The PERInatal MYocardial Remodeling (PERIMYR) cohort study protocol: A prospective study of cardiac remodeling and "recovery" in pregnancy as a model to understand the impact of comorbidities in cardiac remodeling and reverse remodeling

Data de publicação: 01/06/2023 Data Ahead of Print: 01/06/2023

Autores da FMUP

• Francisca Almeida Saraiva

  Autor

• Sara Vanessa Amorim Leite

  Autor

• Carla Margarida Castanheira Sousa

  Autor

• Joaquim Adelino Correia Ferreira Leite Moreira

  Autor

• Carla Maria De Almeida Ramalho

  Autor

• Inês Maria Falcão Sousa Pires Marques

  Autor

Participantes de fora da FMUP

• Ferreira, AF
• Azevedo, MJ
• Trindade, F
• Barros, A.
• Proenca, T
• Machado, AP
• Sampaio Maia, B.

Unidades de investigação

• Cirurgia e Fisiologia

• Ginecologia-Obstetrícia e Pediatria

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction: Heart failure (HF) is among the leading causes of morbidity and mortality worldwide. Several conditions trigger left ventricular chronic pressure or volume overload, hypertrophy, systolic and diastolic dysfunction, leading to cardiac remodeling and a rapid pro-gression toward HF. Therapeutic interventions elicit reverse remodeling (RR), a highly variable myocardial response that ranges from none to total ventricular structural/functional recovery. However, HF patients present several comorbidities and medications that mask a comprehen-sive molecular knowledge of RR and hinder the identification of potential biomarkers of its progression or prognosis. Therefore, instead of using this heterogeneous population or even animal models to understand myocardial remodeling, we propose studying pregnancy-induced cardiovascular remodeling and postpartum-induced RR. Objectives: To assess cardiovascular functional and structural adaptations during pregnancy and in postpartum, characterizing the associated molecular changes; as well as to explore the impact of hypertension, obesity and diabetes on these processes. Methods: We will perform echocardiography and assess endothelial function and arterial stiffness (EndoPAT & REG; and pulse wave velocity, respectively) and assess potential markers of remodeling and RR using plasma and urine samples from pregnant women. To translate to a HF context, we will determine the impact of risk factors (hypertension, obesity and diabetes) by studying subgroups of pregnant women with these comorbidities. Results: Not applicable. Conclusion: We are convinced that understanding the impact of these comorbidities in such a homogeneous population, such as pregnant women, provides a valuable model to unveil the most relevant pathologic and often masked signaling pathways underlying cardiac remodeling and incomplete RR in a heterogeneous population, such as HF patients. Moreover, we expect to identify potential novel biomarkers of RR progression/prognosis more easily. & COPY; 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espan & SIM;a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Keywords

• Pregnant woman; Pregnancy; Post-partum; Cardiovascular remodeling; Reverse remodeling; Comorbidities; Hypertension; Diabetes; Obesity; Hemodynamic overload; Cardiac function