30 Maternal cardiac function in twin pregnancy and reeclampsia: A ongitudinal study

Abstract

Introduction Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure towards the end of pregnancy or in the months following delivery without other causes of heart failure. PPCM is a life-threatening disease, and twin pregnancy and preeclampsia are considered risk factors of peripartum cardiomyopathy. While preeclampsia causes heart failure because of diastolic dysfunction, which is caused by heart remodeling for the adaptation to hypertension, twin pregnancy can also be a stress on maternal heart because twin pregnant women are exposed to more significant hemodynamic changes than singleton pregnant women. However, the effect of preeclampsia on maternal cardiac function in twin pregnant women remains unclear. Objectives The aim of this study was to examine whether preeclampsia had additive effect on maternal cardiac function in twin pregnant women and to investigate longitudinal changes of maternal cardiac function. Methods This was a single center prospective cohort study. A total of 144 patients with twin pregnancy who underwent perinatal check-ups and delivered at our hospital between January 2010 and February 2015 were enrolled in this study. Among the twin pregnant patients, 22 patients had preeclampsia. Thirty-two singleton pregnant women without any complications were enrolled as the control group. Trans-thoracic echocardiography was examined at the early (11–23 gestational weeks), middle (24–33 gestational weeks), and late stages of pregnancy (34–40 gestational weeks), within 5 days postpartum, and one month postpartum. The left ventricular ejection fraction (LVEF) and early transmitral velocity/early diastolic velocity of the mitral annulus (E/e’) were measured to evaluate systolic and diastolic cardiac functions. Results Maternal age and pre-pregnancy BMI were not different among three groups. Although LVEF tended to decrease at late pregnancy in twin patients with preeclampsia, statistically significant changes of LVEF were not detected in all groups. On the other hand, E/e’ elevation was observed at late pregnancy (9.6 ± 2.8, p ± 2.2, p ± 1.9) in twin pregnant women without preeclampsia, whereas E/e’ did not significantly change in singleton pregnant women. Twin pregnant women with preeclampsia also developed E/e’ elevation at middle pregnancy (9.6 ± 2.6, p ± 4.6, p ± 2.9, p ± 1.8). E/e’ of twin pregnant women with preeclampsia at middle pregnancy (p = 0.02) and late pregnancy (p = 0.02) were significantly higher than that of twin pregnant women without preeclampsia. The figure shows longitudinal cardiac function changes of twin pregnant women with or without preeclampsia. Conclusions Twin pregnancy and preeclampsia deteriorate maternal cardiac function, and the diastolic function was predominantly affected. Twin pregnant patients compromised by preeclampsia had a risk of earlier and more severe deterioration of maternal cardiac function. Twin pregnant patients with preeclampsia should be considered as a high-risk group of cardiac dysfunction especially from the late stage of pregnancy to the early postpartum period. Download : Download high-res image (179KB) Download : Download full-size image