Cardiovascular Fluid Dynamics Laboratory HER, Department of Civil, Environmental and Architectural Engineering, University of Padova, Padova, Italy.
Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Int J Numer Method Biomed Eng. 2022 Jan;38(1):e3536. doi: 10.1002/cnm.3536. Epub 2021 Oct 18.
Pregnancy is a unique and dynamic process characterized by significant changes in the maternal cardiovascular system that are required to satisfy the increased maternal and fetal metabolic demands. Profound structural and hemodynamic adaptations occur during healthy pregnancy that allows the mother to maintain healthy hemodynamics and provide an adequate uteroplacental blood circulation to ensure physiological fetal development. Investigating these adaptations is crucial for understanding the physiology of pregnancy and may provide important insights for the management of high-risk pregnancies. However, no previous modeling studies have investigated the maternal cardiac structural changes that occur during gestation. This study, therefore, had two aims. The first was to develop a lumped parameter model of the whole maternal circulation that is suitable for studying global hemodynamics and cardiac function at different stages of gestation. The second was to test the hypothesis that myofiber stress and wall shear stress homeostasis principles can be used to predict cardiac remodeling that occurs during normal pregnancy. Hemodynamics and cardiac variables predicted from simulations with and without controlled cardiac remodeling algorithms were compared and evaluated with reference clinical data. While both models reproduced the hemodynamic variations that arise in pregnancy, importantly, we show that the structural changes that occur with pregnancy could be predicted by assuming invariant homeostatic "target" values of myocardial wall stress and chamber wall shear stress.
妊娠是一个独特而动态的过程，其特征是母体心血管系统发生重大变化，以满足母体和胎儿代谢需求的增加。在健康妊娠期间会发生深刻的结构和血液动力学适应性变化，使母亲能够维持健康的血液动力学，并提供足够的胎盘血液循环，以确保胎儿的生理发育。研究这些适应性变化对于了解妊娠生理学至关重要，并且可能为高危妊娠的管理提供重要的见解。然而，以前没有建模研究调查过妊娠期间母体心脏的结构变化。因此，这项研究有两个目的。第一个目的是开发一个适合研究不同妊娠阶段整体血液动力学和心脏功能的整体母体循环的集总参数模型。第二个目的是检验心肌纤维应力和壁面切应力稳态原则可以用于预测正常妊娠期间发生的心脏重塑的假设。对有和没有控制心脏重塑算法的模拟预测的血液动力学和心脏变量进行了比较，并参考临床数据进行了评估。虽然这两种模型都复制了妊娠中出现的血液动力学变化，但重要的是，我们表明可以通过假设心肌壁应力和室壁切应力的不变稳态“目标”值来预测妊娠期间发生的结构变化。
