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

Journal of Cardiovascular Magnetic Resonance, vol. 22, pp. 52

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.

Authors 12

1. Anne S. Siegmund

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

2. Tineke P. Willems

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

3. Petronella G. Pieper

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

4. Caterina Maddalena Bilardo

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

5. Thomas M. Gorter

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

6. Berto Jorrit Bouma

   Amsterdam UMC Location University of Amsterdam · University of Amsterdam

   Affiliation as printed

   Department of Cardiology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

7. Monique R.M. Jongbloed Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands

8. Gertjan T. Sieswerda

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands

9. Jolien W. Roos‐Hesselink

   Erasmus MC · Erasmus University Rotterdam

   Affiliation as printed

   Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, the Netherlands

10. Arie P.J. van Dijk

    Radboud University Nijmegen · Radboud University Medical Center

    Affiliation as printed

    Department of Cardiology, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands

11. Dirk Jan van Veldhuisen

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

12. Michael G. Dickinson corresponding

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. m.g.dickinson@umcg.nl

    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands