Ventricular efficiency in pregnant women with congenital heart disease

• Published in: International journal of cardiology Vol. 261; pp. 58 - 61
• Main Authors: Muneuchi, Jun, Yamasaki, Keiko, Watanabe, Mamie, Fukumitsu, Azusa, Kawakami, Takeshi, Nakahara, Hiromasa, Joo, Kunitaka
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-06-2018
• Subjects: Cardiac function; Heart failure; Ventricular–arterial coupling; Heart failure; Cardiac function; Ventricular–arterial coupling
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.01.090

Pregnant women with congenital heart disease (CHD) are at risk of cardiovascular events during pregnancy as well as postpartum. The aim of our study is to address the feasibility of echocardiography-derived ventricular–arterial coupling during pregnancy and postpartum among women with CHD.
In 31 pregnant women with CHD, we performed serial echocardiography at the first and third trimesters, early and late postpartum. The indices of contractility (single-beat determined end-systolic elastance, Eesab) and afterload (effective arterial elastance, Ea) were approximated on the basis of the systemic blood pressure and systemic ventricular volume. The ratio of stroke work and pressure–volume area (SW/PVA) representing ventricular efficiency was also calculated.
Age at the delivery was 28 (24–31) years. ZAHARA score was 0.75 (0.75–1.50). Gestational age and birth weight of newborns were 38 (37–39) weeks and 2.73 (2.42–2.92) kg, respectively. Heart rate, systemic ventricular end-diastolic volume and stroke volume significantly increased from the first trimester to the third trimester and reversed postpartum to the values of the first trimester. Eesab and Ea significantly decreased from the first trimester to the third trimester (Eesab; 4.90 [2.86–7.14] vs 3.41 [2.53–4.61] mm Hg/ml, p = 0.0001, Ea; 2.83 [1.74–3.30] vs 2.18 [1.67–2.68] mm Hg/ml, p = 0.0012), and reversed early postpartum parallelly. Ejection fraction and SW/PVA remained unchanged throughout pregnancy and postpartum.
Echocardiography-derived ventricular–arterial coupling is feasible to understand ventricular function in pregnant women with CHD.
•Ventricular-arterial coupling is useful to assess ventricular function in pregnant women with congenital heart disease.•The pressure-volume relationship loop is shifted rightward during pregnancy.•Ventricular efficiency is constant throughout pregnancy and postpartum.