Maternal echocardiographic changes in twin pregnancies with and without pre‐eclampsia

Journal article

Giorgione, V., Melchiorre, K., O’Driscoll, J., Khalil, A., Sharma, R. and Thilaganathan, B. 2022. Maternal echocardiographic changes in twin pregnancies with and without pre‐eclampsia. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.24852
AuthorsGiorgione, V., Melchiorre, K., O’Driscoll, J., Khalil, A., Sharma, R. and Thilaganathan, B.
Abstract

Objectives
Twin pregnancies are at increased risk of developing hypertensive disorders of pregnancy (HDP) compared to singletons resulting in a substantially higher rate of maternal and perinatal complications. Despite this, the strain caused by a twin pregnancy on the maternal cardiovascular system is still poorly studied. The objective of this study was to evaluate the changes in maternal cardiac morphology and diastolic function in a cohort of women carrying normotensive and hypertensive twin pregnancies.

Methods
This was a cross-sectional study conducted at a tertiary referral university centre. Women with singleton or twin pregnancies were enrolled prospectively to undergo maternal transthoracic echocardiography throughout pregnancy. Multiple of median (MoM) were calculated for measured indices using a reference group of uncomplicated singleton pregnancies (n=411) in order to adjust for changes with gestational age. Cardiac findings were indexed to body surface area and compared among normotensive twins, singleton pregnancies complicated by HDP and twin pregnancies complicated by HDP.

Results
119 HDP singletons, 52 normotensive twins and 24 HDP twins were included in the analysis. Left ventricle mass index (LVMi) MoM did not differ between singletons complicated by HDP and normotensive twins, but LVMi was significantly higher in HDP twins [1.31 (1.08-1.53) vs 1.17 (0.98-1.35), p=0.032]. Left atrial volume index MoM [1.12 (0.66-1.38) vs 0.65 (0.55-0.84), p=0.003] and diastolic index such as E/e’ MoM [1.29 (1.09-1.54) vs 0.99 (0.99-1.02), p=0.036] were significantly higher in HDP twins when compared to normotensive twins. In normotensive twins compared to HDP singletons, stroke volume index (SVi) MoM was higher [1.20 (1.03-1.36) vs 1.00 (0.81-1.15), p=0.004] and total vascular resistance index (TVRi) was lower [0.73 (0.70-0.86) vs 1.29 (1.04-1.56), p<0.0001]. In contrast, SVi MoM was lower [1.10 (1.02-1.35) vs 1.20 (1.03-1.36), p=0.018] and TVRi was higher [1.00 (0.88-1.31) vs 0.73 (0.70-0.86), p=0.029] in hypertensive twins compared to normotensive twin pregnancies.

Conclusions
The maternal cardiovascular system is severely altered by a twin pregnancy with and without HPD. Despite a low total vascular resistance, cardiac changes in normotensive twins are comparable with those seen in singletons complicated by HDP reflecting the high cardiovascular demand imposed by a twin pregnancy.

KeywordsRadiological and ultrasound technology; Cardiovascular; Pregnancy; Twin pregnancies; Echocardiography; Gestational hypertension; Preeclampsia; Hypertensive disorders of pregnancy
Year2022
JournalUltrasound in Obstetrics & Gynecology
PublisherWiley
ISSN0960-7692
1469-0705
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.24852
Official URLhttps://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.24852
Publication dates
Online08 Jan 2022
Publication process dates
Accepted22 Dec 2021
Deposited19 Jan 2022
Accepted author manuscript
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Lea, J., O'Driscoll, J., Coleman, D. and Wiles, J. 2021. Validity and reliability of the ‘Isometric Exercise Scale’ (IES) for measuring ratings of perceived exertion during continuous isometric exercise. Scientific Reports. 11 (5334). https://doi.org/10.1038/s41598-021-84803-8
Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study
Woodward, W., Dockerill, Cameron, McCourt, Annabelle, Upton, Ross, O'Driscoll, Jamie, Balkhausen, Katrin, Chandrasekaran, Badrinathan, Firoozan, Soroosh, Kardos, Attila, Wong, Kenneth, Woodward, Gary, Sarwar, Rizwan, Sabharwal, N., Benedetto, Elena, Spagou, Nancy, Sharma, Rajan, Augustine, Daniel, Tsiachristas, Apostolos, Senior, R., Leeson, P., Boardman, Henry, d’Arcy, Joanna, Abraheem, Abraheem, Banypersad, Sanjay, Boos, Christopher, Bulugahapitiya, Sudantha, Butts, Jeremy, Coles, Duncan, Easaw, Jacob, Hamdan, Haytham, Jamil-Copley, Shahnaz, Kanaganayagam, Gajen, Mwambingu, Tom, Pantazis, Antonis, Papachristidis, Alexandros, Rajani, Ronak, Rasheed, Muhammad Amer, Razvi, Naveed A, Rekhraj, Sushma, Ripley, David P, Rose, Kathleen, Scheuermann-Freestone, Michaela, Schofield, Rebecca and Sultan, Ayyaz 2021. Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study. European Heart Journal - Cardiovascular Imaging. 23 (5), pp. 689-698. https://doi.org/10.1093/ehjci/jeab092
Continuous cardiac autonomic and haemodynamic responses to isometric exercise in females
O'Driscoll, J., Boucher, C., Vilda, M., Taylor, K. and Wiles, J. 2020. Continuous cardiac autonomic and haemodynamic responses to isometric exercise in females. European Journal of Applied Physiology and Occupational Physiology. https://doi.org/10.1007/s00421-020-04525-z
Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study
Edwards, J., Taylor, K.A., Cottam, C., Jalaludeen, N., Coleman, D.A., Wiles, J.D., Sharma, R. and O'Driscoll, J.M. 2020. Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study. Journal of Hypertension. https://doi.org/10.1097/HJH.0000000000002630
Centre of pressure, vertical ground reaction forces and neuromuscular responses of special-forces soldiers to 43km load carriage in the field
Scales, J., O'Driscoll, J., Coleman, D., Giannoglou, D, Gkougkoulis, I, Ntontis, I, Zisopoulou, C and Brown, M. 2020. Centre of pressure, vertical ground reaction forces and neuromuscular responses of special-forces soldiers to 43km load carriage in the field. Journal of Applied Biomechanics.
Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study
Jalaludeen, N., Bull, S., Taylor, K. A., Wiles, J., Coleman, D., Mukhtar, O., Cheriyan, J., Wilkinson, I.B., Sharma, R. and O'Driscoll, J. 2020. Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study. European Journal of Applied Physiology. https://doi.org/10.1007/s00421-020-04416-3
Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study [Abstract]
Jalaludeen, N., Bull, S., Taylor, K. A., Wiles, J., Coleman, D., Mukhtar, O., Cheriyan, J., Wilkinson, I.B., Sharma, R. and O'Driscoll, J. 2020. Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study [Abstract]. European Heart Journal - Cardiovascular Imaging. 21 (1). https://doi.org/10.1093/ehjci/jez319.221
Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals
Millar, L. M., Fanton, Z., Finnochiaro, G., Sanchez-Fernandez, G., Dhutia, H., Malhotra, A., Merghani, A., Papadakis, M., Behr, E. R., Bunce, N., Oxborough, D., Reed, M., O'Driscoll, J., Tome Esteban, M. T., D'Silva, A., Carr-White, G., Sharma, R. and Sharma, S. 2020. Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals. Heart. https://doi.org/10.1136/heartjnl-2019-316147
The impact of demographic, anthropometric and athletic characteristics on left atrial size in athletes.
O'Driscoll, J. and Christou, G. 2020. The impact of demographic, anthropometric and athletic characteristics on left atrial size in athletes. Clinical Cardiology. 43 (8), pp. 834-842. https://doi.org/10.1002/clc.23368
Speckle tracking echocardiography: new ways of translational approaches in preeclampsia to detect cardiovascular dysfunction
Kraker, K., Schutte, T., O'Driscoll, J., Birukov, A., Patey, O., Herse, F., Muller, D.N., Thilaganathan, B., Haase, N. and Dechend, R. 2020. Speckle tracking echocardiography: new ways of translational approaches in preeclampsia to detect cardiovascular dysfunction. International Journal of Molecular Sciences. 21 (3). https://doi.org/10.3390/ijms21031162
Challenge and threat: a critical review of the literature and an alternative conceptualization
Uphill, M., Rossato, C., Swain, J. and O'Driscoll, J. 2019. Challenge and threat: a critical review of the literature and an alternative conceptualization. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2019.01255
Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study
Green, D., Vassallo, D., Handley, K., Ives, N., Wheatley, K., Chrysochou, C., Hegarty, J., Wright, J., Moss, J., Patel, R., Deighan, C., Webster, J., Rowe, P., Carr, S., Cross, J., O'Driscoll, J., Sharma, R., Mark, P. and Kalra, P. 2019. Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study. BMC Nephrology. https://doi.org/10.1186/s12882-019-1406-y
Characteristics of torque production of the lower limb are significantly altered after 2 hours of treadmill load carriage
Scales, J., Coleman, D., O'Driscoll, J. and Brown, M. 2018. Characteristics of torque production of the lower limb are significantly altered after 2 hours of treadmill load carriage. Translational Sports Medicine. 2 (1). https://doi.org/10.1002/tsm2.54
The impact of gestational diabetes on maternal cardiac adaptation to pregnancy.
Buddeberg, B.S., Sharma, R., O'Driscoll, J., Kaelin, A., Khalil, A. and Thilaganathan, B. 2019. The impact of gestational diabetes on maternal cardiac adaptation to pregnancy. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.21941
Statins Reverse Postpartum Cardiovascular Dysfunction in a Rat Model of Preeclampsia
Kräker, Kristin, O’Driscoll, Jamie M., Schütte, Till, Herse, Florian, Patey, Olga, Golic, Michaela, Geisberger, Sabrina, Verlohren, Stefan, Birukov, Anna, Heuser, Arnd, Müller, Dominik N., Thilaganathan, Basky, Dechend, Ralf and Haase, Nadine 2019. Statins Reverse Postpartum Cardiovascular Dysfunction in a Rat Model of Preeclampsia. Hypertension. 75 (1), pp. 202-210. https://doi.org/10.1161/hypertensionaha.119.13219
Left ventricular function and cardiac biomarker release – the influence of exercise intensity, duration and mode: a systematic review and meta-analysis
Donaldson, J., Wiles, J., Coleman, D., Papadakis, M., Sharma, R. and O'Driscoll, J. 2019. Left ventricular function and cardiac biomarker release – the influence of exercise intensity, duration and mode: a systematic review and meta-analysis. Sports Medicine. https://doi.org/10.1007/s40279-019-01142-5
Cardiac maladaptation in obese pregnancy at term
Buddeberg, B., Sharma, R., O'Driscoll, J., Kaelin Agten, A., Khalil, A. and Thilaganathan, B. 2018. Cardiac maladaptation in obese pregnancy at term. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.20170
A 4-week resistance training intervention improves stability, strength and neuromuscular activity in the lower limb: a case study of a cerebral palsy adult
McManus, A., Bembridge, M., Scales, J., Wiles, J., Coleman, D. and O'Driscoll, J. 2018. A 4-week resistance training intervention improves stability, strength and neuromuscular activity in the lower limb: a case study of a cerebral palsy adult. International Journal of Sports Science & Medicine. 2 (2), pp. 050-055.
Neurohumoral and ambulatory haemodynamic adaptations following isometric exercise training in unmedicated hypertensive patients
Taylor, K., Wiles, J., Coleman, D., Leeson, P., Sharma, R. and O'Driscoll, J. 2018. Neurohumoral and ambulatory haemodynamic adaptations following isometric exercise training in unmedicated hypertensive patients. Journal of Hypertension. https://doi.org/10.1097/HJH.0000000000001922
Cardiac autonomic and left ventricular mechanics following high intensity interval training: a randomised cross-over controlled study.
O'Driscoll, J., Wrigth, S., Taylor, K., Coleman, D., Sharma, R. and Wiles, J. 2018. Cardiac autonomic and left ventricular mechanics following high intensity interval training: a randomised cross-over controlled study. Journal of Applied Physiology. https://doi.org/10.1152/japplphysiol.00056.2018
Cardiac maladaptation in term pregnancies with preeclampsia
Buddeberg, B., Sharma, R., O'Driscoll, J., Kaelin Agten, A., Khalil, A. and Thilaganathan, B. 2018. Cardiac maladaptation in term pregnancies with preeclampsia. Pregnancy Hypertension. 13, pp. 198-203. https://doi.org/10.1016/j.preghy.2018.06.015
The safety of isometric exercise: rethinking the exercise prescription paradigm for those with stage 1 hypertension.
Wiles, J., Taylor, K., Coleman, D., Sharma, R. and O'Driscoll, J. 2018. The safety of isometric exercise: rethinking the exercise prescription paradigm for those with stage 1 hypertension. Medicine. 97 (10). https://doi.org/10.1097/MD.0000000000010105
An alternative approach to isometric exercise training prescription for cardiovascular health
Wiles, J., Goldring, N., O'Driscoll, J., Taylor, K. and Coleman, D. 2018. An alternative approach to isometric exercise training prescription for cardiovascular health. Translational Journal of the American College of Sports Medicine. 3 (2), pp. 10-18. https://doi.org/10.1249/TJX.0000000000000052
Baseline mitral regurgitation predicts outcome in patients referred for dobutamine stress echocardiography
O'Driscoll, J., Gargallo-Fernandez, P., Araco, M., Perez-Lopez, M. and Sharma, R. 2017. Baseline mitral regurgitation predicts outcome in patients referred for dobutamine stress echocardiography. International Journal of Cardiovascular Imaging. https://doi.org/10.1007/s10554-017-1163-6
Blood pressure responses to isometric exercise: safety considerations for exercise prescription
Wiles, J., Taylor, K., Coleman, D., Sharma, R. and O'Driscoll, J. 2017. Blood pressure responses to isometric exercise: safety considerations for exercise prescription.
Ambulatory blood pressure responses to home-based isometric exercise training in pre-hypertensive males
Taylor, K., Wiles, J., Coleman, D., Sharma, R. and O'Driscoll, J. 2017. Ambulatory blood pressure responses to home-based isometric exercise training in pre-hypertensive males.
Cardiac autonomic modulation and high intensity interval training in physically inactive men
O'Driscoll, J., Wright, S., Taylor, K., Coleman, D. and Wiles, J. 2017. Cardiac autonomic modulation and high intensity interval training in physically inactive men.
A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training
Steele, J., Fisher, J., Skivington, M., Dunn, C., Arnold, J., Tew, G., Batterham, A., Nunan, D., O'Driscoll, J., Mann, S., Beedie, C., Jobson, S., Smith, D., Vigotsky, A., Phillips, S., Estabrooks, P. and Winett, R. 2017. A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training. BMC Public Health. https://doi.org/10.1186/s12889-017-4209-8
Continuous cardiac autonomic and haemodynamic responses to isometric exercise in pre-hypertensive males
Taylor, K., Wiles, J., Coleman, D., Sharma, R. and O'Driscoll, J. 2017. Continuous cardiac autonomic and haemodynamic responses to isometric exercise in pre-hypertensive males. Medicine & Science in Sports & Exercise (MSSE). https://doi.org/10.1249/MSS.0000000000001271
Acute cardiac functional and mechanical responses to isometric exercise in pre-hypertensive males
O'Driscoll, J., Taylor, K., Wiles, J., Coleman, D. and Sharma, R. 2017. Acute cardiac functional and mechanical responses to isometric exercise in pre-hypertensive males. Physiological Reports. https://doi.org/10.14814/phy2.13236
Body mass index mortality paradox in chronic kidney disease patients with suspected cardiac chest pain
O'Driscoll, J., Slee, A. and Sharma, R. 2017. Body mass index mortality paradox in chronic kidney disease patients with suspected cardiac chest pain. Journal of Cachexia, Sarcopenia and Muscle Clinical Reports. 2 (1).
Strongman training – Needs analysis and integration into strength and conditioning programming: part 2.
McManus, A., O'Driscoll, J., Coleman, D. and Wiles, J. 2016. Strongman training – Needs analysis and integration into strength and conditioning programming: part 2. Professional Strength & Conditioning. 44, pp. 7-15.
Strongman training – a rationale for its inclusion in strength & conditioning: part 1
McManus, A., Wiles, J., Coleman, D. and O'Driscoll, J. 2016. Strongman training – a rationale for its inclusion in strength & conditioning: part 1. Professional Strength & Conditioning. 43, pp. 7-18.
Acute cardiac autonomic responses to an incremental isometric exercise test in pre-hypertensive males
Taylor, K., Wiles, J., Coleman, D., Sharma, R. and O'Driscoll, J. 2016. Acute cardiac autonomic responses to an incremental isometric exercise test in pre-hypertensive males.
Transthoracic echocardiography provides important long-term prognostic information in selected patients undergoing endovascular abdominal aortic repair
O'Driscoll, J., Bahia, S., Gravina, A., Di Fino, S., Thompson, M., Karthikesalingam, A., Holt, P. and Sharma, R. 2016. Transthoracic echocardiography provides important long-term prognostic information in selected patients undergoing endovascular abdominal aortic repair. Circulation Cardiovascular Imaging. https://doi.org/10.1161/CIRCIMAGING.115.003557
Reverse left ventricular remodelling - effect of cardiac rehabilitation exercise training in myocardial infarction patients with preserved ejection fraction
McGregor, G., Gaze, D., Oxborough, D., O'Driscoll, J. and Shave, R. 2015. Reverse left ventricular remodelling - effect of cardiac rehabilitation exercise training in myocardial infarction patients with preserved ejection fraction. European Journal of Physcial and Rehabilitation Medicine. 52 (3), pp. 370-378.
The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients
O'Driscoll, J., Rossato, C., Gargallo-Fernandez, P., Araco, M., Giannoglou, D., Sharma, S. and Sharma, R. 2015. The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients. Cardiovascular Ultrasound. 13 (36). https://doi.org/10.1186/s12947-015-0028-1
Non-invasive assessment of the autonomic nervous system
O'Driscoll, J. and Sharma, R. 2015. Non-invasive assessment of the autonomic nervous system. International Journal of Clinical Therapeutics and Diagnosis. 3 (3), pp. 85-91.
Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia
Sharma, R., O'Driscoll, J., Saha, A., Sritharan, M., Sutton, R. and Rosen, S. 2015. Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia. The Journal of Physiology. 593 (9), pp. 2171-2184. https://doi.org/10.1113/JP270063
The safety and clinical usefulness of dobutamine stress echocardiography among octogenarians
O'Driscoll, J., Marciniak, A., Ray, K., Schmid, K., Smith, R. and Sharma, R. 2014. The safety and clinical usefulness of dobutamine stress echocardiography among octogenarians. Heart. 2014 (100), pp. 1001-1007. https://doi.org/10.1136/heartjnl-2013-305229
The implementation of problem based learning styles to teach the Coach-Athlete relationship to undergraduate Sport and Exercise Science students
Rossato, C. and O'Driscoll, J. 2013. The implementation of problem based learning styles to teach the Coach-Athlete relationship to undergraduate Sport and Exercise Science students. International Journal of Sport Studies. 3, pp. 859-864.
Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia
Sharma, R., O'Driscoll, J., Bromley, P., Sritharan, M. and Rosen, S. 2008. Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia.
Dobutamine stress echocardiography accurately detects significant coronary artery disease in Indian Asians living in the United Kingdom
Itam, S., O'Driscoll, J., Milad, E. and Sharma, R. 2008. Dobutamine stress echocardiography accurately detects significant coronary artery disease in Indian Asians living in the United Kingdom.
The effects of a high-protein, paleolithic-type diet on body composition and exercise performance in amateur mixed martial artists
Slee, A., O'Driscoll, J., Burnet, S., Hughes, G. and Chen, M. 2009. The effects of a high-protein, paleolithic-type diet on body composition and exercise performance in amateur mixed martial artists.
Subjective global assessment is an independent predictor of cardiac ischaemia in patients with mild chronic kidney disease
Aldous, G., Sharma, R., O'Driscoll, J., Ashby, D., Tarn, F. and Choi, P. 2010. Subjective global assessment is an independent predictor of cardiac ischaemia in patients with mild chronic kidney disease.
A National Health Service hospital's cardiac rehabilitation programme: a qualitative analysis of provision
O'Driscoll, J., Shave, R. and Cushion, C. 2007. A National Health Service hospital's cardiac rehabilitation programme: a qualitative analysis of provision. Journal of Clinical Nursing. 16 (10), pp. 1908-1918. https://doi.org/10.1111/j.1365-2702.2007.01815.x
Inequalities in the training and implementation of cardiac rehabilitation in the United Kingdom
O'Driscoll, J. and Sharma, R. 2009. Inequalities in the training and implementation of cardiac rehabilitation in the United Kingdom. in: Bennington, E. (ed.) Horizons in World Cardiovascular Research Hauppauge, New York Nova Science Publishers.