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The impact of comorbidities in cardiac remodelling and reverse remodelling induced by pregnancy
Session:
Comunicações Orais (Sessão 16) - Doença CV em Populações Especiais
Speaker:
Ana Filipa da Silva Ferreira
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.7 Pregnancy and Cardiovascular Disease
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Filipa Ferreira; Diana Jesus; Maria João Azevedo; Francisca Saraiva; Tânia Proença; Ana Paula Machado; 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>Hemodynamic overload during pregnancy induces cardiac remodelling which is characterized by non-pathological left ventricle (LV) eccentric hypertrophy and left-atrium enlargement. After delivery, the woman's heart undergoes reverse remodelling (RR) and myocardial performance normalize to their pre-gravid state. Currently, the impact of comorbidities in cardiac remodelling and RR is variable and remains to clarify.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To characterize cardiac remodelling and RR during pregnancy and postpartum, as well as to investigate the impact of comorbidities in these processes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This prospective cohort study included volunteer pregnant women recruited in two tertiary centres between 2019 and 2021. Women were evaluated by echocardiography at the 1<sup>st </sup>[1T, 10-15 weeks] and 3<sup>rd</sup> trimesters [3T, 30-35 weeks] of pregnancy as well as at the 1<sup>st </sup>and 6<sup>th</sup> month after delivery. Kruskal-Wallis test and Friedman test were used as appropriate to between and within groups comparisons. </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, 31% being hypertensive and/or obese and/or diabetic. As shown in Table 1, pregnant women tended to develop from 1T to 3T eccentric hypertrophy, characterized by a significant increase of LV mass index (LVMi, p=0.001), accompanied by atrial (p=0.012) and ventricular enlargement (p<0.001). A significant rise in filling pressures was also documented during gestation (E/e’,p=0.011).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During postpartum, while indexed left atrial (p=0.001) and ventricular volumes (p=0.002) normalized as soon as 1 month after delivery, regression of hypertrophy decreased significantly only 6 months after delivery (p<0.001). Ventricular filling pressures also normalized 1 month after delivery (p<0.001). Systolic function was preserved with a significant increase of ejection fraction after delivery (3T to 6 months postpartum, p=0.025), while global longitudinal (p=0.801) and circunferential strains (p=0.319) were similar between all time-points. Regarding right ventricle, a significant reduction of TAPSE (p=0.035) and S' (p<0.001) were documented after delivery.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Compared to the healthy pregnant women, the group with comorbidities showed higher relative wall thickness (RWT) for all time points, except 6 months after delivery (p=0.53), with similar values of LVMi and indexed cardiac volumes. Pregnant women with comorbidities revealed higher values of E/e’ from the 3<sup>rd</sup> trimester (p=0.046) until the 6<sup>th</sup> month of postpartum (p=0.009). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Right ventricle seems to be more sensitive to pregnancy-induced volume overload, as evident by increased systolic function in the 3<sup>rd</sup> trimester. While most cardiac parameters recover as soon as one month after delivery others, such as hypertrophy, only normalize 6 months after delivery. Pregnant women with comorbidities showed higher RWT and diastolic dysfunction when compared with healthy women. </span></span></p>
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