Pregnancy causes a transient decrease in systemic ventricular function in women with pre-existing cardiac disease

Abstract

Pregnancy is known to induce significant hemodynamic changes. The purpose of our study was to determine the effects of these hemodynamic changes during pregnancy on systemic ventricular function (SVF) in women with pre-existing cardiac disease.A retrospective review of women followed in the Wisconsin Adult Congenital Heart Disease program with a concurrent pregnancy from 2006 to 2015 was conducted. The SVF was measured in a baseline echocardiogram (obtained ≤12months prior to the estimated dated of conception (EDC)), an echocardiogram during pregnancy, and a post-partum echocardiogram. To verify stability of the SVF in the years prior to pregnancy, SVF was also measured on a control echocardiograms (obtained >12months prior to EDC) and compared to the baseline echocardiogram. Systemic ventricular function was assessed in each echocardiogram by measuring global peak longitudinal strain (GPLS) and ejection fraction (EF).A total of 46 pregnancies were included. The average age at the EDC was 25.7±5years and the median gestational age at time of delivery was 38.0weeks. The most common cardiac anomaly was coarctation of the aorta (26.1%) followed by tetralogy of Fallot (13%). The mean GPLS for the control echocardiograms, baseline echocardiograms, pregnancy echocardiograms and post-partum echocardiograms were as follows: −18.9±2.5, −18.0±3.4%, −15.9±2.9% and −17.9±3.6%. When measuring GPLS there was a significant drop in SVF during pregnancy (0=0.04) with a return to baseline in the post-partum period. When SVF was measured by EF there was a strong trend toward a significant drop in SVF during pregnancy (p=0.08).Our results show there is a significant drop in systemic ventricular function during pregnancy in women with pre-existing cardiac disease when measured by GPLS, which returns to baseline in the post-partum period.