Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors

Data de publicação: 01/01/2024 Data Ahead of Print: 09/02/2024

Autores da FMUP

Francisca Almeida Saraiva

Autor
Joaquim Adelino Correia Ferreira Leite Moreira

Autor
António Sousa Barros

Autor

Participantes de fora da FMUP

Ferreira A.F.
Azevedo M.J.
Morais J.
Almeida-Coelho J.
Leite-Moreira A.M.
Lourenço A.P.
Diaz S.O.
Amador A.F.
Sousa C.
Machado A.P.
Sampaio-Maia B.
Ramalho C.
Falcão-Pires I.

Unidades de investigação

Cirurgia e Fisiologia
Laboratório Associado RISE- Rede de Investigação em Saúde

Investigador

Fernando Carlos De Landér Schmitt
RISE-Health

Investigador

Fernando Carlos De Landér Schmitt

Abstract

Pressure overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy’s chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Thirty-seven women (1st trimester, 1stT) and a separate group of 31 (3rd trimester, 3rdT) women [healthy or with CVR factors (obesity and/or hypertension and/or with gestational diabetes)] underwent echocardiography determination of left ventricular end-diastolic volume (LVEDV) and E/e0 before (T0), immediately after (T1), and 15 min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Acute leg elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1stT and 3rdT, confirming AVO. LVEDV and E/e0 also increased immediately after AVO (T1) in both 1stT and 3rdT. SIC adaptation (T2, 15 min after AVO) significantly decreased E/e0 in both trimesters, with additional expansion of LVEDV only in the 1stT. NT-pro-BNP increased slightly after AVO but only in the 1stT. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. A distinct functional response to SIC was observed between 1stT and 3rdT, which was influenced by CVR factors. The LV of 3rdT pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, whereas the lower LV filling pressure values suggest increased diastolic compliance. NEW & NOTEWORTHY The sudden increase of volume overload triggers an acute myocardial stretch characterized by an immediate rise in contractility by the Frank–Starling mechanism, followed by a progressive increase known as the slow force response. The present study is the first to characterize echocardiographically the stretch-induced compliance (SIC) mechanism in the context of physiological hypertrophy induced by pregnancy. A distinct functional adaptation to SIC was observed between first and third trimesters, which was influenced by cardiovascular risk factors. Copyright © 2024 the American Physiological Society.

Dados da publicação

ISSN/ISSNe:: 0363-6135, 1522-1539
Tipo:: Article
Páginas:: 1193-1203
DOI:: 10.1152/ajpheart.00701.2023
Link para outro recurso:: www.scopus.com

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Ferreira A.F.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Azevedo M.J.:: Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal

Instituto Nacional de Engenharia Biomédica, Porto, Portugal

i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal

Academic Center for Dentistry Amsterdam, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Morais J.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Almeida-Coelho J.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Leite-Moreira A.M.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Lourenço A.P.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Saraiva F.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Diaz S.O.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Amador A.F.:: Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Sousa C.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Machado A.P.:: Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Sampaio-Maia B.:: Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal

Instituto Nacional de Engenharia Biomédica, Porto, Portugal

i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
Ramalho C.:: i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal

Obstetrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal

Obstetrics, Gynaecology and Pediatrics Department, Faculty of Medicine, the University of Porto, Porto, Portugal
Leite-Moreira A.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

Anesthesiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Barros A.S.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Falcão-Pires I.:: Cardiovascular Research and Development Unit, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

Keywords

Cardiomegaly; Cardiovascular Diseases; Female; Heart; Heart Disease Risk Factors; Humans; Pregnancy; Risk Factors; Ventricular Function, Left; acetylsalicylic acid; amino terminal pro brain natriuretic peptide; metformin; adult; Article; biological adaptation; cardiovascular risk factor; clinical feature; cohort analysis; demographics; echocardiography; female; first trimester pregnancy; gestational diabetes; heart hypertrophy; heart left ventricle enddiastolic volume; heart muscle compliance; heart muscle contractility; heart stroke volume; heart ventricle overload; human; hypertension; inferior cava vein; left ventricular filling pressure; major clinical study; obesity; pregnancy; pregnant woman; quantitative analysis; Starling law; stretch induced compliance; third trimester pregnancy; vein diameter; cardiomegaly; cardiovascular disease; diagnostic imaging; heart; heart disease risk factor; heart left ventricle function; pregnancy; risk factor

Financiamento

Bolsa de Estudo João Porto da Sociedade Portuguesa de Cardiologia

European Regional Development Fund

European Regional Development Fund ((NORTE-01–0145-FEDER-000039))

Fundação para a Ciência e a Tecnologia

Fundação para a Ciência e a Tecnologia ((SFRH/BD/144982/2019)

Fundação para a Ciência e a Tecnologia (SFRH/BD/138925/ 2018)

Fundação para a Ciência e a Tecnologia (UIBD1523062021)

Fundação para a Ciência e a Tecnologia (UIDB/00051/2020))

Fundação para a Ciência e a Tecnologia (UIDP/00051/ 2021)