131 Preload, contractility and afterload during the course of normal pregnancy ?an echocardiographic study

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• 作者：Oana Savu¹ ; Ruxandra Jurcut¹ ; Sorin Giusca¹ ; Ilinca Gussi² ; Roxana Enache¹ ; Bogdan Alexandru Popescu¹ ; Jan D&rsquo ; Hooge³ ; Jan Deprest⁴ ; Jens-Uwe Voigt³ ; Carmen Ginghina¹
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：43
• 全文大小：78 K

文摘

Purpose

Pregnancy is a physiologic condition associated with increased intravascular volume and decreased systemic vascular resistance. The aim of the study was to provide a longitudinally evaluation of the normal maternal cardiac function through echocardiography.

Methods

Twenty-seven pregnant women (mean age 30.7¡À2.9y) and 14 age and sex-matched non-pregnant controls (30.2¡À4.4y) were included. Echocardiography with conventional and speckle tracking based myocardial deformation imaging were performed longitudinally at 11-14, 22-24 and 32 weeks during pregnancy, and at inclusion for the control group. Total vascular resistance (TVR), aortic distensibility (ADis) and arterial elastance (Ea) were calculated for characterization of vascular adaptation. Beside conventional echocardiographic parameters, LV end-systolic wall stress (ESWS) and end-systolic elastance (Ees) were calculated, and ventriculo-arterial coupling index was derived.

Results

During pregnancy we found a progressive increase in LVEDV (93.8 ¡À 7.0 vs 88.8 ¡À 6.0 ml in 3^rd vs 1^st trimester, p<0.01) and stroke volume (78.7 ¡À 14.8 vs 68.7 ¡À 12.5 ml, p<0.05), associated to decreased TVR (982.7¡À284 vs 1189.1¡À158 dyne.s/cm5, P<0.05), which was significantly lower than in controls (1372.9 ¡À 212 dyne.s/cm5, p<0.01). End-systolic wall stress decresed longitudinally during pregnancy (29.4 ¡À 5.6 vs 41.9 ¡À 9.6 g/cm2, p<0.01) with a peak during the 3^rd trimester and lower values than in control during the whole pregnancy, while ADis progressively increased reaching the peak during the 3^rd trimester (7.55 ¡À 2.5 vs 6.25 ¡À 2.1 mmHg-1, p<0.05). The ventriculo-arterial coupling index was stable throughout pregnancy (0.79 ¡À 0.11 vs 0.75 ¡À 0.11, NS).

Conclusions

Pregnancy is associated with increased preload and decreased afterload, with progressively decreased total vascular resistance and increased aortic compliance, decreased end-systolic wall stress, increased cardiac output and preserved ventriculo-arterial coupling.