Effects of physiologic load of pregnancy on left ventricular contractility and remodeling

Left ventricular (LV) adaptation to the hemodynamic load of pregnancy has been studied with load-sensitive ejection-phase indexes, but the results of these studies are conflicting. The aim of this study was to examine the effects of the hemodynamic load of pregnancy on the contractile state of the left ventricle by using load-adjusted indexes of contractility. Thirty-four healthy women were prospectively studied by serial echo and Doppler examinations at six periods during pregnancy and after delivery. LV volume increased 10.5%, paralleling the change in stroke volume. End-systolic stress, an index of myocardial afterload, decreased 28.8% because of a decrease in end-systolic pressure and an increase in LV thickness/diameter ratio. Despite the increase in preload and the decrease in afterload, ejection phase indexes did not change during or after pregnancy. Although remaining within the normal range, the afterload-adjusted velocity of circumferential fiber shortening, an index of contractility that is relatively insensitive to preload, transiently decreased by 1.75 SDs during gestation, returning to non-pregnant values 2 to 4 weeks postpartum. Thus the increase in hemodynamic load that characterizes normal pregnancy is associated with preservation of global pump function. The transient decrease in contractile state may represent an adaptation phase of the contractile elements of the myocardium to the rapid changes in loading conditions observed during the first trimester of pregnancy.