Maternal and Fetal Hemodynamic Adaptations to Pregnancy and Clinical Outcomes in Maternal Cardiac Disease.

Autor: Ducas R; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada., Saini BS; Division of Cardiology, Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Yamamura K; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada., Bhagra C; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada., Marini D; Division of Cardiology, Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada., Silversides CK; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada., Roche SL; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada., Colman JM; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada., Kingdom JC; Department of Obstetrics and Gynaecology, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada., Sermer M; Department of Obstetrics and Gynaecology, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada., Hanneman K; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada., Seed M; Division of Cardiology, Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada., Wald RM; Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada. Electronic address: rachel.wald@uhn.ca.
Jazyk: angličtina
Zdroj: The Canadian journal of cardiology [Can J Cardiol] 2021 Dec; Vol. 37 (12), pp. 1942-1950. Date of Electronic Publication: 2021 Jul 02.
DOI: 10.1016/j.cjca.2021.06.015
Abstrakt: Background: Although insufficient maternal cardiac output (CO) has been implicated in poor outcomes in mothers with heart disease (HD), maternal-fetal interactions remain incompletely understood. We sought to quantify maternal-fetal hemodynamics with the use of magnetic resonance imaging (MRI) and explore their relationship with adverse events.
Methods: Pregnant women with moderate or severe HD (n = 22; mean age 32 ± 5 years) were compared with healthy control women (n = 21; 34 ± 3 years). An MRI was performed during the third trimester at peak output (maternal-fetal) and 6 months postpartum with return of maternal hemodynamics to baseline (reference). Phase-contrast MRI was used for flow quantification and was combined with T1/T2 relaxometry for derivation of fetal oxygen delivery/consumption.
Results: Third-trimester CO and cardiac index (CI) measurements were similar in HD and control groups (CO 7.2 ± 1.5 vs 7.3 ± 1.6 L/min, P = 0.79; CI 4.0 ± 0.7 vs 4.3 ± 0.7 L/min/m, 2 P = 0.28). However, the magnitude of CO/CI increase (Δ, peak pregnancy - reference) in the HD group exceeded that in the control group (CO 46 ± 24% vs 27 ± 16% [P = 0.007]; CI 51 ± 28% vs 28 ± 17% [P = 0.005]). Fetal growth and oxygen delivery/consumption were similar between groups. Adverse cardiovascular outcomes (nonmutually exclusive) in 6 HD women included arrhythmia (n = 4), heart failure (n = 2), and hypertensive disorder of pregnancy (n = 1); premature delivery was observed in 2 of these women. The odds of a maternal cardiovascular event were inversely associated with peak CI (odds ratio 0.10, 95% confidence interval 0.001-0.86; P = 0.04) and Δ,CI (0.02, 0.001-0.71; P = 0.03).
Conclusions: Maternal-fetal hemodynamics can be well characterised in pregnancy with the use of MRI. Impaired adaptation to pregnancy in women with HD appears to be associated with development of adverse outcomes of pregnancy.
(Copyright © 2021 Canadian Cardiovascular Society. All rights reserved.)
Databáze: MEDLINE
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