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Obesity in pregnancy is a predictor of persistent subclinical myocardial dysfunction over postpartum period

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Abstract

Purpose

No previous study provided a complete functional evaluation of all cardiac chambers in pregnant women with obesity. Moreover, the impact of cardiovascular changes associated with obesity in pregnancy on maternal outcome is unclear.

Methods

46 consecutive pregnant women with obesity, defined by body mass index (BMI) ≥ 30 Kg/m2, and 83 age- (35.5 ± 4.1 vs. 34.1 ± 5.1 yrs, p = 0.11), ethnicity- (caucasian 65.2 vs. 66.3%, p = 0.90) and gestational week-matched (36.3 ± 1.7 vs. 36.5 ± 1.5 wks, p = 0.49) pregnant women without obesity (BMI < 30 Kg/m2) were examined in the first trimester (12–14 weeks), third trimester (36–38 weeks) and 6–10 weeks postpartum. All women underwent obstetric visit, blood tests and transthoracic echocardiography implemented with two-dimensional speckle tracking echocardiography analysis of biventricular and biatrial myocardial deformation indices at the three time points. Outcome was persistent subclinical myocardial dysfunction, defined as an absolute value of left ventricular global longitudinal strain (LV-GLS) less negative than − 20%, in postpartum.

Results

Despite normal biventricular systolic function, all myocardial strain indices were significantly lower in pregnant women with obesity than controls. At 8.2 ± 2.2 weeks postpartum, LV-GLS remained less negative than − 20% in 86.9% of women with obesity in pregnancy. Maternal age (OR 1.68, 95%CI 1.14–2.48), third trimester BMI (OR 7.17, 95%CI 1.77–28.9) and third trimester neutrophil-to-lymphocyte ratio (NLR) (OR 1.75, 95%CI 1.22–2.51) were independently associated with outcome. Maternal age ≥ 35 years, BMI ≥ 30 Kg/m2 and NLR ≥ 5.5 were the optimal cut-off values for predicting persistent subclinical myocardial dysfunction in postpartum.

Conclusions

Pregnant women with obesity, age ≥ 35 yrs and low chronic inflammation have significantly increased risk of persistent subclinical myocardial dysfunction over postpartum.

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Abbreviations

2D:

two-dimensional

BMI:

body mass index

BSA:

body surface area

CI:

confidence interval

CO:

cardiac output

DBP:

diastolic blood pressure

EAT:

epicardial adipose tissue

GCS:

global circumferential strain

GLS:

global longitudinal strain

GRS:

global radial strain

GSA+:

positive global atrial strain

GSA-:

negative global atrial strain

ICC:

intraclass correlation coefficient

LA:

left atrial

LV:

left ventricular

LVEF:

left ventricular ejection fraction

LVMi:

left ventricular mass index

LVOT:

left ventricular outflow tract

MAP:

mean arterial pressure

MAPSE:

mitral annular plane systolic excursion

NLR:

neutrophil-to-lymphocyte ratio

RA:

right atrial

RDW:

red cell distribution width

ROC:

receiver operating characteristics

RV:

right ventricular

RWT:

relative wall thickness

SBP:

systolic blood pressure

SPAP:

systolic pulmonary artery pressure

STE:

speckle tracking echocardiography

SV:

stroke volume

TAPSE:

tricuspid annular plane systolic excursion

TGSA:

total global atrial strain

TPR:

total peripheral resistance

TTE:

transthoracic echocardiography

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Funding

This work has been supported by Italian Ministry of Health Ricerca Corrente - IRCCS MultiMedica.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy

    Andrea Sonaglioni M.D. & Michele Lombardo M.D.

  2. Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi M.D.

  3. Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy

    Andrea Sonaglioni M.D. & Stefano Bianchi M.D.

Authors
  1. Andrea Sonaglioni M.D.
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  2. Gian Luigi Nicolosi M.D.
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  3. Stefano Bianchi M.D.
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  4. Michele Lombardo M.D.
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Contributions

Andrea Sonaglioni: Conceptualization; Data curation; Investigation; Methodology; Software; Visualization; Writing—original draft. Gian Luigi Nicolosi: Conceptualization; Data curation; Methodology; Writing—review & editing. Stefano Bianchi: Supervision; Validation; Writing—review & editing. Michele Lombardo: Supervision; Validation; Writing—review & editing.

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Correspondence to Andrea Sonaglioni M.D..

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We wish to confirm that there are no conflicts of interest associated with this publication. Andrea Sonaglioni declares that he has no conflict of interest. Gian Luigi Nicolosi declares that he has no conflict of interest. Stefano Bianchi declares that he has no conflict of interest. Michele Lombardo declares that he has no conflict of interest.

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Sonaglioni, A., Nicolosi, G.L., Bianchi, S. et al. Obesity in pregnancy is a predictor of persistent subclinical myocardial dysfunction over postpartum period. Int J Cardiovasc Imaging 38, 1895–1907 (2022). https://doi.org/10.1007/s10554-022-02579-y

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