The Right Study – A Pilot Study to Evaluate Right Heart Function During Pregnancy

Abstract

During pregnancy the maternal heart undergoes significant physiological change. Technological advancements in echocardiography (echo) have improved our ability to assess the right heart in detail and yet there is little research into adaptation during pregnancy. In this pilot study, we considered how three measures of right heart function changed in normal women from the 1st trimester through to the post-partum period. We observed a significant increase in tricuspid annulus planar systolic excursion (TAPSE) and right ventricular systolic velocity (RV S’) from the 1st to the 2nd trimester; both measures of longitudinal right ventricular function. There was no significant difference in right ventricular systolic area change, which is more difficult to accurately measure, and reflects radial function. TAPSE and RV S’ are easy to accurately measure with modern echo technology. This pilot study suggests that any reduction in these values from the 1st to the 2nd trimester should prompt more detailed assessment, and correlation with clinical symptoms. It would be valuable to undertake a comprehensive study to define normal ranges for common measures of right ventricular function, using echo, during pregnancy. The ability to assess the right heart, with an understanding of expected normal values, has the potential to significantly improve our understanding and management of maternal cardiovascular disease.