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Right cardiovascular remodelling and reverse remodelling during pregnancy and postpartum
Session:
Sessão de Posters 34 - Medicina Cardiovascular: Para além dos cardiologistas
Speaker:
Ana Filipa da Silva Ferreira
Congress:
CPC 2024
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
30.7 Pregnancy and Cardiovascular Disease
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Filipa Ferreira; Joana Araújo; Maria João Azevedo; Francisca Almeida Saraiva; Sílvia Oliveira Diaz; Carla Sousa; Ana Paula Machado; Carla Ramalho; Adelino Leite-Moreira; António Sousa Barros; Mário Santos; Inês Falcão-Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Many studies have focused on pregnancy-induced left ventricular remodelling, overlooking the changes in right cardiac chambers. </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 the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of CV risk (CVR) factors on 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 was recruited at two tertiary centers from 2019 to 2022, including 51 healthy and 79 obese and/or hypertensive and/or with gestational diabetes and/or smoking habits pregnant women (cardiovascular risk [CVR] group). Women were evaluated by transthoracic echocardiography at the 1<sup>st</sup> trimester (1T) and 3<sup>rd</sup> trimester (3T) of pregnancy, as well as one-month (PP1), six-months (PP2), and one-year postpartum (PP3). Generalized linear mixed-effects models were used for the analysis of right CV remodelling and RR and to evaluate the impact of CVR factors on these processes. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> This study included 130 pregnant women, 60.8% primiparous, with a median age of 33 years. Despite all echocardiographic results being within the normality range, we describe the progression of right heart adaptations throughout pregnancy and postpartum (Table 1), namely: 1) Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions throughout pregnancy, recovering at PP2 except for RA in the CVR group; 2) Preserved RV systolic function throughout pregnancy in both groups, while the postpartum hemodynamic normalization triggers a reduction of (TAPSE) and tricuspid S' wave velocity; 3) Reduced RA strain in both groups during pregnancy, more evident in CVR group, which had a slower postpartum recovery; 4) Preserved RV global longitudinal strain (GLS) throughout follow-up time, being significantly reduced in 3T of CVR group and recovering at PP2; 5) Reduction of tricuspid E/A ratio from 1T to 3T in both groups with an early recovery at PP1, being these values significantly higher in the healthy group, and 6) Steady pulmonary artery systolic pressure (PASP) values throughout follow-up time, showing consistently higher values in the CVR group. </span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> This study describes the subclinical right cardiac functional and structural changes within the physiological range, which recover 6 months after delivery. CVR factors impact the magnitude of the subclinical RV diastolic function changes, PASP and myocardial deformation (strain) without any impact on classic RV systolic function.</span></span> </span></span></p>
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