, Inoko M. Left Ventricular Diastolic Function During the Normal Peripartum Period. Circ J 2019; 83:2265-2270. [PMID: 31548443 DOI: 10.1253/circj.cj-19-0501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because cardiovascular function and hemodynamics markedly change during pregnancy, our aim was to elucidate left ventricular (LV) diastolic function in pregnant women.Methods and Results:We prospectively collected the data of 397 pregnant women treated between 2012 and 2013. We evaluated their LV systolic and diastolic functions via echocardiography during the 3rd trimester (28-30 weeks' gestation) and within 4 days of delivery. Additionally, we analyzed the cardiac geometry: relative wall thickness and LV mass index (LVMI). Diastolic dysfunction was defined as early diastolic mitral annulus velocity (e') <7 cm/s and peak early filling velocity (E)/e' ratio >15. The pregnant women were 33.7±5.0 years old and the prevalence of hypertensive disorders in pregnancy (HDP) was 4.0%. LV systolic function was preserved in all pregnant women. However, diastolic function significantly decreased after delivery (mean e': 12.6 vs. 11.6 cm/s, P<0.0001; median E/e' ratio: 6.4 vs. 7.3, P<0.0001). Diastolic function after delivery was associated with the prevalence of HDP (P=0.035) and was correlated with age (R=-0.17, P=0.0009) and LVMI (R=-0.30, P<0.0001). However, these changes in diastolic function remained within the normal range and only 1 woman (1/397, 0.3%) had LV diastolic dysfunction after delivery. CONCLUSIONS LV diastolic function decreased after delivery in pregnant women but was within the normal range.
Collapse
Affiliation(s)
- Yuki Kimura
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiromi Miyata
- Department of Obstetrics and Gynecology, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Issei Sasaki
- Department of Health and Sports Sciences, Kyoto Pharmaceutical University
| | - Eri Minamino-Muta
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Yoshinori Nagasawa
- Department of Health and Sports Sciences, Kyoto Pharmaceutical University
| | - Shigeharu Numao
- Department of Health and Sports Sciences, Kyoto Pharmaceutical University
| | - Tadayoshi Nagano
- Department of Obstetrics and Gynecology, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Moriaki Inoko
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital
| |
Collapse
|
16
|
Umazume T, Yamada S, Yamada T, Ishikawa S, Furuta I, Iwano H, Murai D, Hayashi T, Okada K, Morikawa M, Tsutsui H, Minakami H. Association of peripartum troponin I levels with left ventricular relaxation in women with hypertensive disorders of pregnancy. Open Heart 2018; 5:e000829. [PMID: 30245837 PMCID: PMC6144895 DOI: 10.1136/openhrt-2018-000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/01/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Objective Women with hypertensive disorders of pregnancy (HDP) show elevated risk of heart failure despite decreased circulating plasma volume compared with those with normotensive control pregnancies (NCP). This study was performed to better characterise the heart in women with HDP and determine whether high-sensitivity troponin I (hs-TnI) around childbirth predicts reduced left ventricular (LV) relaxation at 1 month postpartum. Methods Echocardiography was performed longitudinally during the first, second and third trimesters and immediately postpartum within 1 week and 1 month postpartum in 24 women with HDP, with simultaneous determination of blood variables in comparison with 51 women with NCP. Results Compared with NCP, HDP showed greater antepartum left atrial (LA) volume, LV mass and inferior vena cava (IVC) diameter, higher peripartum brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide and hs-TnI with the highest value immediately postpartum, and lower early diastolic mitral annular velocity (e') during pregnancy/postpartum. In analyses of data on HDP and NCP, hs-TnI at the third trimester as well as that immediately postpartum was negatively correlated with later e' at 1 month postpartum. The areas under the receiver operating characteristic curves were 0.82 and 0.81 for hs-TnI at the third trimester and immediately postpartum, respectively, in the prediction of reduced LV relaxation at 1 month postpartum. Conclusion Reduced LV diastolic function and decreased splanchnic blood reservoir may contribute to the increased third trimester IVC diameter and LA volume in women with HDP. The rise in hs-TnI around childbirth was associated with poor LV relaxation ability at 1 month postpartum.
Collapse
Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Ishikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Itsuko Furuta
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Murai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Taichi Hayashi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|