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Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot

BACKGROUND: Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV an...

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Autores principales: Siegmund, Anne S., Willems, Tineke P., Pieper, Petronella G., Bilardo, Caterina M., Gorter, Thomas M., Bouma, Berto J., Jongbloed, Monique R. M., Sieswerda, Gertjan Tj., Roos-Hesselink, Jolien W., van Dijk, Arie P. J., van Veldhuisen, Dirk J., Dickinson, Michael G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364780/
https://www.ncbi.nlm.nih.gov/pubmed/32669114
http://dx.doi.org/10.1186/s12968-020-00645-9
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author Siegmund, Anne S.
Willems, Tineke P.
Pieper, Petronella G.
Bilardo, Caterina M.
Gorter, Thomas M.
Bouma, Berto J.
Jongbloed, Monique R. M.
Sieswerda, Gertjan Tj.
Roos-Hesselink, Jolien W.
van Dijk, Arie P. J.
van Veldhuisen, Dirk J.
Dickinson, Michael G.
author_facet Siegmund, Anne S.
Willems, Tineke P.
Pieper, Petronella G.
Bilardo, Caterina M.
Gorter, Thomas M.
Bouma, Berto J.
Jongbloed, Monique R. M.
Sieswerda, Gertjan Tj.
Roos-Hesselink, Jolien W.
van Dijk, Arie P. J.
van Veldhuisen, Dirk J.
Dickinson, Michael G.
author_sort Siegmund, Anne S.
collection PubMed
description BACKGROUND: Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV and left ventricular (LV) function measured by cardiovascular magnetic resonance with uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF). METHODS: Women with repaired ToF were examined, who had been enrolled in a prospective multicenter study of pregnant women with congenital heart disease. Clinical data and CMR evaluation before pregnancy were compared with uteroplacental Doppler parameters at 20 and 32 weeks gestation. In particular, pulsatility index (PI) of uterine and umbilical artery were studied. RESULTS: We studied 31 women; mean age 30 years, operated at early age. Univariable analyses showed that reduced RV ejection fraction (RVEF; P = 0.037 and P = 0.001), higher RV end-systolic volume (P = 0.004) and higher LV end-diastolic and end-systolic volume (P = 0.001 and P = 0.003, respectively) were associated with higher uterine or umbilical artery PI. With multivariable analyses (corrected for maternal age and body mass index), reduced RVEF before pregnancy remained associated with higher umbilical artery PI at 32 weeks (P = 0.002). RVEF was lower in women with high PI compared to women with normal PI during pregnancy (44% vs. 53%, p = 0.022). LV ejection fraction was not associated with uterine or umbilical artery PI. CONCLUSIONS: Reduced RV function before pregnancy is associated with abnormal uteroplacental Doppler flow parameters. It could be postulated that reduced RV function on pre-pregnancy CMR (≤2 years) is a predisposing factor for impaired placental function in women with repaired ToF.
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spelling pubmed-73647802020-07-20 Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot Siegmund, Anne S. Willems, Tineke P. Pieper, Petronella G. Bilardo, Caterina M. Gorter, Thomas M. Bouma, Berto J. Jongbloed, Monique R. M. Sieswerda, Gertjan Tj. Roos-Hesselink, Jolien W. van Dijk, Arie P. J. van Veldhuisen, Dirk J. Dickinson, Michael G. J Cardiovasc Magn Reson Research BACKGROUND: Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV and left ventricular (LV) function measured by cardiovascular magnetic resonance with uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF). METHODS: Women with repaired ToF were examined, who had been enrolled in a prospective multicenter study of pregnant women with congenital heart disease. Clinical data and CMR evaluation before pregnancy were compared with uteroplacental Doppler parameters at 20 and 32 weeks gestation. In particular, pulsatility index (PI) of uterine and umbilical artery were studied. RESULTS: We studied 31 women; mean age 30 years, operated at early age. Univariable analyses showed that reduced RV ejection fraction (RVEF; P = 0.037 and P = 0.001), higher RV end-systolic volume (P = 0.004) and higher LV end-diastolic and end-systolic volume (P = 0.001 and P = 0.003, respectively) were associated with higher uterine or umbilical artery PI. With multivariable analyses (corrected for maternal age and body mass index), reduced RVEF before pregnancy remained associated with higher umbilical artery PI at 32 weeks (P = 0.002). RVEF was lower in women with high PI compared to women with normal PI during pregnancy (44% vs. 53%, p = 0.022). LV ejection fraction was not associated with uterine or umbilical artery PI. CONCLUSIONS: Reduced RV function before pregnancy is associated with abnormal uteroplacental Doppler flow parameters. It could be postulated that reduced RV function on pre-pregnancy CMR (≤2 years) is a predisposing factor for impaired placental function in women with repaired ToF. BioMed Central 2020-07-16 /pmc/articles/PMC7364780/ /pubmed/32669114 http://dx.doi.org/10.1186/s12968-020-00645-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Siegmund, Anne S.
Willems, Tineke P.
Pieper, Petronella G.
Bilardo, Caterina M.
Gorter, Thomas M.
Bouma, Berto J.
Jongbloed, Monique R. M.
Sieswerda, Gertjan Tj.
Roos-Hesselink, Jolien W.
van Dijk, Arie P. J.
van Veldhuisen, Dirk J.
Dickinson, Michael G.
Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot
title Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot
title_full Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot
title_fullStr Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot
title_full_unstemmed Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot
title_short Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot
title_sort reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of fallot
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364780/
https://www.ncbi.nlm.nih.gov/pubmed/32669114
http://dx.doi.org/10.1186/s12968-020-00645-9
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