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Maternal cardiac function in twin pregnancies compared with singleton pregnancies.

This study investigates the changes in cardiac function in twin pregnancies compared with singleton pregnancies and explores the risks of heart failure or peripartum cardiomyopathy caused by diastolic dysfunction. The study concludes that twin pregnancies require careful attention, especially during the peripartum period, and suggests that BNP may be a helpful marker to evaluate diastolic function.

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Maternal cardiac function in twin pregnancies compared with singleton pregnancies.

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  1. Maternal cardiac function in twin pregnancies compared with singleton pregnancies. Makiko Kato, Yu Yaegashi, Shinji Monoe, Takuji Ueno, Takuma Yamada, Takehiko Takeda, Sho Tano, Kaname Uno, Michinori Mayama, Mayu Ukai, Teppei Suzuki, Yasuyuki Kishigami and Hidenori Oguchi Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Aichi, Japan

  2. Disclosure of conflict of interest We have nothing to declare for this study.

  3. Background • The maternal cardiac system undergoes significant changes throughout pregnancy, and twin pregnancies are exposed to more significant hemodynamic changes than singleton pregnancies. • These physiological changes impose considerable stress on maternal hearts and increase the risks of pulmonary edema and peripartum cardiomyopathy(PPCM).

  4. Background • The current definition of PPCM only includes patients with left ventricular systolic dysfunction. • Some authors presented cases of peripartum heart failure with normal EF and raise the possibility that the definition of PPCM be expanded to include left ventricular diastolic dysfunction1). • Data on diastolic dysfunction in twin pregnancies are sparse. 1) Afonso et al:Comparison of Patients With Peripartum Heart Fairule and Normal(≧55%) Versus Low(<45%) Left Ventricular Ejection Fractions:Am J Cardiol 2014;114:290-293

  5. Objective • To reveal the changes in cardiac function in twin pregnancies compared with singleton pregnancies. • To investigate if twin pregnancies carry considerable risks of heart failure or PPCM caused by diastolic dysfunction.

  6. Material and Methods • Study Design A single perinatal medical center, prospective cohort study.

  7. Material and Methods Twin pregnancies (n=145) Singleton pregnancies (n=44) Not suitable for study: Intrauterine fetal death at least 1 baby (n=1) Development of preeclampsia (n=23) Enrolled (n=121)

  8. Material and Methods • Trans-thoracic echocardiography and serum brain natriuretic peptide (BNP) levels were examined at early, middle, late pregnancy, within 5 days after delivery, and at one-month postpartum.

  9. Methods • Trans-thoracic echocardiography • Left ventricular ejection fraction (LVEF) was measured to evaluate systolic function. LVEF<55% was defined as systolic dysfunction. • Early transmitral velocity/early diastolic velocity of the mitral annulus (E/E’) was measured to diastolic function. E/E’<8was defined as normal diastolic function.

  10. Maternal Cardiac function of singleton pregnancies and twin pregnancies

  11. Maternal Cardiac function of singleton pregnancies and twin pregnancies

  12. Maternal Cardiac function of singleton pregnancies and twin pregnancies p<0.01 p<0.01

  13. Maternal Cardiac function of singleton pregnancies and twin pregnancies

  14. Maternal Cardiac function of singleton pregnancies and twin pregnancies p<0.001 p<0.008

  15. Result • In twin pregnancies, diastolic function deteriorates in late pregnancy and early postpartum, whereas systolic function maintains through all periods. • Serious BNP level is relevant with diastolic deterioration, so it has the potential to being used as a valuable marker of diastolic dysfunction.

  16. Discussion • In twin pregnancies, compared with singletons, maternal cardiac output is higher by 20-40%2). • This greater hemodynamic change could be considered to be a risk of cardiac dysfunction in twin pregnancies. • To date, whether twin pregnancies are associated with future cardiovascular disease are controversial. 2) Kametas et al: Maternal Cardiac Function in Twin Pregnancy: The American College of Obstetricians and Gynecologists.Vol.102,NO.4,OCTOBER 2003:806-815

  17. Discussion • According to our study, diastolic dysfunction in twin pregnancies was showed temporarily and it reverted after one month delivery. • This result suggests that twin pregnancies may not be a risk factor of future cardiovascular disease.

  18. Conclusions • In twin pregnancies, because theirs diastolic function deteriorates in peripartum period, they are required careful attention especially during that period. • BNP may be a helpful marker to evaluate diastolic function.

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