Subscribe to RSS
DOI: 10.1055/s-0037-1603820
Impact of Pregnancy on Maternal Cardiac Atria
Publication History
04 May 2017
11 May 2017
Publication Date:
16 June 2017 (online)
![](https://www.thieme-connect.de/media/ajp/201711/lookinside/thumbnails/10-1055-s-0037-1603820_170232-1.jpg)
Abstract
Objective The aim of this study was to assess atrial changes across pregnancy and postpartum using cardiac magnetic resonance imaging (cMRI) to measure atrial end-diastolic volume (EDV).
Study Design This was a 2-year prospective observational study of healthy nulliparous women. Each underwent serial cMRI in both maternal left lateral and supine positions at five epochs: 12 to 16 weeks, 26 to 30 weeks, 32 to 36 weeks, within 48 hours after delivery, and 12 weeks postpartum. EDV was calculated and compared with 12-week postpartum values.
Results A total of 24 women completed the study. One woman developed preeclampsia, and her data were excluded. Mean age was 27 ± 2.8 years, and mean body mass index was 25.4 ± 3.8 kg/m2. Left atrial EDV increased by 12 weeks (p = 0.045) and remained significantly elevated through 32 to 36 (p < 0.0001) weeks. Maternal lateral positioning was associated with larger left atrial EDV after 12 weeks. Right atrial EDV was significantly elevated at 26 to 30 (p = 0.04) and 32 to 36 (p = 0.02) weeks in the lateral position, though there was no difference in the supine position.
Conclusion We documented a significant increase in EDV for both atria during pregnancy. Volume changes were greater in the lateral compared with the supine position, with the most dramatic changes in left atrium at 32 to 36 weeks.
Note
Portions of this manuscript were presented at the Society for Maternal-Fetal Medicine's 37th Annual Pregnancy Meeting Poster Session III on January 27, 2017 (Abstract # 508).
-
References
- 1 Linard J. Uber das Minutenvolume des Herzens bei Ruhe und bei Muskelarbeit. Pflugers Arch 1915; 161: 223
- 2 Burwell CS, Strayhorn WD, Flickinger D, Corlette MB, Bowerman EP, Kennedy JA. Circulation during pregnancy. Arch Intern Med (Chic) 1938; 62 (06) 979-1003
- 3 Ueland K, Metcalfe J. Circulatory changes in pregnancy. Clin Obstet Gynecol 1975; 18 (03) 41-50
- 4 Clark SL, Cotton DB, Lee W. , et al. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 1989; 161 (6 Pt 1): 1439-1442
- 5 Germain P, Roul G, Kastler B, Mossard JM, Bareiss P, Sacrez A. Inter-study variability in left ventricular mass measurement. Comparison between M-mode echography and MRI. Eur Heart J 1992; 13 (08) 1011-1019
- 6 Bellenger NG, Burgess MI, Ray SG. , et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable?. Eur Heart J 2000; 21 (16) 1387-1396
- 7 Ducas RA, Elliott JE, Melnyk SF. , et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson 2014; 16: 1 . Doi: 10.1186/1532-429X-16-1
- 8 Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. J Am Coll Cardiol 2009; 55 (01) 1-16
- 9 Waksmonski CA. Cardiac imaging and functional assessment in pregnancy. Semin Perinatol 2014; 38 (05) 240-244
- 10 Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116 (06) 1302-1309
- 11 Stewart RD, Nelson DB, Matulevicius SA. , et al. Cardiac magnetic resonance imaging to assess the impact of maternal habitus on cardiac remodeling during pregnancy. Am J Obstet Gynecol 2016; 214 (05) 640.e1-640.e6
- 12 Nelson DB, Stewart RD, Matulevicius SA. , et al. The effects of maternal position and habitus on maternal cardiovascular parameters as measured by cardiac magnetic resonance. Am J Perinatol 2015; 32 (14) 1318-1323
- 13 Pritchard JA, Wiggins KM, Dickey JC. Blood volume changes in pregnancy and the puerperium. I. Does sequestration of red blood cells accompany parturition?. Am J Obstet Gynecol 1960; 80: 956-964
- 14 Zeeman GG, Cunningham FG, Pritchard JA. The magnitude of hemoconcentration with eclampsia. Hypertens Pregnancy 2009; 28 (02) 127-137
- 15 Desai DK, Moodley J, Naidoo DP. Echocardiographic assessment of cardiovascular hemodynamics in normal pregnancy. Obstet Gynecol 2004; 104 (01) 20-29
- 16 Yosefy C, Shenhav S, Feldman V, Sagi Y, Katz A, Anteby E. Left atrial function during pregnancy: a three-dimensional echocardiographic study. Echocardiography 2012; 29 (09) 1096-1101
- 17 Robson SC, Hunter S, Moore M, Dunlop W. Hemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Br J Obstet Gynaecol 1987; 94 (11) 1026-1039
- 18 Rossi A, Cornette J, Johnson MR. , et al. Quantitative cardiovascular magnetic resonance in pregnant women: cross-sectional analysis of physiological parameters throughout pregnancy and the impact of the supine position. J Cardiovasc Magn Reson 2011; 13: 31 . Doi: 10.1186/1532-429X-13-31
- 19 Yancy CW. The role of race in heart failure therapy. Curr Cardiol Rep 2002; 4 (03) 218-225
- 20 Yancy CW. Heart failure in African Americans: unique etiology and pharmacologic treatment responses. J Natl Med Assoc 2003; 95 (01) 1-9 , quiz 10–12
- 21 Yancy CW. Does race matter in heart failure?. Am Heart J 2003; 146 (02) 203-206
- 22 Yancy CW. Heart failure in African Americans. Am J Cardiol 2005; 96 (7B): 3i-12i