Changes in Maternal Left Ventricle During Pregnancy
Changes in Maternal Left Ventricle During Pregnancy
From the initially enrolled 87 participants, those with poor-quality images (5 participants), lacking at least 2 visits during pregnancy (6 participants), and those pregnancy-related pathology (1 late miscarriage, 2 gestational diabetes mellitus, 1 mild preeclampsia and 2 arterial hypertension during pregnancy) and with fetal abnormalities (2 participants) were excluded from the analysis. Finally, sixty-eight pregnant women were involved in the study. Their mean age was 29.6 ± 4.2 years (range 26 ~ 33 years). The mean age of the 30 participants of the control group was 30 ± 5.1 years (P not significant).
Table 1 summarizes the clinical and hemodynamic characteristics of the study population. Diastolic blood pressure and mean blood pressure were slightly reduced during the second trimester but followed by mild increase toward the third trimester. The cardiac index increased progressively by a mean of 33% between the first and third trimesters principally as a result of late increase in heart rate and in stroke volume.
Data of 2DE parameters are listed in Table 2. A progressive increase in LV diameters and LV wall thickness, consistent with the development of slight eccentric hypertrophy, was detected during pregnancy, which subsequently recovered postpartum. Of note, during the first trimester, indices of LV systolic function in pregnant women were similar to controls, however, both EF and s decreased slightly between the second and third trimesters, which turned to the level of control group after delivery.
3D echocardiography assessment of LV structure and function is reported in Table 3. Indices of LV volume, LV mass index (LVMi), SpI and cardiac index (CI) increased during pregnancy, while 3D EF tended to decrease in the third trimester and consequently recovered postpartum (Figure 3). GLS, GCS, GRS and GAS showed a significant decrease in the second and third trimester, and increased again postpartum (Figure 4). This behavior was found in almost all ventricular walls. The biggest differences were found in the anterior and some segments of inferoseptal, and anteroseptal walls (Table 4). Table 5 summarizes the univariate relations of 3D-derived strain in the pooled population. Among the strain components, GAS showed the strongest associations with 3D EF, SpI and LVMi. GAS showed strong correlations with GLS (r = 0.81, P < 0.01) and GCS (r = 0.82, P < 0.01).
(Enlarge Image)
Figure 3.
Evolution of maternal LV morphology and function during pregnancy and postpartum by 3D STE. Data are presented as mean ± SD. LVEDV indicates left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; LVEDVi, left ventricular end-diastolic volume index; EF, ejection fraction; CI, cardiac index; SVI, stroke volume index; LVMi, left ventricular mass index; LA index, left atrial volume index; *P < 0.05 vs. Controls; †P < 0.05 vs. Trimester 1; ‡P < 0.05 vs. Trimester 3; §P < 0.05 vs. Postpartum.
(Enlarge Image)
Figure 4.
Assessment of myocardial deformation during pregnancy and postpartum by 3D STE. Data are presented as mean ± SD. Note that GLS, GCS, GRS and GAS decreased in Trimester 3, while returned in postpartum. GLS indicates global longitudinal strain; GCS, global circumferential strain; GAS, global area strain; GRS, global radial strain. *P < 0.05 vs. Controls; †P < 0.05 vs. Trimester 1; ‡P < 0.05 vs. Trimester 3; §P < 0.05 vs. Postpartum.
For 3D STE measurements, intraobserver and interobserver variability were 7. 2% and 8.4% for LV EDV measurements; 6.8% and 7.6% for 3D EF measurements; 9.1% and 9.8% for LVMi measurements; and 8.1% and 8.6% for SpI measurements, respectively. Meanwhile, for deformation parameters, intraobserver and interobserver variability were 8.0% and 8.9% for GLS measurements, 9.0% and 9.6% for GCS measurements, 7.1% and 8.4% for GAS measurements as well as 9.4% and 11.2% for GRS measurements, respectively.
Results
Study Subjects
From the initially enrolled 87 participants, those with poor-quality images (5 participants), lacking at least 2 visits during pregnancy (6 participants), and those pregnancy-related pathology (1 late miscarriage, 2 gestational diabetes mellitus, 1 mild preeclampsia and 2 arterial hypertension during pregnancy) and with fetal abnormalities (2 participants) were excluded from the analysis. Finally, sixty-eight pregnant women were involved in the study. Their mean age was 29.6 ± 4.2 years (range 26 ~ 33 years). The mean age of the 30 participants of the control group was 30 ± 5.1 years (P not significant).
Evolution of Clinical and Hemodynamic Characteristics
Table 1 summarizes the clinical and hemodynamic characteristics of the study population. Diastolic blood pressure and mean blood pressure were slightly reduced during the second trimester but followed by mild increase toward the third trimester. The cardiac index increased progressively by a mean of 33% between the first and third trimesters principally as a result of late increase in heart rate and in stroke volume.
Evolution of 2D Echocardiographic Assessment
Data of 2DE parameters are listed in Table 2. A progressive increase in LV diameters and LV wall thickness, consistent with the development of slight eccentric hypertrophy, was detected during pregnancy, which subsequently recovered postpartum. Of note, during the first trimester, indices of LV systolic function in pregnant women were similar to controls, however, both EF and s decreased slightly between the second and third trimesters, which turned to the level of control group after delivery.
Evolution of 3D Echocardiographic Assessment
3D echocardiography assessment of LV structure and function is reported in Table 3. Indices of LV volume, LV mass index (LVMi), SpI and cardiac index (CI) increased during pregnancy, while 3D EF tended to decrease in the third trimester and consequently recovered postpartum (Figure 3). GLS, GCS, GRS and GAS showed a significant decrease in the second and third trimester, and increased again postpartum (Figure 4). This behavior was found in almost all ventricular walls. The biggest differences were found in the anterior and some segments of inferoseptal, and anteroseptal walls (Table 4). Table 5 summarizes the univariate relations of 3D-derived strain in the pooled population. Among the strain components, GAS showed the strongest associations with 3D EF, SpI and LVMi. GAS showed strong correlations with GLS (r = 0.81, P < 0.01) and GCS (r = 0.82, P < 0.01).
(Enlarge Image)
Figure 3.
Evolution of maternal LV morphology and function during pregnancy and postpartum by 3D STE. Data are presented as mean ± SD. LVEDV indicates left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; LVEDVi, left ventricular end-diastolic volume index; EF, ejection fraction; CI, cardiac index; SVI, stroke volume index; LVMi, left ventricular mass index; LA index, left atrial volume index; *P < 0.05 vs. Controls; †P < 0.05 vs. Trimester 1; ‡P < 0.05 vs. Trimester 3; §P < 0.05 vs. Postpartum.
(Enlarge Image)
Figure 4.
Assessment of myocardial deformation during pregnancy and postpartum by 3D STE. Data are presented as mean ± SD. Note that GLS, GCS, GRS and GAS decreased in Trimester 3, while returned in postpartum. GLS indicates global longitudinal strain; GCS, global circumferential strain; GAS, global area strain; GRS, global radial strain. *P < 0.05 vs. Controls; †P < 0.05 vs. Trimester 1; ‡P < 0.05 vs. Trimester 3; §P < 0.05 vs. Postpartum.
Reproducibility
For 3D STE measurements, intraobserver and interobserver variability were 7. 2% and 8.4% for LV EDV measurements; 6.8% and 7.6% for 3D EF measurements; 9.1% and 9.8% for LVMi measurements; and 8.1% and 8.6% for SpI measurements, respectively. Meanwhile, for deformation parameters, intraobserver and interobserver variability were 8.0% and 8.9% for GLS measurements, 9.0% and 9.6% for GCS measurements, 7.1% and 8.4% for GAS measurements as well as 9.4% and 11.2% for GRS measurements, respectively.
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