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Ferreira AF, Azevedo MJ, Morais J, Almeida-Coelho J, Leite-Moreira AM, Lourenço AP, Saraiva F, Diaz SO, Amador AF, Sousa C, Machado AP, Sampaio-Maia B, Ramalho C, Leite-Moreira A, Barros AS, Falcão-Pires I. Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors. Am J Physiol Heart Circ Physiol 2024; 326:H1193-H1203. [PMID: 38334973 DOI: 10.1152/ajpheart.00701.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
Pressure overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy's chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Thirty-seven women (1st trimester, 1stT) and a separate group of 31 (3rd trimester, 3rdT) women [healthy or with CVR factors (obesity and/or hypertension and/or with gestational diabetes)] underwent echocardiography determination of left ventricular end-diastolic volume (LVEDV) and E/e' before (T0), immediately after (T1), and 15 min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Acute leg elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1stT and 3rdT, confirming AVO. LVEDV and E/e' also increased immediately after AVO (T1) in both 1stT and 3rdT. SIC adaptation (T2, 15 min after AVO) significantly decreased E/e' in both trimesters, with additional expansion of LVEDV only in the 1stT. NT-pro-BNP increased slightly after AVO but only in the 1stT. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. A distinct functional response to SIC was observed between 1stT and 3rdT, which was influenced by CVR factors. The LV of 3rdT pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, whereas the lower LV filling pressure values suggest increased diastolic compliance.NEW & NOTEWORTHY The sudden increase of volume overload triggers an acute myocardial stretch characterized by an immediate rise in contractility by the Frank-Starling mechanism, followed by a progressive increase known as the slow force response. The present study is the first to characterize echocardiographically the stretch-induced compliance (SIC) mechanism in the context of physiological hypertrophy induced by pregnancy. A distinct functional adaptation to SIC was observed between first and third trimesters, which was influenced by cardiovascular risk factors.
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Affiliation(s)
- Ana Filipa Ferreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juliana Morais
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida-Coelho
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André M Leite-Moreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Filipa Amador
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Sousa
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Paula Machado
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
- Instituto Nacional de Engenharia Biomédica, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Carla Ramalho
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Obstetrics, Gynaecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António S Barros
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Granton J, Teijeiro-Paradis R. Management of the Critically Ill Patient with Pulmonary Arterial Hypertension and Right Heart Failure. Clin Chest Med 2022; 43:425-439. [PMID: 36116812 DOI: 10.1016/j.ccm.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Right ventricular (RV) failure is a recognized complication of pulmonary hypertension (PH). Pregnancy and surgery represent unique challenges to the patient with PH and require input from an interprofessional team. Approach to treatment must embrace sound physiologic principles that are based on optimization of RV preload, contractility, and afterload to improve cardiac function and tissue perfusion before the onset of multiorgan dysfunction. Failure of medical therapy needs to be recognized before the onset of irreversible shock. When appropriate, eligible patients should be considered for mechanical circulatory support as a bridge to recovery or transplantation.
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Affiliation(s)
- John Granton
- University of Toronto, Pulmonary and Critical Care Medicine, University Health Network, 9-9023 MARS Building, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
| | - Ricardo Teijeiro-Paradis
- Interdepartmental Division of Critical Care, University of Toronto, University Health Network, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
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3
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Supine hypotensive syndrome of pregnancy: A review of current knowledge. Eur J Anaesthesiol 2021; 39:236-243. [PMID: 34231500 DOI: 10.1097/eja.0000000000001554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the first description of supine hypotensive syndrome in the 1950s, its potentially detrimental effects on otherwise healthy women during late pregnancy have become a persistent challenge in obstetric practice. Establishing a 15° left lateral tilt during labour and caesarean section is a fundamental principle of obstetric care, universally adopted and upheld by current guidelines and recommendations. Reassessment of the original landmark studies in the light of current physiological and anatomical knowledge questions adherence to this standard in clinical practice. The modern practice of providing vasopressor support during caesarean delivery under neuraxial anaesthesia appears to negate any potential negative effects of a maternal full supine position. Recent MRI studies provide evidence as to the cause of supine hypotension and the physiological effects of different maternal positions at term. This review highlights current data on the acute supine hypotensive syndrome in contrast to traditional knowledge and established practice.
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Sima RM, Findeklee S, Bădărău IA, Poenaru MO, Scheau C, Pleș L. Comparison of maternal third trimester hemodynamics between singleton pregnancy and twin pregnancy. J Perinat Med 2021; 49:566-571. [PMID: 33567181 DOI: 10.1515/jpm-2020-0169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The impedance cardiography (ICG) technique measures the variation of impedance in the thorax due to the physical contractile activity of the heart. Twin pregnancy is characterized by greater maternal hemodynamic changes than a singleton pregnancy. METHODS In a study on 121 pregnant women in the last trimester we performed ICG, evaluating the following hemodynamic parameters: stroke volume, heart rate, cardiac output, ventricular ejection time, left ventricular ejection time, thoracic impedance, and systemic vascular resistance. RESULTS The study included singleton and twin pregnancies. Heart rate values in women with single fetus was lower than in those carrying twins (85 vs. 100 beats/min, p=0.021) as were the stroke volume values (64 vs. 83 mL, p=0.010) and the cardiac output (p<0.0001). Systemic vascular resistance decreased in twin pregnancies compared to singleton pregnancy (p=0.023). CONCLUSIONS ICG studies are rare, and the validation of their results is an ongoing process. However, the ICG technique is applicable in the third trimester of pregnancy and can yield important information regarding the hemodynamic profile of singleton and twin pregnancies, revealing maternal heart changes specific to twin pregnancies.
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Affiliation(s)
- Romina-Marina Sima
- The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,The "Bucur" Maternity, "Saint John" Hospital, Bucharest, Romania
| | - Sebastian Findeklee
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital Homburg, Homburg, Germany.,Fertility Center Hamburg, Hamburg, Germany
| | - Ioana-Anca Bădărău
- The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mircea-Octavian Poenaru
- The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,The "Bucur" Maternity, "Saint John" Hospital, Bucharest, Romania
| | - Cristian Scheau
- The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liana Pleș
- The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,The "Bucur" Maternity, "Saint John" Hospital, Bucharest, Romania
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Yarlagadda RD, Johnson J, Vårtun Å, Flo K, Acharya G. Maternal plasma pro-atrial and C-type natriuretic peptide levels and their associations with cardiovascular and renal function in the second half of normal pregnancy: a longitudinal study. BMC Pregnancy Childbirth 2021; 21:358. [PMID: 33952207 PMCID: PMC8097896 DOI: 10.1186/s12884-021-03824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/21/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Physiological adaptation in pregnancy is characterized by remodeling of endocrine, cardiovascular and renal functions leading to fluid retention, volume expansion, altered cardiac loading conditions and hyperdynamic circulation. Natriuretic peptides have been used as biomarkers of cardiovascular function, but their associations with gestational age-related changes in maternal cardiac, endothelial and renal function have not been elucidated. The aim of this study was to establish longitudinal reference values for maternal plasma atrial natriuretic peptide (proANP) and C-type natriuretic peptide (CNP) and investigate their temporal association with cardiovascular and renal function in the second half of pregnancy. METHODS This study was a prospective longitudinal study of 53 low-risk pregnancies. Women were examined every 3-5 weeks during 22-40 weeks of gestation (252 observations). Fasting maternal blood samples were obtained to measure proANP, CNP, creatinine, cystatin C, uric acid, and fibrinogen levels. Cardiac function and systemic hemodynamics were assessed noninvasively by impedance cardiography (ICG) and vascular endothelial function by flow-mediated vasodilation of brachial artery (FMD). RESULTS The plasma proANP (R2adj = 0.79; P = 0.007), CNP (R2adj = 0.54; P = 0.005) decreased between 22 and 40 weeks. The creatinine (R2adj = 0.90; P < 0.001), cystatin C (R2adj = 0.93; P = < 0.001) and uric acid (R2adj = 0.83; P < 0.001) increased significantly, whereas the estimated glomerular filtration rate (R2adj = 0.93; P < 0.001) decreased with gestational age. The FMD did not change significantly but fibrinogen (R2adj = 0.79; P < 0.001) increased with advancing gestation. The maternal systemic vascular resistance index (R2adj = 0.50; P < 0.001) increased, stroke index (R2adj = 0.62; P < 0.001) decreased, whereas the cardiac index (R2adj = 0.62; P = 0.438) and thoracic fluid content (R2adj = 0.72; P = 0.132) did not change significantly with gestation. The proANP was associated with thoracic fluid content (R2adj = 0.74; P < 0.001) and fibrinogen (R2adj = 0.78; P = 0.034) but not with other variables of systemic hemodynamics, endothelial function, or renal function. The CNP was not associated significantly with parameters of cardiovascular or renal function. CONCLUSION Longitudinal reference values for maternal plasma proANP and CNP were established. These natriuretic peptides decreased slightly with advancing gestation, but they did not reflect the temporal physiological changes in maternal systemic hemodynamics, vascular endothelial function and renal function during the second half of pregnancy. The proANP correlated with the thoracic fluid content reflecting volume load in pregnancy.
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Affiliation(s)
- Rima D Yarlagadda
- Department of Clinical Medicine, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway.,The University of Virginia, College of Arts and Science, Charlottesville, VA, USA
| | - Jonas Johnson
- Division of Obstetrics and Gynecology, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Åse Vårtun
- Department of Clinical Medicine, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Kari Flo
- Department of Clinical Medicine, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway.,University Hospital of North Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Ganesh Acharya
- Department of Clinical Medicine, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway. .,Division of Obstetrics and Gynecology, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. .,University Hospital of North Norway, Tromsø, Norway.
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6
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Akaishi T, Abe M, Miki T, Miki M, Funamizu Y, Ito S, Abe T, Ishii T. Ratio of diastolic to systolic blood pressure represents renal resistive index. J Hum Hypertens 2020; 34:512-519. [PMID: 31586124 PMCID: PMC7367813 DOI: 10.1038/s41371-019-0264-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/12/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022]
Abstract
Increased intrarenal vascular resistance is suggested to accompany chronic kidney diseases (CKD), which is known to be closely associated with hypertension. However, there are few studies that have examined the relationship between blood pressure and intrarenal vascular resistance. Renal color Doppler ultrasonography is one method that can non-invasively evaluate intrarenal vascular resistance. In this study, we comprehensively studied the correlations between ultrasonic parameters and blood pressure indices to elucidate their relationships. In total, 162 patients with suspected CKD were enrolled for this study. Demographics, blood pressure, blood test, urine test, and renal color Doppler ultrasonography data were obtained. The ratio of diastolic to systolic blood pressure (D/S ratio) and pulse pressure were calculated. Our results indicated strong negative correlations between the renal resistive index (RI) values in all four of the studied kidney regions and the D/S ratio. The RI values also showed significant correlations with diastolic pressure and pulse pressure, but they were weaker. Partial correlation coefficients between pulse pressure, mean arterial pressure, D/S ratio, and RI showed that D/S ratio significantly correlated with RI, but pulse pressure or mean arterial pressure did not. Systolic blood pressure did not correlate with any of the studied ultrasonic values. The negative correlation between RI values and the D/S ratio was still observed in subjects without renal dysfunction or any medications. In conclusion, D/S ratio, rather than pulse pressure or mean arterial pressure, would be the most appropriate index to estimate/calculate/judge intrarenal vascular resistance.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University, Sendai, Japan.
| | - Takashi Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Mika Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Yasuharu Funamizu
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Sadayoshi Ito
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University, Sendai, Japan
| | - Takaaki Abe
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
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Maternal Complications and Hemodynamic Changes Following Intrauterine Interventions for Twin-to-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies. J Clin Med 2019; 8:jcm8050605. [PMID: 31052564 PMCID: PMC6572341 DOI: 10.3390/jcm8050605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 11/17/2022] Open
Abstract
Twin-to-twin transfusion syndrome (TTTS) is a challenging complication in monochorionic diamniotic (MCDA) twins. Intrauterine interventions, such as fetoscopic laser ablation and cord occlusion followed by amniodrainage, are established treatments. Little is known about maternal complications and hemodynamics following these interventions. We performed a retrospective analysis of maternal procedure-related complications and the impact of such procedures on maternal hemodynamics and blood characteristics. Within the study period, 100 women with severe TTTS treated by fetoscopic laser ablation (FLA) or cord occlusion (CO) were identified. Clinically relevant maternal complications were reported in four (4%) cases. There was a significant decrease in hemoglobin, hematocrit, and albumin between admission and postoperative measurements (all p < 0.001). Systolic and diastolic blood pressure, as well as maternal heart rate, decreased from time of skin suture to postoperative measurements (all p < 0.001). Within a 24 h interval, there was a positive correlation between hematocrit (Spearman's rho 0.325; p = 0.003), hemoglobin (Spearman's rho 0.379; p < 0.001), and albumin (Spearman's rho 0.360; p = 0.027), and the amount of amniodrainage during the intervention. Maternal procedure-related complications are relatively rare. Significant hemodynamic alterations and maternal hemodilution are common clinical findings following intrauterine interventions.
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Liang H, Vårtun Å, Flo K, Widnes C, Acharya G. Maternal cardiac function, uterine artery hemodynamics and natriuretic peptides at 22-24 weeks of gestation and subsequent development of hypertensive disorders of pregnancy. Acta Obstet Gynecol Scand 2019; 98:507-514. [PMID: 30586148 DOI: 10.1111/aogs.13525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Maternal cardiac dysfunction as well as abnormal uterine artery (UtA) Doppler are associated with hypertensive disorders of pregnancy (HDP), but their relation is unclear. We investigated the correlation between maternal cardiac function, UtA hemodynamics and natriuretic peptides, and explored differences between women who subsequently developed HDP and those who did not. MATERIAL AND METHODS This was a prospective cross-sectional cohort study of 347 pregnant women at 22-24 weeks. Maternal cardiac function and systemic hemodynamics were investigated at baseline and after 90 seconds of passive leg raising using impedance cardiography. Preload reserve was defined as percent change (Δ%) in stroke volume and cardiac output from baseline to passive leg raising. UtA hemodynamics was studied using Doppler ultrasonography. UtA blood flow, resistance and pulsatility index were calculated. Fasting venous blood samples were analyzed for natriuretic peptides (pro atrial natriuretic peptide [proANP], N-terminal pro brain natriuretic peptide [Nt-proBNP] and C-type natriuretic peptide [CNP]). The course and outcome of pregnancy were recorded. RESULTS At baseline, ProANP correlated significantly with cardiac output (r = -0.122; P = .023) and left cardiac work index (r = -0.112; P = .037), whereas Nt-ProBNP correlated significantly with acceleration index (r = .127; P = .018) and velocity index (r = -0.111; P = .039. CNP correlated significantly with UtA blood flow (r = .118; P = .028) and resistance (r = -0.112; P = .037) but not with UtA pulsatility index (r = .034; P = .523). None of the natriuretic peptides correlated with preload reserve. At 22-24 weeks, women who subsequently developed HDP had lower UtA blood flow (552 vs 692 mL/min; P = .028), higher UtA resistance (0.28 vs .17 mmHg/mL/min; P = .004) and higher mean UtA pulsatility index (1.12 vs .84; P < .001) compared with those who did not; however, the natriuretic peptide levels were similar in the two groups. Women developing HDP had a significantly higher increase in stroke volume and cardiac output and more reduction in systemic vascular resistance following passive leg raising compared with the reference group. Left cardiac work index, acceleration index and velocity index decreased following passive leg raising in the reference group but increased in women who later developed HDP. CONCLUSIONS ProANP correlated with cardiac output and cardiac work, Nt-proBNP with indices of cardiac contractility, and CNP with UtA blood flow and resistance. None of these natriuretic peptides measured at 22-24 weeks of gestation reflected cardiac preload reserve or predicted development of HDP.
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Affiliation(s)
- Huan Liang
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Obstetrics, and Gynecology, Hospital of Fudan University, Shanghai, China
| | - Åse Vårtun
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
| | - Kari Flo
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
| | - Christian Widnes
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
| | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway.,Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
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9
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Orabona R, Prefumo F, Zanardini C, Magri R, Loardi C, Cappa V, Calza S, Frusca T, Acharya G. Maternal functional hemodynamics in uncomplicated twin pregnancies: A longitudinal study using impedance cardiography. Acta Obstet Gynecol Scand 2018; 98:188-195. [PMID: 30289562 DOI: 10.1111/aogs.13479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Longitudinal studies of maternal hemodynamics in twin pregnancy are scarce and preload reserve in twin pregnancies has not been studied. Thus, we aimed to investigate serial changes in maternal systemic hemodynamics from the first to third trimester, and cardiovascular response to passive leg raising to evaluate preload reserve using impedance cardiography in a cohort of uncomplicated twin pregnancies. MATERIAL AND METHODS This was a prospective longitudinal study of 50 twin pregnancies. Maternal hemodynamics was assessed at baseline and 120 seconds after passive leg raising using impedance cardiography, at five time points during gestation. Women were excluded from the analysis if there were pregnancy complications or fewer than three of five planned assessments were available. RESULTS Data from 37 uncomplicated twin pregnancies were available for analysis. Mean arterial pressure slightly decreased until 17 weeks' gestation, then increased. Systemic vascular resistance was constant in the first half of pregnancy before rising steadily thereafter, whereas the cardiac output increased from the first trimester, peaked by the end of the second trimester and then decreased in the third trimester. The change in stroke volume and cardiac output following passive leg raising during pregnancy ranged from -2.2% to 1.6% and from -3.7% to 3.2%, respectively. Although passive leg raising caused no significant changes in systemic vascular resistance, cardiac output or heart rate, mean arterial pressure decreased in the first and second trimesters. CONCLUSIONS In uncomplicated twin pregnancies, maternal cardiovascular adaptation is evident from the first trimester. Twin pregnancies show a reduced preload reserve in the second half of gestation.
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Affiliation(s)
- Rossana Orabona
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Cristina Zanardini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Roberta Magri
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Chiara Loardi
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Veronica Cappa
- Unit of Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Ganesh Acharya
- Department of Clinical Science, Intervention & Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
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10
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Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73:1265-1279. [DOI: 10.1111/anae.14354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix Marseille university C2VN France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care Medicine Hospices Civils de Lyon Hôpital Femme Mère Enfant Bron France
| | - S. Einav
- General Intensive Care Shaare Zedek Medical Centre Hebrew University Faculty of Medicine Jerusalem Israel
| | - G. Duclos
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
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11
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Agreement between preload reserve measured by impedance cardiography and echocardiography during pregnancy. Arch Gynecol Obstet 2018; 298:59-66. [PMID: 29623416 PMCID: PMC5995996 DOI: 10.1007/s00404-018-4773-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/03/2018] [Indexed: 11/17/2022]
Abstract
Purpose Accurate assessment of cardiac function is important during pregnancy. Echocardiography and impedance cardiography (ICG) are commonly used noninvasive methods to measure stroke volume (SV) and cardiac output (CO). The difference in stroke volume (ΔSV) or cardiac output (ΔCO) measured at baseline and after passive leg raising (PLR) is a measure of preload reserve that predicts volume responsiveness. However, the agreement between these two methods in measuring preload reserve during pregnancy is unclear. The aim of our study was to investigate the correlation and the agreement between Doppler echocardiography and ICG in assessing preload reserve in pregnant women. Methods In this prospective observational cross-sectional study, preload reserve was assessed by measuring the SV and CO during baseline and 90 s after PLR simultaneously by Doppler echocardiography and ICG in healthy pregnant women during the second and third trimesters. Bland–Altman analysis was used to determine the agreement between the two methods. Bias was calculated as the mean difference between two methods and precision as 1.96 SD of the difference. Results A total of 53 pregnant women were included. We found a statistically significant correlation between ΔSV (R = 0.56, p < 0.0001) and ΔCO (R = 0.39, p = 0.004) measured by ICG and Doppler echocardiography. The mean bias for ΔSV was 2.52 ml, with a precision of 18.19 ml. The mean bias for ΔCO was 0.21 l/min, with a precision of 1.51 l/min. Conclusion There was a good agreement and a statistically significant correlation between ICG and Doppler echocardiography for measuring preload reserve.
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Chawla S, Jose T, Paul M. Critical Care in Obstetrics: Where are We. J Obstet Gynaecol India 2018; 68:155-163. [PMID: 29895993 DOI: 10.1007/s13224-018-1109-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/06/2018] [Indexed: 12/19/2022] Open
Abstract
Maternal mortality is disastrous news for the society, family, newborn, and the obstetrician. Yet, we all who are care providers to these apparently healthy women carrying another life within them are dumbfounded by the clinical conditions arising due to the pregnancy or the effects of the pregnancy, that it becomes difficult to provide an ideal care to them. The rapid uprising of a condition and the worsening of commonly occurring benign conditions-preeclampsia, hemorrhage, etc., necessitates that all obstetricians are well versed with the physiological changes and should be able to not only provide the best of obstetric care to the mother and the newborn but also perform or assist in performance of life-saving procedures.
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Affiliation(s)
- Sushil Chawla
- 1Department of Obstetrics and Gynaecology, AFMC, Pune, India
| | - T Jose
- 1Department of Obstetrics and Gynaecology, AFMC, Pune, India
| | - Manish Paul
- 2Department of Anaesthesiology, Pain & Critical Care, AFMC, Pune, India
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Guy GP, Ling HZ, Machuca M, Poon LC, Nicolaides KH. Effect of change in posture on maternal functional hemodynamics at 35-37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:368-374. [PMID: 28294444 DOI: 10.1002/uog.17466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/26/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate the effect of posture change from the supine to the sitting position and before and after passive leg raising on maternal functional hemodynamics in pregnant women at 35-37 weeks' gestation, and to compare the changes in pregnancies that subsequently developed pre-eclampsia (PE) or gestational hypertension (GH) with those that remained normotensive. METHODS In 2764 singleton pregnancies at 35-37 weeks' gestation, maternal cardiovascular parameters were measured using an automated non-invasive cardiac monitor. The hemodynamic response to a change from the supine to the sitting position and before and after passive leg raising in the left lateral position was examined and compared between women who subsequently developed PE or GH and those who remained normotensive. RESULTS In normotensive singleton pregnancies at 35-37 weeks' gestation, both change from the supine to the sitting position and passive leg raising were associated with an increase in cardiac index and stroke volume index and a decrease in total peripheral resistance index; there was a small increase in mean arterial pressure with both postural changes and a slight decrease in heart rate with passive leg raising. In pregnancies that subsequently developed PE or GH, compared with normotensive pregnancies, cardiac index and stroke volume index were lower and total peripheral resistance index was higher. In general, change from the supine to the sitting position and passive leg raising were associated with similar but less marked changes in cardiovascular parameters as in normotensive pregnancies. CONCLUSIONS Paradoxically, in late third-trimester normal pregnancy, both change from the supine to a sitting position and passive leg raising may result in an increase in preload with a consequent increase in cardiac and stroke volume indices and a decrease in total peripheral resistance index. In pregnancies that develop PE or GH, the effects of postural change on cardiovascular parameters are similar but less marked than in normotensive pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G P Guy
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - H Z Ling
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Machuca
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
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Vårtun Å, Flo K, Widnes C, Acharya G. Static and Functional Hemodynamic Profiles of Women with Abnormal Uterine Artery Doppler at 22-24 Weeks of Gestation. PLoS One 2016; 11:e0157916. [PMID: 27308858 PMCID: PMC4911143 DOI: 10.1371/journal.pone.0157916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/07/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To compare cardiac function, systemic hemodynamics and preload reserve of women with increased (cases) and normal (controls) uterine artery (UtA) pulsatility index (PI) at 22–24 weeks of gestation. Materials and Methods A prospective cross-sectional study of 620 pregnant women. UtA blood flow velocities were measured using Doppler ultrasonography, and PI was calculated. Mean UtA PI ≥ 1.16 (90th percentile) was considered abnormal. Maternal hemodynamics was investigated at baseline and during passive leg raising (PLR) using impedance cardiography (ICG). Preload reserve was defined as percent increase in stroke volume (SV) 90 seconds after passive leg raising compared to baseline. Results Mean UtA PI was 1.49 among cases (n = 63) and 0.76 among controls (n = 557) (p < 0.0001). Eighteen (28.6%) cases and 53 (9.5%) controls developed pregnancy complications (p <0.0001). The mean arterial pressure and systemic vascular resistance were 83 mmHg and 1098.89±293.87 dyne s/cm5 among cases and 79 mmHg and 1023.95±213.83 dyne s/cm5 among controls (p = 0.007 and p = 0.012, respectively). Heart rate, SV and cardiac output were not different between the groups. Both cases and controls responded with a small (4–5%) increase in SV in response to PLR, but the cardiac output remained unchanged. The preload reserve was not significantly different between two groups. Conclusion Pregnant women with abnormal UtA PI had higher blood pressure and systemic vascular resistance, but similar functional hemodynamic profile at 22–24 weeks compared to controls. Further studies are needed to clarify whether functional hemodynamic assessment using ICG can be useful in predicting pregnancy complications.
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Affiliation(s)
- Åse Vårtun
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
- * E-mail:
| | - Kari Flo
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
| | - Christian Widnes
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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