The forgotten ventricle—right ventricular remodeling across pregnancy and postpartum: a report of original research

The forgotten ventricle-right ventricular remodeling across pregnancy and postpartum: a report of original research OBJECTIVE:Despite well-known cardiovascular adaptations leading to increased cardiac output, little is known about the right ventricle's (RV) response to the physiological demands of pregnancy.1 Because complex geometry limits echocardiography, the standard for evaluation of the RV is cardiac magnetic imaging (cMRI).2,3 Using cMRI, we report changes in the RV with associated biomarker surveillance. STUDY DESIGN:This was a secondary analysis of a prospective, observational study of pregnant individuals throughout pregnancy and the postpartum period using cMRI.4 Twentythree nulliparas aged 18-30 years with a singleton pregnancy and without hypertension, pregestational diabetes mellitus, preexisting cardiovascular disease, or substance use between June 2012 and May 2014 were included with Institutional Review Board approval.Each patient underwent cMRI at 12 -16, 26-30, 32-36 weeks, delivery, and 12 weeks postpartum on a 1.5-Tesla coil system.End-diastolic and end-systolic endocardial and epicardial borders were systematically traced to measure RV dimensions.RV mass was used as a marker of cardiac remodeling, and papillary muscles and trabeculations were not included in the calculations.Right ventricular enddiastolic volume (RVEDV) was used as a measure of function and was evaluated in the left-lateral position.N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured using the STAT assay (NT-proBNP II STAT; Roche Cobas e601) at 12 weeks, delivery, and 12 weeks postpartum as a marker of ventricular volume expansion and pressure overload.Variables were compared with a function of time across pregnancy and indices stratified by habitus at the time of cMRI.RV mass was compared using Wilcoxon signed rank, and RVEDV was compared using repeated measures, mixed-random, and fixed-effects.