Cardiovascular remodelling and reverse remodelling during pregnancy and postpartum: Looking at the right side

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health Pub Date : 2024-11-22 DOI:10.1016/j.preghy.2024.101171

Ana Filipa Ferreira , Joana Araújo , Maria João Azevedo , Francisca Saraiva , Sílvia O. Diaz , Carla Sousa , Ana Paula Machado , Benedita Sampaio-Maia , Carla Ramalho , Adelino F. Leite-Moreira , António Sousa Barros , Mário Santos , Inês Falcão-Pires

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Abstract

Background

Considering the limited information available on right cardiac remodelling during gestation, we aimed to characterise the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of perinatal CV risk (CVR) factors on these processes.

Methods

This prospective cohort was recruited at two tertiary centres during 2019–2022, including 51 healthy pregnant women and 79 with perinatal CVR factors. Participants were evaluated by transthoracic echocardiography during pregnancy (1st[1T] and 3rd[3T] trimesters) and postpartum (one-month[PP1], six-months[PP2], and one-year postpartum[PP3]). Generalised linear mixed-effects models were used for statistical analysis.

Results

Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions was observed throughout pregnancy, normalising at PP2 values similar to PT1. This anatomical postpartum recovery was accompanied by an increase of RV global longitudinal strain, being statistically significant in perinatal CVR group. Interestingly, at 3T, this group revealed lower RV and RA strain compared to healthy participants. Despite both groups maintained preserved RV systolic function from 1T to PP3, a significant reduction of TAPSE and tricuspid S’ velocity was observed at PP1. Concomitantly, all participants showed a significant increase of E/A at the same time-point, suggesting the recovery of diastolic deterioration seen from 1T to 3T that was persistingly higher in the perinatal CVR group througout the postpartum. Constant pulmonary artery systolic pressure (PASP) was documented throughout follow-up time, showing consistently higher values in the perinatal CVR group. All these echocardiographic index changes were within the normality range.

Conclusion

This study described subtle right cardiac changes within the normal/physiological range, recovering six-months after delivery. Coexisting perinatal CVR factors seem to affect the magnitude of RV diastolic function changes, PASP and myocardial deformation without any impact on other RV systolic function indexes.

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孕期和产后心血管重塑和逆重塑：从右侧看

背景：考虑到有关妊娠期右心重塑的信息有限，我们旨在描述妊娠和产后分别诱发的右心血管重塑和反向重塑（RR）的特征，以及围产期心血管风险（CVR）因素对这些过程的影响：该前瞻性队列于2019-2022年间在两个三级中心招募，包括51名健康孕妇和79名有围产期CVR因素的孕妇。参与者在孕期（第1个[1T]孕期和第3个[3T]孕期）和产后（一个月[PP1]、六个月[PP2]和产后一年[PP3]）接受经胸超声心动图评估。统计分析采用广义线性混合效应模型：整个孕期观察到右心房（RA）和右心室（RV）的尺寸有相似的增大，在 PP2 值与 PT1 值相似时趋于正常。这种解剖学上的产后恢复伴随着 RV 整体纵向应变的增加，在围产期 CVR 组中具有显著的统计学意义。有趣的是，在 3T 条件下，与健康参与者相比，该组显示出较低的 RV 和 RA 应变。尽管从 1T 到 PP3，两组均保持了 RV 收缩功能，但在 PP1 时观察到 TAPSE 和三尖瓣 S'速度显著下降。与此同时，所有参与者在同一时间点的 E/A 都明显增加，这表明从 1T 到 3T 的舒张功能恶化得到了恢复，而围产期 CVR 组的舒张功能在整个产后都持续较高。在整个随访期间，肺动脉收缩压（PASP）保持稳定，显示围产期 CVR 组的数值持续较高。所有这些超声心动图指标变化均在正常范围内：这项研究描述了在正常/生理范围内的右心微妙变化，这些变化在产后六个月恢复。同时存在的围产期 CVR 因素似乎会影响 RV 舒张功能变化、PASP 和心肌变形的程度，而对其他 RV 收缩功能指标没有任何影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health OBSTETRICS & GYNECOLOGYPERIPHERAL VASCULAR-PERIPHERAL VASCULAR DISEASE

CiteScore

4.90

自引率

0.00%

发文量

127

期刊介绍： Pregnancy Hypertension: An International Journal of Women''s Cardiovascular Health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. We publish articles pertaining to human and animal blood pressure during gestation, hypertension during gestation including physiology of circulatory control, pathophysiology, methodology, therapy or any other material relevant to the relationship between elevated blood pressure and pregnancy. The subtitle reflects the wider aspects of studying hypertension in pregnancy thus we also publish articles on in utero programming, nutrition, long term effects of hypertension in pregnancy on cardiovascular health and other research that helps our understanding of the etiology or consequences of hypertension in pregnancy. Case reports are not published unless of exceptional/outstanding importance to the field.