Methods
This prospective study was performed in a tertiary center and included a total of 600 consecutive women (200 consecutive women who had no parity, 200 women who had a parity number from1 to 4and 200 women who had a parity number more than 4). The minimum time of pregnancy-free interval was 12 months. The duration of study was 4 months, from July 2020 to October 2020.The patients who had no structural heart disease, history of preeclampsia and eclampsia, atrial fibrillation, neither structural nor vascular pulmonary disease, any autoimmune disease and any systemic disorder with the exception of obesity, hypertension (HT), hyperlipidemia (HL) and diabetes mellitus (DM) are included in the present study in order to eliminate the other factors that can cause morphological changes in RV. Ethical clearance was obtained from the ethics and research committee of our university. All participants gave written informed consent before enrollment in the study. The research was conducted in accordance with the principles of the Declaration of Helsinki.
HT was defined as systolic pressure greater than 140 mm Hg or diastolic pressure greater than 90 mm Hg. DM was defined as the use of insulin or antidiabetic agents in the patient’s medical history or a fasting glucose level greater than 126 mg/dl. HL was defined as serum total cholesterol > 240 mg/dl, serum triglyceride >200 mg/dl, low-density lipoprotein cholesterol >130 mg/dl, and previously diagnosed HL. Echocardiogram was performed using a Vivid 7 system (GE Vingmed Ultrasound AS, Horten, Norway). The parameters assessed were RV length, basal and mid diameters in cm , RV free wall thickness in mm, RV systolic and diastolic areas in cm2, right atrial (RA) area in cm2and RA volume in cm3,fractional area change (FAC), DTI-derived tricuspid lateral annular systolic velocity wave (S’) in cm/s, tricuspid annular plane systolic excursion (TAPSE) in cm, estimated pulmonary arterial pressure (PAP) calculated using the tricuspid regurgitation jet, LV end-diastolic dimension and LV ejection fraction. The measurements were done according to American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines (5). RV dilation was defined as RV basal diameter greater than 4,1 cm. RV hypertrophy was defined as RV free wall thickness greater than 5 mm.