Department of Cardiology, Ospedale San Giuseppe MultiMedica, Milan, Italy.
Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy.
J Clin Ultrasound. 2021 Jul;49(6):586-596. doi: 10.1002/jcu.22996. Epub 2021 Feb 26.
There is still controversy regarding the changes of ventricular-arterial coupling (VAC) during normal pregnancy. The possible influence of chest shape on VAC during normal pregnancy has never been investigated.
Between October 2019 and June 2020, 59 healthy pregnant women (33.7 ± 4.4 years/old) were consecutively included. They underwent obstetric visit, modified Haller index (MHI) assessment, and complete echocardiographic evaluation with blood pressure measurement to assess arterial elastance (Ea), end-systolic elastance (Ees), and Ea/Ees as an index of VAC, at 12-14 weeks and 36-38 weeks gestation, then 6-9 weeks after delivery.
VAC progressively increased from the first to the third trimester of pregnancy, then decreased in the postpartum (P < 0.0001) in the whole study population. Women with concave-shaped chest wall (MHI >2.5, n = 31) but not women with normal chest shape (MHI ≤2.5, n = 28) showed a progressive increase in VAC during normal pregnancy. Women with MHI >2.5 showed a significantly less pronounced increase in stroke volume index (SVi) from the first to the third trimester of pregnancy. There was a strong linear correlation between third trimester MHI and VAC (r = 0.93).
Anatomical and/or extrinsic mechanical factors rather than impaired arterial elastance or reduced left ventricular contractility may contribute to changes in VAC during normal pregnancy in women with concave-shaped chest wall.
关于正常妊娠期间心室-动脉偶联（VAC）的变化仍存在争议。正常妊娠期间胸廓形状对 VAC 的可能影响从未被研究过。
2019 年 10 月至 2020 年 6 月期间，连续纳入 59 名健康孕妇（33.7±4.4 岁）。她们在妊娠 12-14 周和 36-38 周时进行了产科检查、改良 Haller 指数（MHI）评估和完整的超声心动图评估，并测量了血压以评估动脉弹性（Ea）、收缩末期弹性（Ees）和 Ea/Ees 作为 VAC 的指标，然后在分娩后 6-9 周进行了评估。
在整个研究人群中，VAC 从妊娠早期到晚期逐渐增加，然后在产后期间下降（P<0.0001）。具有凹形胸廓（MHI>2.5，n=31）的女性而非具有正常胸廓形状（MHI≤2.5，n=28）的女性在正常妊娠期间 VAC 呈进行性增加。MHI>2.5 的女性在妊娠早期到中期的每搏输出量指数（SVi）增加幅度明显较小。第三孕期的 MHI 与 VAC 之间存在很强的线性相关性（r=0.93）。
在具有凹形胸廓的女性中，解剖和/或外在机械因素而不是动脉弹性受损或左心室收缩力降低可能导致正常妊娠期间 VAC 的变化。
