Deterioration in cardiac systolic and diastolic function late in normal human pregnancy

Author:

Zentner Dominica12,du Plessis Moira2,Brennecke Shaun34,Wong James2,Grigg Leeanne2,Harrap Stephen B.1

Affiliation:

1. Department of Physiology, University of Melbourne, Parkville, VIC 3010, Australia

2. Department of Cardiology, The Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia

3. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia

4. Royal Women's Hospital, Flemington Rd, Parkville, VIC 3052, Australia

Abstract

The aim of the present study was to undertake a longitudinal study of systolic and diastolic cardiac function during normal pregnancy. At a median of 16 weeks of gestation, 100 primiparous women underwent echocardiography, including tissue Doppler imaging, determining left ventricular mass, cardiac output, systolic and diastolic velocities, and wall stress. A total of 32 were assessed again at a median of 37 weeks of gestation. Non-pregnant control estimates (n=9) were obtained by averaging four separate measures over two menstrual cycles. Initially, the pregnant women had significantly higher pulse rates than controls, associated with greater ventricular wall stress (two-tailed P value=0.015), and systolic (two-tailed P value=0.005) and diastolic (two-tailed P value=0.018) lateral wall myocardial velocities, but no differences in systolic blood pressure, left ventricular mass or cardiac output. By 37 weeks of gestation, increased blood pressure (two-tailed P value <0.001) and left ventricular mass (two-tailed P value=0.002) were associated with a significant increase in ventricular wall stress (two-tailed P value <0.001), and reductions in septal systolic (two-tailed P value=0.004) and septal and lateral early diastolic (two-tailed P value <0.001) myocardial velocities. The diastolic velocities at 37 weeks correlated inversely with maternal weight and age. In conclusion, by term pregnancy, an increase in ventricular wall stress is accompanied by a deterioration in cardiac function.

Publisher

Portland Press Ltd.

Subject

General Medicine

Reference56 articles.

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