Influence of chest conformation on ventricular-arterial coupling during normal pregnancy

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Abstract
Purpose: There is still controversy regarding the changes of ventricular-arterial coupling
(VAC) during normal pregnancy. The possible influence of chest shape on VAC
during normal pregnancy has never been investigated.
Methods: Between October 2019 and June 2020, 59 healthy pregnant women
(33.7 ± 4.4 years/old) were consecutively included. They underwent obstetric visit,
modified Haller index (MHI) assessment, and complete echocardiographic evaluation
with blood pressure measurement to assess arterial elastance (Ea), end-systolic
elastance (Ees), and Ea/Ees as an index of VAC, at 12-14 weeks and 36-38 weeks
gestation, then 6-9 weeks after delivery.
Results: VAC progressively increased from the first to the third trimester of pregnancy,
then decreased in the postpartum (P < 0.0001) in the whole study population.
Women with concave-shaped chest wall (MHI >2.5, n = 31) but not women with normal
chest shape (MHI ≤2.5, n = 28) showed a progressive increase in VAC during
normal pregnancy. Women with MHI >2.5 showed a significantly less pronounced
increase in stroke volume index (SVi) from the first to the third trimester of pregnancy.
There was a strong linear correlation between third trimester MHI and
VAC (r = 0.93).
Conclusions: Anatomical and/or extrinsic mechanical factors rather than impaired
arterial elastance or reduced left ventricular contractility may contribute to changes
in VAC during normal pregnancy in women with concave-shaped chest wall.