Significantly Increased Left Ventricular Afterload in Adolescents and Young Adults Conceived through Assisted Reproductive Technologies: Insights from the Munich heARTerY Study

Background: Assisted reproductive technologies (ART) are estimated to facilitate 3 to 6% of births in Germany. In the past, an increased cardiovascular morbidity, including vascular and left ventricular (LV) dysfunction, was suggested within the ART offspring. This study aimed to evaluate whether differences in LV hemodynamics and efficiency can be observed between adolescents/young adults conceived through ART and spontaneously conceived peers by generating noninvasive LV pressure volume loops (PVLs).

Method: For this analysis, ART subjects and spontaneously conceived peers ≥16 years were included. LV M-Mode echocardiography and simultaneous brachial blood pressure measurements were conducted enabling the generation of noninvasive LV PVLs. The following parameters were analyzed: heart rate (HR, bpm), systolic blood pressure (SBP, mm Hg), stroke volume (SV, mL), ejection fraction (EF, %), LV afterload visualized by arterial elastance (Ea, mm Hg/mL), LV contractility visualized by end-systolic elastance (Ees, mm Hg/mL), total mechanical LV energy visualized by pressure-volume area (PVA, mm Hg/mL). Cardiac efficiency (mm Hg) was defined as PVA/SV. The independent t-test and the Mann–Whitney U-test were used for data analysis. A p < 0.05 was considered as statistically significant.

Results: In total, 19 ART subjects and 28 controls were included. Both groups did not differ significantly in age (20.47 ± 2.46 years vs. 20.94 ± 2.82 years, p = 0.558) or sex. No statistical difference between ART and control group was found for HR (66.95 ± 11.95 bpm vs. 67.64 ± 13.85 bpm, p = 0.859) and SBP (123.35 ± 8.93 mm Hg vs. 120.27 ± 7.48 mm Hg, p = 0.207). Significantly higher values for LV afterload (Ea: 1.95 (1.46–3.14) mm Hg/mL vs. 1.79 (1.21–3.43) mm Hg/mL, p = 0.047) and LV contractility (Ees: 3.35 (2.41–5.43) mm Hg/mL vs. 2.88 (1.65–6.20) mm Hg/mL, p = 0.013) were demonstrated within the ART cohort. No statistical differences were found between both groups regarding the remaining LV hemodynamic and efficiency parameters.

Conclusion: This study suggests a significantly higher LV afterload (Ea) in young ART subjects compared to spontaneously conceived peers. To sustain sufficient LV pump function, an increase of LV contractility (Ees) might be required. The use of non-invasive LV PVLs might help in the detection of subtle LV alterations, as conventional parameters of LV and vascular function (e.g., SV, EF, and SBP) did not differ significantly between both groups. In the future, further studies are required that evaluate cardiac function in ART patients at advanced age.

Publication History

Article published online:
28 January 2023