Cardiac remodeling in normotensive pregnancy and in pregnancy complicated by hypertension: systematic review and meta‐analysis

Haas, Sander de; Ghossein‐Doha, Chahinda; Geerts, L.; Kuijk, Sander M. J. van; Drongelen, J. van; Spaanderman, M.E.A.

doi:10.1002/uog.17410

Cited by 66 publications

(54 citation statements)

References 63 publications

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“…Moreover, it evidences the presence of these systemic rearrangements that is based on structural and functional changes at the cellular level which is provided with the whole complex of gasotransmitter and mediator systems, the key element of which is the NO system. The obtained data of the myocardium NO system of the rats with intermittent hypoxia prove numerous facts of other researchers who argue that the shortterm intermittent hypoxia leads to activation of urgent adaptation mechanisms, an important component of which they considered nitric oxide and NOS isoforms [1,4,5]. Zhang Y.…”

Section: Discussionsupporting

confidence: 75%

“…With their excess, the amount of NO increases, and its signaling and physiological functions change to pathological, triggering processes that lead to apoptosis or cell necrosis. The purpose of changing the state of this system in response to physiological effects or stressors is to improve functioning and adapt to new conditions [1]. Hypoxia is one of the classic examples of physiological stress, but the extent of its manifestation depends on the duration, severity and origin.…”

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confidence: 99%

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The features of the nitric oxide system in the left ventricle myocardium in the rats with experimental intermittent hypoxia of different duration

2019

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The aim was to determine the features of the NO system status in the left ventricular myocardium in the rats with intermittent hypoxic hypobaric hypoxia during 15 and 60 days. Material and methods. The study was conducted on the 30 Wistar male rats, which were divided into 3 experimental groups: the 1 st-control, the 2 nd-rats exposed to intermittent hypoxia during 15 days and the 3 rd group-the rats exposed to intermittent hypoxia during 60 days. Blood pressure was measured in all the rats. The objects and methods of the study were blood plasma (nitrotyrosine detection with immunoassay) and the myocardium of the left ventricle (concentration of nitrites by Griess nitrite test and content of immunoreactive material to the nitric oxide synthase isoforms by immunofluorescence method). mRNA expression of NOS isoforms was determined by PCR-RT method in the myocardium. Results. In the rats with 15-day hypoxia there was an increase in systolic pressure compared to control, and in 60-day hypoxia, there was also an increase in diastolic pressure although this changes were within the normotensive range. mRNA to all the myocardial NOS isoforms was characterized by an increase in both hypoxia groups. At the same time, the indices of the immunoreactive material content to the NOS isoforms were dependent on the hypoxia term. The concentration of the nitrotyrosine increased in both hypoxic groups, but in the long term it occurred along with a decrease in the level of nitrite, which indicates the possibility of nitro-oxidative stress. Conclusions. The 15-day intermittent hypoxia changes the myocardial NO system: an increase in the expression of all 3 isoforms, an increase in the nitrite and the nitrotyrosine content. iNOS becomes the predominant form of the enzyme in the myocardium with the increasing its mRNA. In 60-day hypoxia, the profile of the NOS enzyme is characterized by increased expression of the constitutive isoforms and decreased inducible NOS expression that was accompanied with significant increase in mRNA of all three forms. The level of terminal metabolites of NO was characterized by a decrease in the nitrite while the content of the nitrotyrosine increased.

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Section: Discussionsupporting

confidence: 75%

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confidence: 99%

The features of the nitric oxide system in the left ventricle myocardium in the rats with experimental intermittent hypoxia of different duration

2019

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“…This systematic review and meta-analysis on the remodeling of SpA ow velocimetry during human pregnancy is part of a large series of meta-analysis on physiological and pathophysiological adaptation of relevant indices in pregnancy (16)(17)(18). The review was conducted in accordance to the "PRISMA Statement" for reporting systematic reviews and meta-analyses (19).…”

Section: Methodsmentioning

confidence: 99%

Spiral artery blood flow during pregnancy: a systematic review and meta-analysis.

Schiffer

Evers

Haas

et al. 2020

Preprint

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Abstract Background: Downstream remodeling of the spiral arteries (SpA) decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta at all circumstances. We systematically evaluated available reports to visualize adaptation of spiral arteries throughout pregnancy by ultra-sonographic measurements and evaluated when this process is completed.Methods: A systematic review and meta-analysis of spiral artery flow (pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV)) was performed. English articles were obtained from Pubmed, EMBASE and Cochrane Library and included articles were assessed on quality and risk of bias. Weighted means of Doppler indices were calculated using a random-effects model. Results: In healthy pregnancies, PI and RI decreased from 0.80 (95% CI: 0.70-0.89) and 0.50 (95% CI: 0.47-0.54) in the first trimester to 0.50 (95% CI: 0.45-0.55, p<0.001) and 0.39 (95% CI: 0.37-0.42, p<0.001) in the second trimester and to 0.49 (95% CI: 0.44-0.53, p=0.752) and 0.36 (95% CI: 0.35-0.38, p=0.037) in the third trimester, respectively. In parallel, PSV altered from 0.22 m/s (95% CI: 0.13-0.30 m/s) to 0.28 m/s (95% CI: 0.17-0.40 m/s, p=0.377) and to 0.25 m/s (95% CI: 0.20-0.30 m/s, p=0.560) in the three trimesters. In absence of second and third trimester Doppler data in complicated gestation, only a difference in PI was observed between complicated and healthy pregnancies during the first trimester (1.49 vs 0.80, p<0.001). Although individual studies have identified differences in PI between SpA located in the central part of the placental bed versus those located at its periphery, this meta-analysis could not confirm this (p=0.349).Conclusions: This review and meta-analysis concludes that an observed decrease of SpA PI and RI from the first towards the second trimester parallels the physiological trophoblast invasion converting SpA during early gestation, a process completed in the midst of the second trimester. Higher PI was found in SpA of complicated pregnancies compared to healthy pregnancies, possibly reflecting suboptimal utero-placental circulation. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for complicated pregnancies are yet to be carried out.

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“…34 However, there is an increase in left ventricular wall thickness and left ventricular mass during pregnancy, causing a concentric left ventricular remodeling due to additional circulatory needs during pregnancy. 35 Commonly, a physiologic third heart sound and a cervical venous hum may be heard during pregnancy and need to be interpreted with caution being signs of systolic heart failure and patent ductus arteriosus, respectively.…”

Section: Heart Rate Variations During Pregnancymentioning

confidence: 99%

Physiological Changes in Cardiovascular System during Normal Pregnancy: A Review

Taranikanti

2018

Ind J Car Dis Wom

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Pregnancy is a complex biological process associated with changes in physiologic functions of the body. Dramatic changes take place in the cardiovascular physiology leading to gradual adaptation of these changes by the body of the pregnant woman. Cardiac output increases during pregnancy to 30 to 50% above the prepregnant levels. The increase in cardiac output occurs due to increase in stroke volume initially during gestation and later by increase in heart rate. These changes in cardiac output are attributed to either neurohumoral factors such as estrogen and progesterone or placental factors. Maternal body position affects cardiac output with highest in kneel-chest and left lateral positions. Along with these changes, variations in heart rate, blood pressure, and blood volume are observed following a specific pattern of change during pregnancy. Hence, it is necessary to understand the cardiovascular changes during pregnancy to interpret, predict, and diagnose any cardiac disease efficiently.

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Cardiac remodeling in normotensive pregnancy and in pregnancy complicated by hypertension: systematic review and meta‐analysis

Cited by 66 publications

References 63 publications

The features of the nitric oxide system in the left ventricle myocardium in the rats with experimental intermittent hypoxia of different duration

The features of the nitric oxide system in the left ventricle myocardium in the rats with experimental intermittent hypoxia of different duration

Spiral artery blood flow during pregnancy: a systematic review and meta-analysis.

Physiological Changes in Cardiovascular System during Normal Pregnancy: A Review

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