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Published on: July 18, 2014
Ventricular efficiency in pregnant women with congenital heart disease
Jun Muneuchi1, Keiko Yamasaki1, Mamie Watanabe1
1Department of Pediatrics, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan.
Insights
Echocardiography can assess ventricular-arterial coupling in pregnant women with congenital heart disease (CHD). This method is feasible for understanding ventricular function throughout pregnancy and postpartum in this high-risk population.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Biomedical Engineering
Background:
- Pregnant women with congenital heart disease (CHD) face increased risks of cardiovascular events.
- Monitoring cardiovascular function during pregnancy and postpartum in CHD patients is crucial.
Purpose of the Study:
- To assess the feasibility of using echocardiography to evaluate ventricular-arterial coupling in pregnant women with CHD.
- To understand changes in ventricular function and arterial load during pregnancy and postpartum in this cohort.
Main Methods:
- Serial echocardiography was performed on 31 pregnant women with CHD during the first and third trimesters, and early and late postpartum.
- Ventricular contractility (end-systolic elastance, Eesab) and arterial afterload (effective arterial elastance, Ea) were derived.
- Ventricular efficiency was assessed using the ratio of stroke work to pressure-volume area (SW/PVA).
Main Results:
- Heart rate, ventricular end-diastolic volume, and stroke volume increased significantly from the first trimester to the third trimester, returning to baseline postpartum.
- End-systolic elastance (Eesab) and effective arterial elastance (Ea) decreased significantly from the first to the third trimester, with postpartum reversal.
- Ejection fraction and ventricular efficiency (SW/PVA) remained stable throughout the study period.
Conclusions:
- Echocardiography-derived ventricular-arterial coupling is a feasible method for assessing ventricular function in pregnant women with CHD.
- This approach provides valuable insights into cardiovascular adaptation during pregnancy and postpartum in this high-risk group.
Backgrounds:
Pregnant women with congenital heart disease (CHD) are at risk of cardiovascular events during pregnancy as well as postpartum. The aim of our study is to address the feasibility of echocardiography-derived ventricular-arterial coupling during pregnancy and postpartum among women with CHD.
Methods:
In 31 pregnant women with CHD, we performed serial echocardiography at the first and third trimesters, early and late postpartum. The indices of contractility (single-beat determined end-systolic elastance, Eesab) and afterload (effective arterial elastance, Ea) were approximated on the basis of the systemic blood pressure and systemic ventricular volume. The ratio of stroke work and pressure-volume area (SW/PVA) representing ventricular efficiency was also calculated.
Results:
Age at the delivery was 28 (24-31) years. ZAHARA score was 0.75 (0.75-1.50). Gestational age and birth weight of newborns were 38 (37-39) weeks and 2.73 (2.42-2.92) kg, respectively. Heart rate, systemic ventricular end-diastolic volume and stroke volume significantly increased from the first trimester to the third trimester and reversed postpartum to the values of the first trimester. Eesab and Ea significantly decreased from the first trimester to the third trimester (Eesab; 4.90 [2.86-7.14] vs 3.41 [2.53-4.61] mm Hg/ml, p = 0.0001, Ea; 2.83 [1.74-3.30] vs 2.18 [1.67-2.68] mm Hg/ml, p = 0.0012), and reversed early postpartum parallelly. Ejection fraction and SW/PVA remained unchanged throughout pregnancy and postpartum.
Conclusions:
Echocardiography-derived ventricular-arterial coupling is feasible to understand ventricular function in pregnant women with CHD.
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