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Gestational changes in left ventricular myocardial contractile function: new insights from two-dimensional speckle tracking echocardiography

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Abstract

The goal of this study was to evaluate the impact of pregnancy and labor on left ventricular (LV) myocardial mechanics using speckle tracking echocardiography (STE). Pregnancy is characterized by profound hormonal and hemodynamic alterations that directly or indirectly influence cardiac structure and function. However, the impact of these changes on left ventricular (LV) myocardial contractile function has not been fully elucidated. In this prospective, longitudinal study, 35 pregnant women underwent serial clinical and echocardiographic evaluation during each trimester and at labor. Two dimensional STE was performed to measure global LV longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively). Similar data obtained from 20 nulliparous, age-matched women were used as control. All strain values during pregnancy were adjusted for age and hemodynamic parameters. There was a progressive increase in heart rate, systolic and diastolic blood pressure, cardiac output and LV stroke-work during pregnancy. LV end-diastolic and end-systolic volumes also increased progressively but LV ejection fraction remained unaltered, except for slight reduction during the second trimester. Compared to the controls, GLS and GCS were reduced in the first trimester itself (GLS −22.39 ± 5.43 % vs. −18.66 ± 0.64 %, P 0.0002; GCS −20.84 ± 3.20 vs. −17.88 ± 0.09, P < 0.001) and remained so throughout the pregnancy and labor. In contrast, GRS showed an increase during pregnancy which peaked during the second trimester (24.18 ± 0.39 % vs. 18.06 ± 8.14 % in controls, P < 0.001). Alterations in loading conditions during pregnancy are associated with counterbalancing changes in the myocardial mechanics. LV longitudinal and circumferential strain are reduced whereas radial strain is increased. These counterbalancing changes serve to maintain overall LV ejection performance within a normal range and enable the maternal heart to meet the hemodynamic demands of pregnancy and labor.

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Abbreviations

A:

Mitral inflow late diastolic velocity

BP:

Blood pressure

CS:

Circumferential strain

E:

Mitral inflow early diastolic velocity

E′:

Early diastolic mitral annular velocity

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

LA:

Left atrial

LAV:

Left atrial volume

LS:

Longitudinal strain

LV:

Left ventricular

RS:

Radial strain

STE:

Speckle tracking echocardiography

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Authors and Affiliations

  1. Sengupta Hospital and Research Institute, Ravinagar, Nagpur, India

    Shantanu P. Sengupta

  2. Medanta-The Medicity, Gurgaon, India

    Manish Bansal

  3. Cardiology Centre, Utrecht, The Netherlands

    Leonard Hofstra

  4. Mount Sinai School of Medicine, New York, NY, USA

    Partho P. Sengupta & Jagat Narula

Authors
  1. Shantanu P. Sengupta
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  2. Manish Bansal
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  3. Leonard Hofstra
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  4. Partho P. Sengupta
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  5. Jagat Narula
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Correspondence to Shantanu P. Sengupta.

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Informed consent was obtained from all individual participants included in the study and the study was approved by the institutional ethics committee.

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Sengupta, S.P., Bansal, M., Hofstra, L. et al. Gestational changes in left ventricular myocardial contractile function: new insights from two-dimensional speckle tracking echocardiography. Int J Cardiovasc Imaging 33, 69–82 (2017). https://doi.org/10.1007/s10554-016-0977-y

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  • DOI: https://doi.org/10.1007/s10554-016-0977-y

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