Cardiac structural, functional, and energetic assessments during and after pregnancy in women with gestational diabetes mellitus, preeclampsia, and healthy pregnancy.
Thirunavukarasu S., Ansari F., Kotha S., Giannoudi M., Procter H., Cash L., Chowdhary A., Jex N., Shiwani H., Forbes K., Valkovič L., Kellman P., Plein S., Greenwood JP., Everett T., Scott EM., Levelt E.
BACKGROUND: Gestational diabetes mellitus (GDM) and preeclampsia are common complications of pregnancy, for which overweight/obesity is a common risk factor. Both conditions are associated with a two-to-four-fold increase in future incident heart failure, which may be linked to early maladaptive myocardial changes. OBJECTIVE: To determine maternal myocardial structural, functional, and energetic responses to pregnancies complicated by GDM or preeclampsia compared to healthy pregnancies (HP) at third-trimester of pregnancy and 12-months postpartum. STUDY DESIGN: Thirty-eight women with HP, 30 GDM, 20 preeclampsia, 10 nonpregnant controls with overweight (Overweight-NC), and 10 with normal-weight were recruited. Cardiovascular magnetic resonance spectroscopy and imaging were used to define myocardial energetics (phosphocreatine: ATP ratio [PCr/ATP]), left ventricular (LV) volumes, mass, and ejection fraction and global longitudinal shortening (GLS). Pregnancy groups underwent repeat scans 12-months postpartum, nulliparous-controls were assessed once. RESULTS: During third-trimester, compared to HP, women with either GDM or preeclampsia displayed higher BMI, higher LV-mass (HP: 90 [85, 94] g, GDM: 103 [96, 112], Preeclampsia: 118 [111, 125] g; P=.001) and lower PCr/ATP (HP: 2.2 [2.1, 2.4], GDM: 1.9 [1.7, 2], Preeclampsia: 1.9 [1.8, 2.1]; P=.0004) and GLS (HP: 20 [18, 21]%, GDM: 18 [17, 19]%, Preeclampsia: 16 [14, 17]%; P=.01). Post-pregnancy, no group saw significant changes in LV-mass, PCr/ATP, or GLS. There were no significant differences in LV-mass, PCr/ATP or GLS between the GDM and preeclampsia groups during or post-pregnancy. Moreover, the Overweight-NC showed no significant differences in LV-mass (53 [43, 63])g, PCr/ATP (2.0 [1.8, 2.2]), or GLS (-19 [17, 21]%) compared to GDM or preeclampsia groups during or post-pregnancy. CONCLUSION: Women with GDM or preeclampsia exhibit similar myocardial phenotypes during pregnancy with persistent subclinical alterations in LV mass, energetics, and GLS 12-months postpartum. These myocardial alterations are similar to those detected in Overweight-NC, potentially suggesting the myocardial changes may predominantly be driven by overweight/obesity.