LAUSR

Introduction During pregnancy, left ventricular (LV) diastolic function is of utmost importance to accommodate the increased preload in order to maintain increased cardiac output without triggering excessive sympathetic-tone-regulated reliance on heart rate. Insight in the physiological adaptation of diastolic function during pregnancy may enable the identification of women with impaired cardiac compliance, maladaptive to the pregnancy associated volume overload. Objective To meta-analytically determine the pattern of diastolic function indices during singleton normotensive pregnancies and hypertensive complicated pregnancies. Methods We performed a systematic review and meta-analysis on diastolic function during pregnancy using PubMed and Embase. We included studies that reported a non-pregnant reference measurement. Indices of interest were: mitral E-wave velocity, mitral A-wave velocity, E/A ratio, and left atrial volume (LAV). Mean differences between pregnant and reference measurements were calculated for predefined gestational age intervals using a random-effects model. Results We included 29 eligible studies. Normotensive pregnancies were characterized by a larger increase in passive LV filling (E-wave, 12%) compared to active LV filling during diastole (A-wave, 5%) resulting in a 17% increase of the E/A ratio in the first trimester. The E/A ratio progressively decreased during advancing gestation with 18%, resulting from normalized E-waves and increased A-waves. Hypertensive complicated pregnancies had a tendency of a larger decrease of the E/A ratio although not statistically significant (31%, p = 0.74). LAV increased more in hypertensive pregnancies compared to normotensive pregnancies (30% vs. 112% respectively, p  Discussion Diastolic function in normotensive pregnancy is mainly dominated by passive filling in the first trimester while more by active filling later on in pregnancy. The E/A ratio therefore increases in the first trimester, to eventually progressively decrease in the second half of pregnancy. Stronger decline in E/A ratio along with concomitant increase in LAV in hypertensive pregnancies suggest fortified loss in cardiac diastolic function.