This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mesa, A. Articles by Wilansky, S. Search for Related Content PubMed PubMed Citation Articles by Mesa, A. Articles by Wilansky, S. Related Collections Pulmonary circulation and disease Coronary imaging: angiography/ultrasound/Doppler/CC Echocardiography

(Circulation. 1999;99:511-517.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Left Ventricular Diastolic Function in Normal Human Pregnancy

Andres Mesa, MD; Carlos Jessurun, MD; Antonieta Hernandez, MD; Karolina Adam, MD; Dale Brown, MD; William K. Vaughn, PhD; Susan Wilansky, MD

From the Departments of Cardiology (A.M., C.J., A.H., S.W.) and Obstetrics and Gynecology (K.A., D.B.), St Luke's Episcopal Hospital and Baylor College of Medicine, and the Department of Biostatistics and Epidemiology (W.K.V.), Texas Heart Institute, Houston.

Correspondence to Susan Wilansky, MD, 6624 Fannin, Suite 2480, Houston, TX 77030. E-mail hallgar{at}hgcardio.com

Background—Little information is available about changes in left ventricular diastolic function during pregnancy. We used mitral inflow and pulmonary venous flow profiles to evaluate left ventricular diastolic function in 37 healthy pregnant women 26 to 41 years old (mean, 32 years).

Methods and Results—Echocardiographic studies were performed at the end of each trimester. Eight subjects (control group) underwent similar testing 1 to 3.5 months (mean, 1.7 months) postpartum. During pregnancy, the cardiac output increased significantly as a result of an increased heart rate and, to a lesser degree, stroke volume. Significantly decreased systemic vascular resistance and increased left ventricular mass were also noted. Peak mitral flow velocity in early diastole (E) increased 13.3% during the first trimester and remained at the high end of normal throughout pregnancy. Peak A-wave velocity (A) increased maximally in the third trimester. Compared with control subjects, first-trimester subjects had a significantly increased E/A ratio. The ratio subsequently decreased, reflecting the augmented A-wave velocity. Pulmonary venous peak systolic forward flow velocity increased, peaking in the second trimester (nonsignificant), but returned to baseline levels postpartum. The pulmonary venous diastolic time-velocity integral decreased significantly from the first to the third trimester. Peak pulmonary venous reverse flow velocity at atrial contraction increased significantly, without being markedly changed in duration.

Conclusions—Pregnancy, a chronic, natural volume-overload state, has important effects on hemodynamic and echocardiographic variables. Based on pulmonary venous flow and left ventricular inflow velocities, our results provide a standard reference concerning diastolic filling dynamics by trimester.

Key Words: pregnancy • hemodynamics • echocardiography • diastole

This article has been cited by other articles:

				P. Presbitero, G. G. Boccuzzi, C. J.M. Groot, and J. W. Roos-Hesselink CHAPTER 33 Pregnancy and Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				S. Andrietti, A.-J. Kruse, S. C. A. M. Bekkers, S. Sep, M. Spaanderman, and L. L. H. Peeters Cardiac Adaptation to Pregnancy in Women with a History of Preeclampsia and a Subnormal Plasma Volume Reproductive Sciences, December 1, 2008; 15(10): 1059 - 1065. [Abstract] [PDF]

				J. A. Hill and E. N. Olson Cardiac Plasticity N. Engl. J. Med., March 27, 2008; 358(13): 1370 - 1380. [Full Text] [PDF]

				J. E.A.K. Bamfo, N. A. Kametas, K. H. Nicolaides, and J. B. Chambers Maternal left ventricular diastolic and systolic long-axis function during normal pregnancy Eur J Echocardiogr, October 1, 2007; 8(5): 360 - 368. [Abstract] [Full Text] [PDF]

				J. G. Williams, T. Rincon-Skinner, D. Sun, Z. Wang, S. Zhang, X. Zhang, and T. H. Hintze Role of nitric oxide in the coupling of myocardial oxygen consumption and coronary vascular dynamics during pregnancy in the dog Am J Physiol Heart Circ Physiol, October 1, 2007; 293(4): H2479 - H2486. [Abstract] [Full Text] [PDF]

				L. H Naylor, L. F Arnolda, J. A Deague, D. Playford, A. Maurogiovanni, G. O'Driscoll, and D. J Green Reduced ventricular flow propagation velocity in elite athletes is augmented with the resumption of exercise training J. Physiol., March 15, 2005; 563(3): 957 - 963. [Abstract] [Full Text] [PDF]

				L. A. Simmons, A. G. Gillin, and R. W. Jeremy Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1627 - H1633. [Abstract] [Full Text] [PDF]

				A. Linke, W. Li, H. Huang, Z. Wang, and T. H. Hintze Role of cardiac eNOS expression during pregnancy in the coupling of myocardial oxygen consumption to cardiac work Am J Physiol Heart Circ Physiol, September 1, 2002; 283(3): H1208 - H1214. [Abstract] [Full Text] [PDF]

				H. Valensise, G. P. Novelli, B. Vasapollo, G. Di Ruzza, M. E. Romanini, M. Marchei, G. Larciprete, D. Manfellotto, C. Romanini, and A. Galante Maternal Diastolic Dysfunction and Left Ventricular Geometry in Gestational Hypertension Hypertension, May 1, 2001; 37(5): 1209 - 1215. [Abstract] [Full Text] [PDF]