Introduction: T he cardiovascular maternal adaptati-on to pregnancy implies hemodynamic and structural changes. During pregnancy the cardiac performance is overall improved whereas there is not clearly defined the impact on the cardiac contractility of the gestatio-nal changes.
Objective: We sought to examine the cardiovascular contractility during pregnancy in a population tested for inherited thrombophilia using current echocardio-graphic imaging modalities.
Methods: We made a cohort study which included women, in the first semester of pregnancy which were genetically teste for inherited thrombophilia. The study participants had four echocardiographic evaluations, three during pregnancy, and the last at 6 months after giving birth. For a complete assessment of the cardi-ac contractility we analyzed left (2D and 3D) and right (3D) ventricle ejection fraction (EF), fractional area change (FAC) for the right ventricle, tricuspid annu-lar plane systolic excursion (TAPSE) and deformation parameters using Speckle tracking and tissue Doppler imaging. Also was analyzed the pressure gradient between right atria and ventricle.
Results: We enrolled 87 women with a mean age of 32 4.3 years old, classified subsequent in two groups: high risk inherited thrombophilia (22) and low risk in-herited thrombophilia (65). During pregnancy left and right ventricles EF and all the deformation parameters has a slight decrease with recovery at the forth visit. Left ventricle systolic function decreased from 57.6% to 55.4% (2D Simpson modified), from 60% to 56% (3D TomTec), from 58 to 55% (Auto4DLVQ), with p<0.001. 3D right ventricle EF decreased from 55.2% (high risk group) and 56.4% (low risk group) to 44.7% (high risk group) and 51.4% (low risk group). Regarding the left ventricle systolic function there were no differences between groups. On the other hand, related to the right ventricle systolic function and the value of the pressure gradient between right atria and ventricles there were significant differences between groups (p<0.01), high risk inherited thrombophilia having lower values for all the parameters evaluating the right ventricle contracti-lity and higher values for the pressure gradient. The differences had statistical significance during all 4 visits. Conclusions: High risk inherited thrombophilia asso-ciated with an additional procoagulant status (preg-nancy) could cause pulmonary hypertension and right ventricular systolic dysfunction. Further studies are ne-eded to evaluate long term impact on the right ventri-cle systolic function in presence of high risk inherited thrombophilia.