Toronto Congenital Cardiac Center for Adults, Peter Munk Cardiac Center, Toronto General Hospital; University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2021 Dec;37(12):1942-1950. doi: 10.1016/j.cjca.2021.06.015. Epub 2021 Jul 2.
Although insufficient maternal cardiac output (CO) has been implicated in poor outcomes in mothers with heart disease (HD), maternal-fetal interactions remain incompletely understood. We sought to quantify maternal-fetal hemodynamics with the use of magnetic resonance imaging (MRI) and explore their relationship with adverse events.
Pregnant women with moderate or severe HD (n = 22; mean age 32 ± 5 years) were compared with healthy control women (n = 21; 34 ± 3 years). An MRI was performed during the third trimester at peak output (maternal-fetal) and 6 months postpartum with return of maternal hemodynamics to baseline (reference). Phase-contrast MRI was used for flow quantification and was combined with T1/T2 relaxometry for derivation of fetal oxygen delivery/consumption.
Third-trimester CO and cardiac index (CI) measurements were similar in HD and control groups (CO 7.2 ± 1.5 vs 7.3 ± 1.6 L/min, P = 0.79; CI 4.0 ± 0.7 vs 4.3 ± 0.7 L/min/m,P = 0.28). However, the magnitude of CO/CI increase (Δ, peak pregnancy - reference) in the HD group exceeded that in the control group (CO 46 ± 24% vs 27 ± 16% [P = 0.007]; CI 51 ± 28% vs 28 ± 17% [P = 0.005]). Fetal growth and oxygen delivery/consumption were similar between groups. Adverse cardiovascular outcomes (nonmutually exclusive) in 6 HD women included arrhythmia (n = 4), heart failure (n = 2), and hypertensive disorder of pregnancy (n = 1); premature delivery was observed in 2 of these women. The odds of a maternal cardiovascular event were inversely associated with peak CI (odds ratio 0.10, 95% confidence interval 0.001-0.86; P = 0.04) and Δ,CI (0.02, 0.001-0.71; P = 0.03).
Maternal-fetal hemodynamics can be well characterised in pregnancy with the use of MRI. Impaired adaptation to pregnancy in women with HD appears to be associated with development of adverse outcomes of pregnancy.
尽管心功能不全（CO）不足与心脏病（HD）母亲的不良结局有关，但母婴相互作用仍不完全清楚。我们试图使用磁共振成像（MRI）来量化母婴血液动力学，并探讨其与不良事件的关系。
比较了 22 例患有中度或重度 HD 的孕妇（平均年龄 32 ± 5 岁）和 21 例健康对照组孕妇（平均年龄 34 ± 3 岁）。在妊娠晚期，在母体心脏输出（母子）峰值时和产后 6 个月进行 MRI 检查，此时母体血液动力学恢复到基线（参考）。相位对比 MRI 用于流量量化，并与 T1/T2 弛豫测量法结合用于推导胎儿氧输送/消耗。
HD 组和对照组在妊娠晚期的 CO 和心指数（CI）测量值相似（CO 7.2 ± 1.5 vs 7.3 ± 1.6 L/min，P = 0.79；CI 4.0 ± 0.7 vs 4.3 ± 0.7 L/min/m，P = 0.28）。然而，HD 组的 CO/CI 增加幅度（峰值妊娠-参考）大于对照组（CO 46 ± 24% vs 27 ± 16%[P = 0.007]；CI 51 ± 28% vs 28 ± 17%[P = 0.005]）。两组胎儿生长和氧输送/消耗相似。6 例 HD 女性发生心血管不良结局（非互斥），包括心律失常（n = 4）、心力衰竭（n = 2）和妊娠高血压疾病（n = 1）；其中 2 例发生早产。母体心血管事件的发生几率与峰值 CI（比值比 0.10，95%置信区间 0.001-0.86；P = 0.04）和 CI 增量（比值比 0.02，0.001-0.71；P = 0.03）呈反比关系。
使用 MRI 可以很好地描述妊娠期间母婴血液动力学。HD 妇女对妊娠的适应不良似乎与妊娠不良结局的发生有关。
