title: Left ventricular midwall mechanics at 24 weeks' gestation in high-risk normotensive pregnant women: relationship to placenta-related complications of pregnancy.
abstract: OBJECTIVE
  Most studies during pregnancy have assessed maternal left ventricular (LV) function by load-dependent indices, assessing only chamber function. The aim of this study was to assess afterload-adjusted LV myocardial and chamber systolic function at 24 weeks' gestation and 6 months postpartum in high-risk normotensive pregnant women.
  
  
  METHODS
  A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks' gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled.
  
  
  RESULTS
  The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks' gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001, respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05). In the uncomplicated-outcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicated-outcome group, it was lower during pregnancy than it was postpartum (P < 0.05).
  
  
  CONCLUSIONS
  Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications.
authors.affiliation: Department of Cardiology, San Sebastiano Martire Hospital Frascati, Rome, Italy. bgp.novelli@tiscali.it
authors.forename: G P
authors.initials: GP
authors.lastname: Novelli
authors.forename: B
authors.initials: B
authors.lastname: Vasapollo
authors.forename: G
authors.initials: G
authors.lastname: Gagliardi
authors.forename: G M
authors.initials: GM
authors.lastname: Tiralongo
authors.forename: I
authors.initials: I
authors.lastname: Pisani
authors.forename: D
authors.initials: D
authors.lastname: Manfellotto
authors.forename: L
authors.initials: L
authors.lastname: Giannini
authors.forename: H
authors.initials: H
authors.lastname: Valensise
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001794:Blood Pressure; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007231:Infant, Newborn; D010920:Placenta / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012720:Severity of Illness Index; D013318:Stroke Volume; D055988:Uterine Artery / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology