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Characterization of Left Atrial Function during Cardiac Remodeling and Reverse Remodeling induced by Pregnancy
Session:
Sessão de Posters 12 - Cardio-oncologia e Medicina na Gravidez
Speaker:
Sara Anjos
Congress:
CPC 2024
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Cartazes
FP Number:
---
Authors:
Sara Anjos; Ana Filipa Ferreira; Maria João Azevedo; Juliana Morais; Francisca Almeida Saraiva; Carla Sousa; Ana Paula Machado; Adelino Leite-Moreira; Benedita Sampaio-Maia; Carla Ramalho; António Sousa Barros; Inês Falcão-Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: The hemodynamic overload present in pregnancy leads to cardiovascular remodeling, characterized by enlargement of left atrial (LA) and ventricular (LV) volumes associated with impaired LV relaxation, maintaining preserved systolic function. These changes are reversible during postpartum. Few scientific evidence has been published about LA function yet. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: To assess the changes in LA function through two-dimensional speckle tracking echocardiography analysis during pregnancy and its recovery up to 1 year after delivery and to determine potential predictors of its progression.</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 with gestational diabetes) recruited in two tertiary centers between 2019 and 2021. Women were evaluated by transthoracic echocardiography at the 1<sup>st</sup> trimester [1T, 10-15 weeks, baseline], 3<sup>rd</sup> trimester [3T, 30-35 weeks, peak of cardiac remodeling] of pregnancy as well as at the 1<sup>st</sup>, 6<sup>th</sup> and 12<sup>th</sup> month after delivery (during RR). Generalized linear mixed-effects models evaluate the variation of left atrial function assessed by strain and its potential predictors.</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 130 pregnant women with a median age of 33 [30,36] years, being 39.2% multiparas. Fifty-four (41.5%) have at least one cardiovascular risk factor. A significant enlargement of LA volume (24 [22, 28]mL/m<sup>2</sup> to 29 [25, 33]mL/m<sup>2</sup>, p<0.001) and an increasing of E/e’ (5.85 [5.08, 6.36] to 6.70 [5.67, 7.82], p<0.001) was observed from 1T to 3T, recovering both as soon as 1 month after delivery (LA volume: 29 [25, 33]mL/m<sup>2</sup> to 24 [20, 27] mL/m<sup>2</sup>, p<0.001; E/e’: 6.70 [5.67, 7.82] to 5.70 [4.82, 6.47], p<0.001). Regarding LA function, a significant reduction of LA strain was verified from 1T to 3T (35 [31, 41]% to 31 [29, 36]%, p<0.001), recovering 6 months postpartum (31 [29, 36]% to 33 [30, 38]%, p=0.035). Systemic vascular resistance seemed to be an independent predictor of lower LA strain (-3.83 [-6.40, -1.25], p=0.004). The presence of cardiovascular risk factors (-0.80 [-2.28, 0.68], p=0.287), smoking habits (-1.26 [-2.82, 0.30], p=0.112), parity (-0.33 [-1.93, 1.27], p=0.684) and age (-0.11 [-0.29, 0.08], p=0.257) showed a no significant impact in LA strain.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Despite<strong> </strong>diastolic function and LA volume having recovered 1 month after delivery, the LA function improved significantly only 6 months postpartum. Systemic vascular resistance is an independent predictor of LA strain.</span></span></p>
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