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

Abstract

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.

Early N-terminal pro-B-type natriuretic peptide is associated with cardiac complications and function during pregnancy in congenital heart disease

“…This hypothesis is supported by the fact that we also found a decline in subpulmonary ventricular function later in pregnancy in women with elevated first-trimester NT-proBNP, whereas subpulmonary ventricular function remained stable in women with normal NT-ProBNP. Reduced subpulmonary ventricular function before and during pregnancy is associated with impaired uteroplacental circulation [ 13 , 23 , 24 ], which, in turn, is associated with adverse maternal and neonatal outcome [ 25 , 26 ]. Therefore, close surveillance of subpulmonary ventricular function in women with elevated first-trimester NT-proBNP may be warranted.…”

Right‐heart dysfunction in women with congenital heart disease and pre‐eclampsia

“…It is even more surprising that one of the most important findings from this consortium is not evaluated in the meta‐analysis: the association between right‐heart dysfunction and pregnancy/perinatal outcome. This association was identified in women with corrected tetralogy of Fallot 2 or aortic coarctation 3 , in whom abnormal right‐heart function was demonstrable before conception on both cardiosonography 4 and cardiac magnetic resonance imaging 5 . Right‐heart dysfunction is an intrinsic feature of pre‐eclampsia 6,7 , as is venous hemodynamic dysfunction 8,9 .…”