Serial Echocardiographic Assessment of the Human Heart in Normal Pregnancy

Abstract

Pregnancy is a physiological state that allows characterization of cardiac morphological and physiological adaptation of the human heart to chronic increase in preload and afterload. In addition, this characterization allows clinicians to detect pathological cardiac disease during early stages. Prior echocardiographic studies have described an increase in cardiac dimensions and changes in systolic and diastolic function during normal human pregnancy; however, the studies have been limited by cross-sectional design.1 It is important to develop uniformity in echocardiographic methodology, gestational age, and equipment and data collection when evaluating serial changes in pregnancy. Owing to the strong influence of age, ethnicity, and height on cardiac output and echo Doppler parameters, including tissue Doppler velocities, it is important to study serial changes in these parameters in the same cohort at each trimester of pregnancy and then in the postpartum state, to evaluate changes in cardiac structure and function during pregnancy and if and when the physiologic adaptation of the heart returns to normal. The high dropout rate during serial evaluation in pregnancy, especially during the postpartum state, makes such studies more challenging.2 Normal pregnancy-induced cardiovascular changes include an increase in stroke volume, cardiac output, and a decrease in peripheral vascular resistance.1,2 In this issue of Circulation: Cardiovascular Imaging, Savu et al 3 ought to be congratulated on their collaborative effort at 2 centers in collecting important data in a prospective study of normal pregnant women defining normal morphological changes in the heart during normal pregnancy. The authors still had a 38% dropout rate for the postpartum scan and compensated for this by collecting data on 10 age- and sex-matched controls. Dropout rate postpartum as high as 73% occurred in earlier studies of similar nature.2 Article see p 289 The article by Savu et al provides additional insights into physiological and morphological adaptive changes that occur