title: Morphological and functional adaptation of the maternal heart during pregnancy.
abstract: BACKGROUND
  Pregnancy provides a unique model to study the adaptation of the heart in a physiological situation of transient load changes. The aim of this study was to assess the performance of the left ventricle (LV) in normal, uncomplicated pregnancies while considering the actual LV load and shape.
  
  
  RESULTS
  Serial echocardiographic examinations were performed in 51 women in each pregnancy trimester and 3 to 6 months after delivery. Data from 10 nulliparous, age-matched women were used as the control. Conventional parameters of LV function (ejection fraction) as well as myocardial deformation (strain) were interpreted, taking into consideration maternal hemodynamics and LV shape. Cardiac output increased during pregnancy because of a higher stroke volume in early pregnancy and a late increase in heart rate, whereas total vascular resistance decreased. Progressive development of eccentric hypertrophy was observed, which subsequently recovered postpartum. Sphericity index decreased from the first to the third trimester (1.92±0.17 versus 1.71±0.17) and returned postpartum to values comparable to the control. Although higher LV stroke work was noted toward the third trimester (5.9±1.1 versus 5.3±1.0 Newton meter, P<0.001), ejection fraction showed no significant changes. LV strain decreased significantly in late pregnancy (-19.5±2% to -17.6±1.6%, P<0.001) and returned to baseline values after delivery (-19.5±2%).
  
  
  CONCLUSIONS
  Pregnancy is a physiological process associated with increased cardiac performance and progressive LV remodeling. These changes are not directly reflected by parameters traditionally considered to describe systolic function, such as ejection fraction and longitudinal deformation. While ejection fraction was insensitive to the functional changes, the transient decrease in longitudinal deformation becomes only plausible when considering the changes in LV geometry.
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Oana
authors.initials: O
authors.lastname: Savu
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Jurcuţ
authors.forename: Sorin
authors.initials: S
authors.lastname: Giuşcă
authors.forename: Tim
authors.initials: T
authors.lastname: van Mieghem
authors.forename: Ilinca
authors.initials: I
authors.lastname: Gussi
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghină
authors.forename: Frank
authors.initials: F
authors.lastname: Rademakers
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D000704:Analysis of Variance; D002302:Cardiac Output / Q000502:physiology; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D015588:Observer Variation; D011247:Pregnancy / Q000502:physiology*; D011264:Pregnancy Trimesters; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology; D055815:Young Adult