Morphofunctional cardiac changes in pregnant women: associations with biomarkers

Takeshi Umazume, Takahiro Yamada, Satoshi Yamada, Satoshi Ishikawa, Itsuko Furuta, Hiroyuki Iwano, Daisuke Murai, Taichi Hayashi, Kazunori Okada, Mamoru Morikawa, Takashi Yamada, Kota Ono, Hiroyuki Tsutsui, Hisanori Minakami, Takeshi Umazume, Takahiro Yamada, Satoshi Yamada, Satoshi Ishikawa, Itsuko Furuta, Hiroyuki Iwano, Daisuke Murai, Taichi Hayashi, Kazunori Okada, Mamoru Morikawa, Takashi Yamada, Kota Ono, Hiroyuki Tsutsui, Hisanori Minakami

Abstract

Objective: This longitudinal study was performed to determine changes in echocardiography parameters in association with various biomarker levels in pregnancy/postpartum.

Methods: Fifty-one healthy pregnant women underwent echocardiography with simultaneous determination of blood levels of five biomarkers at each of the first, second and third trimesters of pregnancy, immediately postpartum within 1 week after childbirth and approximately 1 month postpartum. Data on 255 echocardiography scans (five times per woman) and biomarkers were analysed.

Results: Left ventricular end-diastolic dimension, left atrial (LA) volume index and left ventricular (LV) mass index increased with advancing gestation and reached the maximum immediately postpartum concomitant with the highest brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI) and creatine kinase MB levels. The inferior vena cava diameter was significantly reduced in the third trimester compared with that in the first trimester and the peak occurred immediately after childbirth. In 255 paired measurements, hs-TnI level was significantly positively correlated with LA volume index and LV mass index; BNP and NT-proBNP were significantly positively correlated with LA volume index and estimated glomerular filtration rate (eGFR) was significantly positively correlated with the average of early diastolic septal and lateral mitral annular velocity (e').

Conclusions: Maximal cardiac changes in morphology occurred postpartum within 1 week after childbirth, not during pregnancy. BNP/NT-proBNP, hs-TnI and eGFR reflected cardiac changes in pregnancy.

Keywords: echocardiography; heart failure; obstetrics.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Changes in eight representative echocardiographic measurements during pregnancy/postpartum. *P

Figure 2

Changes in levels of blood…

Figure 2

Changes in levels of blood biomarkers during pregnancy/postpartum. *P

Figure 2
Changes in levels of blood biomarkers during pregnancy/postpartum. *P

Figure 3

Comparison of peripartum changes in…

Figure 3

Comparison of peripartum changes in LA volume index, IVC diameter, E/e′, NT-proBNP and…

Figure 3
Comparison of peripartum changes in LA volume index, IVC diameter, E/e′, NT-proBNP and hs-TnI between women with Caesarean section and vaginal delivery. *P

Figure 4

Standardised regression coefficients between blood…

Figure 4

Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression…

Figure 4
Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression coefficient. Regression line was drawn for β>0.25 or
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References
    1. Pritchard JA. Changes in blood volume during pregnancy. Anesthesiology 1965;26:393–9. - PubMed
    1. Melchiorre K, Sharma R, Khalil A, et al. . Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension 2016;67:754–62. 10.1161/HYPERTENSIONAHA.115.06667 - DOI - PubMed
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Figure 2
Figure 2
Changes in levels of blood biomarkers during pregnancy/postpartum. *P

Figure 3

Comparison of peripartum changes in…

Figure 3

Comparison of peripartum changes in LA volume index, IVC diameter, E/e′, NT-proBNP and…

Figure 3
Comparison of peripartum changes in LA volume index, IVC diameter, E/e′, NT-proBNP and hs-TnI between women with Caesarean section and vaginal delivery. *P

Figure 4

Standardised regression coefficients between blood…

Figure 4

Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression…

Figure 4
Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression coefficient. Regression line was drawn for β>0.25 or
Similar articles
Cited by
References
    1. Pritchard JA. Changes in blood volume during pregnancy. Anesthesiology 1965;26:393–9. - PubMed
    1. Melchiorre K, Sharma R, Khalil A, et al. . Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension 2016;67:754–62. 10.1161/HYPERTENSIONAHA.115.06667 - DOI - PubMed
    1. Estensen ME, Beitnes JO, Grindheim G, et al. . Altered maternal left ventricular contractility and function during normal pregnancy. Ultrasound Obstet Gynecol 2013;41:659–66. 10.1002/uog.12296 - DOI - PubMed
    1. Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol 2002;283:H1627–H1633. 10.1152/ajpheart.00966.2001 - DOI - PubMed
    1. Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014;130:1003–8. 10.1161/CIRCULATIONAHA.114.009029 - DOI - PubMed
Show all 34 references
Publication types
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

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MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

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Figure 3
Figure 3
Comparison of peripartum changes in LA volume index, IVC diameter, E/e′, NT-proBNP and hs-TnI between women with Caesarean section and vaginal delivery. *P

Figure 4

Standardised regression coefficients between blood…

Figure 4

Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression…

Figure 4
Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression coefficient. Regression line was drawn for β>0.25 or
Similar articles
Cited by
References
    1. Pritchard JA. Changes in blood volume during pregnancy. Anesthesiology 1965;26:393–9. - PubMed
    1. Melchiorre K, Sharma R, Khalil A, et al. . Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension 2016;67:754–62. 10.1161/HYPERTENSIONAHA.115.06667 - DOI - PubMed
    1. Estensen ME, Beitnes JO, Grindheim G, et al. . Altered maternal left ventricular contractility and function during normal pregnancy. Ultrasound Obstet Gynecol 2013;41:659–66. 10.1002/uog.12296 - DOI - PubMed
    1. Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol 2002;283:H1627–H1633. 10.1152/ajpheart.00966.2001 - DOI - PubMed
    1. Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014;130:1003–8. 10.1161/CIRCULATIONAHA.114.009029 - DOI - PubMed
Show all 34 references
Publication types
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 4
Figure 4
Standardised regression coefficients between blood variable levels and echocardiographic measurements. β, standardised regression coefficient. Regression line was drawn for β>0.25 or

References

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