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Vascular Remodelling during pregnancy and postpartum
Session:
Comunicações Orais (Sessão 15) - Enfermagem e Técnicos de Cardiopneumologia
Speaker:
Ana Filipa da Silva Ferreira
Congress:
CPC 2022
Topic:
M. Cardiovascular Nursing
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.7 Pregnancy and Cardiovascular Disease
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Filipa Ferreira; Maria João Azevedo; Francisca Saraiva; Ana Paula Machado; Sofia Torres; Carla Sousa; Benedita Sampaio-Maia; Adelino Leite-Moreira; Carla Ramalho; Inês Falcão-Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Pregnancy is a physiological condition of hemodynamic overload, characterized by a progressive reduction of peripheral vascular resistance, which normalizes postpartum.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To characterize longitudinal changes in maternal arterial stiffness, endothelial function and ventricular-arterial coupling during pregnancy and postpartum. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Prospective cohort study including volunteer pregnant women (healthy, obese and/or hypertensive and/or diabetic) recruited in two tertiary centres between 2019 and 2020, at their 1<sup>st</sup> or 3<sup>rd</sup> trimester of pregnancy. Women were evaluated at the first trimester [1T, 10-15 weeks, baseline], third trimester of pregnancy [3T, 30-35 weeks, peak of cardiac remodelling] as well as at the 1<sup>st</sup> month and 6<sup>th</sup> month after delivery [during reverse remodelling, RR]. Systemic vascular resistance (SVR), arterial elastance, left ventricular (LV) end-systolic elastance, arterial stiffness and endothelial function were assessed using echocardiography and blood pressure, pulse wave velocity (PWV) and EndoPAT, respectively. Friedman tests were used to compare four evaluation moments.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> We included 77 pregnant women with a median age of 34[26;44] years-old, 69% being healthy. As shown in Table 1, PWV decreased significantly from the 1<sup>st</sup> to the 3<sup>rd</sup> trimester (6.3[5.3;7.8]m/s to 5.7[4.6;7.3]m/s, p<0.001) and normalized as soon as 1 month after delivery (6.4[5.3;8.6]m/s, p<0.001). The SVR rose significantly 1 month after delivery (1336[1015;2049]dyn·s·cm<sup>–5 </sup>to 2087[1283;2699]dyn·s·cm<sup>–5</sup>,p<0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Despite the absence of significant variation of arterial elastance during follow-up period, the ventricular-arterial coupling increased significantly from 1<sup>st</sup> to 3<sup>rd</sup> trimester (0.49[0.34;0.85] to 0.60[0.37;1.49], p<0.001) due to a significant reduction of the net arterial load on the left ventricular between the 1<sup>st</sup> and the 3<sup>rd</sup> trimester, as assessed by LV end-systolic elastance (3.34[2.31;4.76]mmHg/mL to 2.56[1.09;4.93]mmHg/mL,p=0.009). This value normalized only 6 months after delivery (2.56[1.09;4.93]mmHg/mL to 3.19[1.94;7.42],p=0.002). A significant deterioration of endothelial function became evident from 1<sup>st</sup> to 3<sup>rd</sup> trimester, as assessed by the logarithm of reactive hyperemia index [lnRHI, 0.78[0.05;1.36] vs 0.44[-0.20;0.85],p=0.014], followed by slight amelioration 1 month postpartum (0.44[-0.20;0.85] vs 0.45[0.17;1.11], p>0.999). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Our cohort presented a significant decrease in arterial stiffness during pregnancy and normalization at 1<sup>st</sup> month after delivery. The SVR revealed a similar pattern, which recovered as soon as one month after delivery. In addition, an increased ventricular-arterial coupling was documented at peak of vascular remodelling, inherent to volume overload present in pregnancy context.</span></span></p>
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