Maternal cardiac function in normotensive and pre-eclamptic intrauterine growth restriction.
OBJECTIVE
To compare maternal cardiac function between pregnancies complicated by normotensive and pre-eclamptic intrauterine growth restriction (IUGR).


METHODS
Two-dimensional Doppler echocardiography and Doppler tissue imaging (DTI) were used to examine 19 pregnant women with IUGR and 17 with pre-eclampsia complicated by IUGR at 20-38 weeks of gestation. Indices were converted into differences in SDs from the expected normal mean for gestation (Z-scores) and compared.


RESULTS
With respect to normal pregnancy, in the normotensive IUGR compared with the pre-eclamptic IUGR group, there were similar reductions in maternal cardiac output (Z-score, - 1.71 vs. - 1.37, P = 0.26) and heart rate (Z-score, - 3.67 vs. - 9.43, P = 0.1) and a similar increase in total vascular resistance (Z-score, 2.91 vs. 3.93, P = 0.05). There was also a greater decrease in stroke volume (Z-score, - 1.72 vs. - 0.69, P = 0.01), a smaller increase in mean arterial pressure (Z-score, 0.73 vs. 2.94, P < 0.01) and a smaller decrease in DTI systolic velocity at the lateral mitral margin (Z-score, - 0.4 vs. - 1.42, P = 0.02). In terms of diastolic function, there was a smaller transmitral late diastolic velocity (Z-score, 0.04 vs. 0.93, P = 0.03) and a greater DTI early diastolic velocity at the lateral mitral margin (Z-score, - 0.17 vs. - 1.6, P < 0.01).


CONCLUSIONS
In normotensive IUGR and pre-eclamptic IUGR there is a similar alteration in maternal left ventricular systolic function, but there is greater impairment in maternal diastolic function in pre-eclamptic IUGR.
Bamfo
J E A K
JE
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK. fmf@fetalmedicine.com
Kametas
N A
NA
Chambers
J B
JB
Nicolaides
K H
KH
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output; D003430:Cross-Sectional Studies; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D013599:Systole / Q000502:physiology; D016216:Ultrasonography, Prenatal; D014655:Vascular Resistance / Q000502:physiology