"Maternal cardiovascular function in twin pregnancies complicated by pre-eclampsia: a matched cross-sectional study"

Twin pregnancies are at high risk for pre-eclampsia (PE), which is associated with significant geometric and functional changes in the maternal heart, compared to those with singleton pregnancies and twins without preeclampsia.

To compare the maternal hemodynamics and cardiovascular function in twin pregnancies with PE with age and gestational age-matched twins without PE and singleton preeclamptic pregnancies METHODS: This matched cross-sectional study was conducted in a tertiary hospital, comparing cardiac function in twin pregnancies with PE (n=40) to twins without PE (n=80) and singleton with PE (n=40). All mothers underwent conventional 2D, M-mode and Doppler echocardiography to assess cardiac function, remodeling, and hemodynamic indices, which were compared between the groups.

Hemodynamically, stroke volume and cardiac output were elevated in PE, though values adjusted for body surface area were similar; cardiac work index and vascular resistance remained significantly higher. Even though the pattern of left ventricular remodeling was similar, twins with PE had greater left ventricular mass. The diastolic dysfunction was higher in singletons with PE. Twins with PE had higher peak atrial filling velocity (A=80.2±17.6cm s⁻¹ vs 66.7±15.8cm s⁻¹; P<.001), a lower E/A ratio (1.3±0.3 vs 1.5±0.4; p=.008), and identical E wave velocities, indicating early impairment of LV relaxation despite preserved preload.

Twins with pre-eclampsia had distinct hemodynamic changes compared with those without pre-eclampsia and the singleton preeclamptic pregnancies, emphasizing the additive cardiovascular burden with a probable compensated hemodynamic profile.