SPC365

Impact of cardiovascular risk factors in cardiac remodelling and reverse remodelling induced by pregnancy

Session: Sessão de Posters 12 - Cardio-oncologia e Medicina na Gravidez
Speaker: Ana Filipa da Silva Ferreira

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: Ana Filipa Ferreira; Maria João Azevedo; Juliana Morais; Fábio Trindade; Francisca Almeida Saraiva; Sílvia Oliveira Diaz; Carla Sousa; Adelino Leite-Moreira; Benedita Sampaio-Maia; Carla Ramalho; António Sousa Barros; Inês Falcão-Pires

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Haemodynamic overload during pregnancy induces cardiac remodelling, followed by reverse remodelling (RR) after delivery, characterized by normalization to their pre-pregnancy state. The impact of cardiovascular risk factors (CRF) in cardiac remodelling and RR is variable and remains to be clarified.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To characterise cardiac remodelling and RR during pregnancy and postpartum, respectively, and to investigate CRF&#39;s impact 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 (healthy [H group] or obese and/or hypertensive and/or with gestational diabetes [CRF group]) recruited in two tertiary centres between 2019 and 2022. 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 remodelling] 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). Blood samples were collected to quantify plasma troponin I (cTnI), procollagen I COOH-terminal propeptide (PICP), ST2/IL33-receptor, C-reactive protein (CRP) and relaxin-2 by ELISA. Generalised linear mixed-effects models were used to evaluate the extent of RR. Kruskal-Wallis test was used for&nbsp;group&nbsp;comparisons. </span></span></p>

<p style="text-align:justify"><strong>Results:</strong><span style="font-family:Calibri,sans-serif; font-size:11pt"> We included 130 pregnant women with a median age of 33 [30,36] years, 41.5% with at least one CRF. As shown in Table 1, pregnant women developed cardiac hypertrophy with significant atrial and ventricular enlargement from 1T to 3T in both groups. A significant rise in filling pressures was also documented.</span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During postpartum, a significant regression of cardiac hypertrophy and dilation was verified in the two study groups, accompanied by a significant decrease of E/e&rsquo; as soon as 1 month postpartum. Systolic function was preserved during follow-up, showing a significant increase of global longitudinal strain only in&nbsp;CRF group 1-year after delivery. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">These cardiac adaptations induced by pregnancy were accompanied by a significant reduction in plasma cTnI (p=0.048), PICP (p&lt;0.001), ST2/IL33-receptor (p&lt;0.001), CRP (p&lt;0.001) and relaxin-2&nbsp;(p&lt;0.001) levels from 3T to 6-months postpartum.</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 CRF group showed higher relative wall thickness (RWT) for all time points of the follow-up period, with similar values of indexed cardiac mass and volumes. Pregnant women with CRF revealed higher E/e&rsquo;, contrasting with lower ejection fraction and worse global longitudinal strain. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>The significant cardiac reverse remodelling occurred as soon as 1 month after delivery, returning to basal values<strong> </strong>6 months postpartum, supported by a significant reduction of plasma biomarkers levels&nbsp;related to myocardial injury, repair, fibrosis, and inflammation. Pregnant women with CRF showed higher RWT, impaired relaxation and subclinical LV dysfunction when compared with healthy women at all time points of the study. </span></span></p>