Cardiac magnetic resonance imaging to assess the impact of maternal habitus on cardiac remodeling during pregnancy

• Published in: American journal of obstetrics and gynecology 2016-05, Vol.214 (5), p.640.e1-640.e6
• Main Authors: Stewart, Robert D., MD, Nelson, David B., MD, Matulevicius, Susan A., MD, MSCS, Morgan, Jamie L., MD, McIntire, Donald D., PhD, Drazner, Mark H., MD, MSc, Cunningham, F. Gary, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Body Mass Index; cardiac magnetic resonance imaging; cardiac remodeling; concentric hypertrophy; Female; Heart Ventricles - anatomy & histology; Humans; left ventricular mass; Longitudinal Studies; Magnetic Resonance Imaging, Cine; Obstetrics and Gynecology; Overweight; Pilot Projects; Postpartum Period - physiology; Pregnancy; Prospective Studies; Recovery of Function - physiology; Ventricular Function, Left - physiology; Ventricular Remodeling - physiology; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.11.014

Background It is well known that the maternal cardiovascular system undergoes profound alterations throughout pregnancy. Interest in understanding these changes has led investigators to use evolving and increasingly sophisticated techniques to study these changes, most recently with 2-dimensional echocardiography. Despite its clinical utility, echocardiography has limitations, and cardiac magnetic resonance imaging (CMRI) has become increasingly used for evaluation of cardiac structure and function. Objective We used CMRI to evaluate cardiac remodeling according to maternal habitus throughout pregnancy and postpartum. Study Design This was a prospective, observational study of nulliparous women aged 18-30 years, without preexisting medical conditions, conducted from October 2012 through December 2014. Women were classified according to prepregnancy body mass index (BMI) as either normal (BMI 18.5-24.9 kg/m2 ) or overweight (BMI 25-35 kg/m2 ). All women underwent CMRI during 5 epochs throughout gestation: 12-16 weeks, 26-30 weeks, 32-36 weeks, at delivery, and 3 months’ postpartum. Using left ventricular mass (LVM) as a marker of cardiac remodeling, the 2 cohorts were compared. Results There were 14 normal-weight (BMI 22.2 ± 1.3) and 9 overweight (BMI 29.1 ± 2.0) women who participated in the study. Beginning at 26-30 weeks and continuing to delivery, LVM of both normal-weight and overweight women was significantly increased compared with the respective first-trimester studies for each cohort ( P < .001). LVM of both cohorts returned to their index values by 3 months’ postpartum. The geometric ratio of LVM to left ventricular end-diastolic volume was calculated, and both normal-weight and overweight women demonstrated concentric remodeling throughout gestation, however this resolved by 12 weeks’ postpartum. Conclusion There is substantial cardiac remodeling during pregnancy with significant increases in LVM that are proportional to maternal size. Left ventricular geometric remodeling was concentric in both normal-weight and overweight women. All changes in cardiac remodeling resolved by 3 months’ postpartum.