EFFECTS OF REPEATED PREGNANCIES ON LEFT VENTRICULAR MUSCLE MASS IN INDIAN POPULATION
*Dr. Satyam Chakraborty, Anirban Sinha, Dr. Lakshmi Dey, Dr. Praveen Devarbhavi and Kingshuk Bhattacharjee
ABSTRACT
Background: Nothing much is known on the cardiological alterations that pregnancy bestows on an Indian female and whether these cardiological alterations reverse completely after the pregnancy episode is over and more so if these alterations leave any residual sequel in repeated episodes which may cause increased cardiological morbidity in Indian females. Aims: To assess the echo-cardiographic alterations in left ventricle due to repeated pregnancies in Indian population. Materials and Methods: A cross-sectional observational study with 150 Antepartum & Post-partum female patients coming for outdoor visits was randomly selected between September 2010 & October 2011. Respiratory & cardiological parameters were studied clinically by respiratory rate measurements at rest and after 6 –minute walk test. Electro-cardiographic assessments were done to rule out ST – Depression, T-Wave Inversions or any P-Wave abnormalities taking into account the changes in Axis which pregnancy itself can cause. Echo-cardiographic alterations in left ventricle were studied as per the study objective. Results: Number of Subjects having gravida smaller than 3 is 93 whereas the number of Subjects having gravida greater than or equal to 3 is 57. Subjects having gravida of not more than 2 having significant LV Mass is minimal but the situation changes drastically after gravida of 3 & above. After Gravida 5 the % of significant LV Mass (Ante-partum & Post-partum) is 100%,although the data strength is only of 10 Subjects. Based on the data given after 45 days of post pregnancy, it can be claimed with 95.5% confidence level that the LV mass would be within the following range for the specified gravida level. Thus from the present study, we state that with 95% confidence level we can say that if a patient’s gravida level is 1, her LV mass would be in the range of 82.44 --- 153.16 gm. Similarly, If the gravida level is 2 LV mass would be within 79.4 – 190.13 and if the gravida level is 3 LV mass would be within 109.62 – 192.02. If the gravida level is 4 LV mass would be within 97.52 – 214.76, If the gravida level is 5 LV mass would be within 131.99 – 277.50 , If the gravida level is 6 LV mass would be within 149.24 – 269.89 , If the gravida level is 7 LV mass would be within 167.36 – 236.78. Conclusion: Since the risk associated to LV mass appears to be progressive, without a clear threshold, additional input can be added at different baseline risks, defined by the prevalence of other known cardiovascular risk factors. The addition of multiple newer markers, however, leads to a small increment in risk stratification capacity over formulas applying only classical risk factors. Despite these limitations, the role of echocardiography in LV mass determination is of great clinical value. Considering all the aspects, use of echocardiography in clinical studies must be standardized applying already defined criteria. In delineating a study, if two-dimensional is impractical, then two-dimensional guided M-mode, using ASE criteria and Devereux modified formula, may allow estimation of LV mass with an acceptable level of accuracy.
Keywords: LV Mass, Gravida, Pregnancy, Echocardiography.
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