Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Department of Obstetrics and Gynaecology, Mayo Clinic Rochester, Rochester, MN 55905, USA.
Eur Heart J Cardiovasc Imaging. 2024 Nov 27;25(12):1695-1702. doi: 10.1093/ehjci/jeae173.
Women with congenital heart disease (CHD) are at risk of pregnancy-related adverse outcomes (PRAO). The purpose of this study was to assess temporal changes in cardiac structure and function (cardiac remodelling) during pregnancy, and the association with PRAO in women with CHD.
Retrospective study of pregnant women with CHD and serial echocardiograms (2003-2021). Cardiac structure and function were assessed at pre-specified time points: prepregnancy, early pregnancy, late pregnancy, and postnatal period. PRAO was defined as the composite of maternal cardiovascular, obstetric, and neonatal complications. The study comprised 81 women with CHD (age, 29 ± 5 years). Compared to the baseline echocardiogram, there was a relative increase in right ventricular systolic pressure (RVSP) (relative change 13 ± 5%, P < 0.001, in early pregnancy; and 18 ± 5%, P < 0.001, in late pregnancy). There was a relative decrease in right ventricle free wall strain (RVFWS) (relative change -11 ± 3%, P < 0.001, in late pregnancy; and -11 ± 4%, P = 0.003, in postnatal period), and a relative decrease in RVFWS/RVSP (relative change, -10 ± 5%, P = 0.02 in early pregnancy, -26 ± 7%, P < 0.001, in late pregnancy, and -14 ± 5%, P < 0.001, in postnatal period). Baseline right ventricular to pulmonary arterial (RV-PA) coupling, and temporal change in RV-PA coupling were associated with PRAO, after adjustment for maternal age and severity of cardiovascular disease.
Women with CHD had a temporal decrease in RV systolic function and RV-PA coupling, and these changes were associated with PRAO. Further studies are required to delineate the aetiology of deterioration in RV-PA coupling during pregnancy, and the long-term implications of right heart dysfunction observed in the postnatal period.
患有先天性心脏病（CHD）的女性有妊娠相关不良结局（PRAO）的风险。本研究旨在评估 CHD 女性在怀孕期间心脏结构和功能（心脏重构）的时间变化，并评估其与 PRAO 的相关性。
对 2003 年至 2021 年期间患有 CHD 的孕妇进行回顾性研究，并进行了一系列超声心动图检查。在特定的时间点评估心脏结构和功能：孕前、孕早期、孕晚期和产后。PRAO 定义为母体心血管、产科和新生儿并发症的综合。该研究包括 81 名 CHD 女性（年龄 29±5 岁）。与基线超声心动图相比，右心室收缩压（RVSP）相对增加（孕早期相对变化 13±5%，P<0.001；孕晚期相对变化 18±5%，P<0.001）。右心室游离壁应变（RVFWS）相对减少（孕晚期相对变化-11±3%，P<0.001；产后相对变化-11±4%，P=0.003），RVFWS/RVSP 相对减少（孕早期相对变化-10±5%，P=0.02；孕晚期相对变化-26±7%，P<0.001；产后相对变化-14±5%，P<0.001）。在调整了母亲年龄和心血管疾病严重程度后，基线右心室与肺动脉（RV-PA）偶联以及 RV-PA 偶联的时间变化与 PRAO 相关。
患有 CHD 的女性在怀孕期间右心室收缩功能和 RV-PA 偶联呈时间性下降，这些变化与 PRAO 相关。需要进一步研究以阐明妊娠期间 RV-PA 偶联恶化的病因以及产后观察到的右心功能障碍的长期影响。
