Longitudinal study to assess changes in arterial stiffness and cardiac output parameters among low-risk pregnant women

Osman, Mugtaba; Nath, Mintu; Khalil, Asma; Webb, David R.; Robinson, Thompson G.; Mousa, H.

doi:10.1016/j.preghy.2017.10.007

Cited by 19 publications

(23 citation statements)

References 40 publications

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“…Pregnancy is a unique physiologic model showing that morphologic, hemodynamic, and functional adaptation of the heart in the transient preload and afterload changes. Increasing the volumetric load and decreasing peripheral resistance during pregnancy have been well documented in previous publications . The increase in the volume load in the third trimester worsens potential heart disease.…”

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confidence: 52%

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Evaluation of Left Atrial Functions by 2‐dimensional Speckle‐Tracking Echocardiography During Healthy Pregnancy

Taşar

Kocabay

Karagöz

et al. 2019

J of Ultrasound Medicine

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Objectives We aimed to determine the effects of normal pregnancy on left atrial (LA) mechanics using 2‐dimensional speckle‐tracking echocardiography. Methods A total of 47 healthy women with singleton pregnancies were prospectively enrolled in this study. A total of 4 visits, including each trimester and postpartum at 6 months, were planned. Echocardiographic studies were performed with a Vivid 7 device equipped with a 2.5‐MHz transducer (GE Vingmed Ultrasound AS, Horten, Norway). Results Although the LA reservoir phase strain showed a gradual decrease from the first trimester to the third trimester during pregnancy, the measurements in the postpartum period were found to return to initial levels (mean ± SD: first trimester, 40.3% ± 11.7%; second trimester, 37.5% ± 12.9%; third trimester, 33.5% ± 9.0%; postpartum, 42.1% ± 11.1%; P < .001). The LA pump function strain was also parallel to the LA reservoir strain and gradually decreased from the first trimester to the third trimester during pregnancy, and it was observed that rose to the initial level in the postpartum period (first trimester, 16.7% ± 7.4%; second trimester, 14.8% ± 5.5%; third trimester, 12.7% ± 4.3%; postpartum, 15.8% ± 5.5%; P < .001). Conclusions We prospectively determined normal reference values for LA deformation parameters using speckle‐tracking echocardiography in each trimester and the postpartum period in healthy pregnancy. These reference values may help identify subclinical LA dysfunction in several cardiovascular or systemic conditions. According to this study, these parameters decreased toward the third trimester during pregnancy and recovered in the postpartum period.

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confidence: 52%

“…Increasing the volumetric load and decreasing peripheral resistance during pregnancy have been well documented in previous publications. 1,2 The increase in the volume load in the third trimester worsens potential heart disease. Previous studies demonstrated changes in left ventricular (LV) function during pregnancy, particularly diastolic function.…”

mentioning

confidence: 99%

Evaluation of Left Atrial Functions by 2‐dimensional Speckle‐Tracking Echocardiography During Healthy Pregnancy

Taşar

Kocabay

Karagöz

et al. 2019

J of Ultrasound Medicine

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“…A plausible physiological candidate for predicting the likelihood of hypotension in C/S patients undergoing spinal anesthesia is arterial stiffness (AS), which has been investigated in the separate contexts of hypotension and pregnancy, and can be assessed using pulse contour analysis [12]. Recent work on the prediction of imminent hypotension has focused on identifying changes in the variability of physiological signals, among them AS [13,14]. Variability changes are due to compensatory mechanisms in the cardiovascular system as it attempts to maintain stability [10,15].…”

Section: Introductionmentioning

confidence: 99%

“…Variability changes are due to compensatory mechanisms in the cardiovascular system as it attempts to maintain stability [10,15]. In the context of pregnancy, significant longitudinal changes in AS have been documented [13]. It is therefore reasonable to investigate whether underlying compromised physiological compensatory reserve can be predicted prior to spinal anesthesia induction.…”

Section: Introductionmentioning

confidence: 99%

The application of a neural network to predict hypotension and vasopressor requirements non-invasively in obstetric patients having spinal anesthesia for elective cesarean section (C/S)

et al. 2020

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Background: Neural networks are increasingly used to assess physiological processes or pathologies, as well as to predict the increased likelihood of an impending medical crisis, such as hypotension. Method: We compared the capabilities of a single hidden layer neural network of 12 nodes to those of a discretefeature discrimination approach with the goal being to predict the likelihood of a given patient developing significant hypotension under spinal anesthesia when undergoing a Cesarean section (C/S). Physiological input information was derived from a non-invasive blood pressure device (Caretaker [CT]) that utilizes a finger cuff to measure blood pressure and other hemodynamic parameters via pulse contour analysis. Receiver-operator-curve/ area-under-curve analyses were used to compare performance. Results: The results presented here suggest that a neural network approach (Area Under Curve [AUC] = 0.89 [p < 0.001]), at least at the implementation level of a clinically relevant prediction algorithm, may be superior to a discrete feature quantification approach (AUC = 0.87 [p < 0.001]), providing implicit access to a plurality of features and combinations thereof. In addition, the expansion of the approach to include the submission of other physiological data signals, such as heart rate variability, to the network can be readily envisioned. Conclusion: This pilot study has demonstrated that increased coherence in Arterial Stiffness (AS) variability obtained from the pulse wave analysis of a continuous non-invasive blood pressure device appears to be an effective predictor of hypotension after spinal anesthesia in the obstetrics population undergoing C/S. This allowed us to predict specific dosing thresholds of phenylephrine required to maintain systolic blood pressure above 90 mmHg.

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“…Pregnancy is associated with significant changes in maternal haemodynamics and measures of arterial stiffness across each trimester (1). In particular, significant increases in arterial stiffness and wave reflection parameters are noted amongst pregnant women who subsequently develop pre-eclampsia and small for gestational age foetuses (2), as well as those with known pre-eclampsia (3).…”

Section: Introductionmentioning

confidence: 99%

The effects of metformin on maternal haemodynamics in gestational diabetes mellitus: A pilot study

Osman

Nath

Khalil

et al. 2018

Diabetes Research and Clinical Practice

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Longitudinal study to assess changes in arterial stiffness and cardiac output parameters among low-risk pregnant women

Cited by 19 publications

References 40 publications

Evaluation of Left Atrial Functions by 2‐dimensional Speckle‐Tracking Echocardiography During Healthy Pregnancy

Evaluation of Left Atrial Functions by 2‐dimensional Speckle‐Tracking Echocardiography During Healthy Pregnancy

The application of a neural network to predict hypotension and vasopressor requirements non-invasively in obstetric patients having spinal anesthesia for elective cesarean section (C/S)

The effects of metformin on maternal haemodynamics in gestational diabetes mellitus: A pilot study

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