From the Guidelines
Pregnancy can lead to increased left ventricular (LV) filling pressures, particularly in women with pre-existing pulmonary arterial hypertension (PAH), due to the substantial hemodynamic demands of pregnancy. The hemodynamic changes associated with pregnancy, including a 30% to 50% increase in blood volume and a similar increase in cardiac output, can impose a marked hemodynamic stress on the heart 1. These changes can lead to increased cardiac filling pressures, especially during labor and immediately postpartum, as a result of decompression of the vena cava and the return of uterine blood into the systemic circulation 1. Key points to consider include:
- The physiologic changes induced by pregnancy can lead to a substantial mortality risk, particularly in women with PAH, with a previously estimated 30% to 50% mortality rate 1.
- More recent data indicate that the outcome of pregnancy in PAH has improved, with a 12% maternal mortality rate reported in a recent survey, at least when PAH is well controlled 1.
- Hormonal changes during and immediately following pregnancy may also be detrimental from a pathophysiologic standpoint, potentially leading to progression of pulmonary hypertension 1.
- The management of pregnant women with PAH typically includes early hospitalization for closer monitoring, supportive therapy with cautious fluid management, supplemental oxygen, diuretics, and dobutamine, as needed, as well as the use of a pulmonary artery catheter for close hemodynamic monitoring 1. In terms of the impact of pregnancy on LV filling pressures, it is essential to consider the individual patient's underlying cardiac condition and the potential for pathologic increases in filling pressures during pregnancy.
From the Research
Effects of Pregnancy on Left Ventricular Filling Pressures
- Pregnancy is associated with changes in left ventricular (LV) diastolic function, which can affect LV filling pressures 2, 3.
- Studies have shown that LV diastolic function is altered during pregnancy, with changes in mitral inflow and pulmonary venous flow profiles 3, 4.
- The E/A ratio, which is a measure of LV diastolic function, is increased during pregnancy, particularly in the first trimester 3.
- Pregnancy-induced hypertension (PIH) can also affect LV diastolic function, with changes in mitral inflow and pulmonary venous flow variables 4.
- The use of Doppler echocardiography and tissue Doppler imaging has provided insights into the changes in LV diastolic function during pregnancy 2, 4.
Changes in Left Ventricular Filling Pressures During Pregnancy
- LV filling pressures are affected by the changes in LV diastolic function during pregnancy, with increased filling pressures observed in some studies 2, 5.
- The increased filling pressures are thought to be due to the increased volume load on the heart during pregnancy, which can lead to changes in LV geometry and function 3, 5.
- The changes in LV filling pressures during pregnancy can be assessed using non-invasive techniques such as echocardiography and Doppler imaging 2, 4.
- The assessment of LV filling pressures during pregnancy is important for the diagnosis and management of cardiac disease in pregnant women 2, 6.
Clinical Implications
- The changes in LV filling pressures during pregnancy have important clinical implications for the management of cardiac disease in pregnant women 2, 6.
- The use of echocardiography and Doppler imaging can provide valuable information on LV diastolic function and filling pressures during pregnancy 2, 4.
- The assessment of LV filling pressures during pregnancy can help identify women at risk of cardiac complications and guide management decisions 2, 6.
- Further studies are needed to fully understand the changes in LV filling pressures during pregnancy and their clinical implications 3, 6.