SPC365

Cardiac Remodelling and Reverse Remodelling in Pregnancy: What is the Impact of Cardiovascular Risk Factors?

Session: Comunicações Orais - Sessão 09 - Técnicos e Enfermeiros
Speaker: Ana Filipa da Silva Ferreira

Congress: CPC 2023
Topic: M. Cardiovascular Nursing
Theme: 32. Cardiovascular Nursing
Subtheme: 32.3 Cardiovascular Nursing - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Filipa Ferreira; Juliana Morais; Maria João Azevedo; Francisca Saraiva; Ana Paula Machado; Ana Filipa Amador; Carla Sousa; Benedita Sampaio-Maia; Adelino Leite-Moreira; Carla Ramalho; Inês Falcão-Pires

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Pregnancy-induced cardiac remodelling (CR) is characterized by non-pathological left ventricle (LV) hypertrophy and left-atrium enlargement. After delivery, the woman&#39;s heart undergoes reverse remodelling (RR) and myocardial function and structure normalization. Currently, the impact of cardiovascular risk (CVR) factors in CR and RR 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 CR and RR during pregnancy and postpartum, respectively, as well as to investigate the impact of CVR factors 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> Pregnant women healthy and with CVR factors (obese, hypertensive and/or with gestational diabetes) were recruited in two tertiary centres between 2019 and 2021. Women were evaluated by transthoracic echocardiography during [1<sup>st</sup> trimester,1T: 10-15 weeks; 3<sup>rd</sup> trimester ,3T: 30-35 weeks] pregnancy and in 1<sup>st</sup> and 6<sup>th</sup> months after delivery. Kruskal-Wallis/ Wilcoxon test and Friedman tests were used for between and within groups comparisons, respectively. </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 125 pregnant women with a median age of 34[21;44]years, 46% having CVR factors. As shown in Table 1, pregnant women tended to develop eccentric hypertrophy from 1T to 3T, characterized by a significant increase in LV mass index (LVMi, p&lt;0.001) and relative wall thickness (RWT, p=0.034), accompanied by atrial and ventricular enlargement (1T to 3T, p&lt;0.001 and p&lt;0.001, respectively). A significant rise in filling pressures was also documented during gestation (E/e&rsquo;, p&lt;0.001).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During postpartum, LVMi and indexed left atrial and ventricular volumes normalized as soon as 1 month after delivery (p=0.012, p&lt;0.001 and p&lt;0.001, respectively). Ventricular filling pressures also normalized 1 month after delivery (p&lt;0.001). LV systolic function remained preserved (ejection fraction, p=0.174). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">These structural adaptations during RR were accompanied by a significant reduction of C-Reactive Protein (CRP, p&lt;0.001), IL33/ST2 (p&lt;0.001) and procollagen type I c-terminal propeptide (</span></span>PICP,&nbsp;<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">p&lt;0.001) from 3T to 6 months 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 CVR factors showed higher RWT in&nbsp;all&nbsp;follow-up moments, but similar values of indexed cardiac volumes. This group also displayed higher values of LVMi when compared with healthy women 6 months after delivery (p=0.036). Pregnant women with CVR factors revealed deterioration of diastolic function (E/e&rsquo;,1<sup>st</sup> month, p=0.002; 6<sup>th</sup> month, p=0.010). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Higher values of CRP (p=0.016), IL33/ST2 (p=0.021) and </span></span>PICP<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;(p=0.005) were reported in pregnant women with CVR factors when compared with the healthy group at 3T.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>All cardiac parameters studied seemed to recover as soon as 1 month after delivery and were associated with a reduction of inflammatory and extracellular matrix turnover biomarkers. Pregnant women with CVR factors showed higher RWT and diastolic deterioration when compared with healthy women.</span></span></p>