CRT-407 Physiological Adaptation of the Left Ventricle during Healthy Pregnancy assessed by Two-Dimensional Speckle Tracking Echocardiography

Ando, Tomo; Kaur, Rupinder; Holmes, Anthony A.; Brusati, A.; Fujikura, Kana; Taub, Cynthia C.

doi:10.1016/j.jcin.2014.12.148

Cited by 16 publications

(21 citation statements)

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“…The indices of LV myocardial strain describe ventricular deformation at regional level, which have been demonstrated to be more sensitive and accurate in the identification of LV functional impairment compared with global performance of the heart [11, 12]. A number of studies on maternal myocardial deformation during pregnancy have been published, but there is still controversy regarding the changes in LV performance [2–4, 13, 14]. Moreover, these findings analyzed the myocardial function considering the complete wall thickness without further distinction between different layers of the myocardium.…”

Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China

Cong

Wang

Jin³

et al. 2016

Cardiovasc Ultrasound

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BackgroundThe myocardial wall of the left ventricle is a complex, multilayered structure and is not homogenous. The aim of this study was to determine longitudinal strain (LS) in the three myocardial layers in normal pregnant women according to gestation proceedings.MethodsThe advanced two-dimensional speckle tracking echocardiography (2D STE) was performed on 62 women during each pregnancy trimester and 6 to 9 weeks after delivery, while 30 age-matched, healthy, nonpregnant women served as controls. LS on endocardial, mid-myocardial and epicardial layers at 18 cardiac segments were measured.ResultsAs gestation proceeded, all of layer-specific LS and global LS progressively decreased, which subsequently recovered postpartum (P < 0.05), and the LS gradient between inner and outer myocardium became greater, which reached its maximum in the late pregnancy. Peak systolic LS was the highest at endocardium and the lowest at epicardium, while the highest at the apical level and the lowest at the base (P < 0.05). In the early pregnancy and postpartum, LS at basal level was homogenous, meanwhile layer-specific LS showed significant differences at mid-ventricular and apical level throughout the progress of normal pregnancy (P < 0.05).ConclusionsUsing 2D STE, three-layer assessment of LS can be performed in pregnant women and shall give us new insights into the quantitative analysis of global and regional LV function during pregnancy. Future studies on the detection of pregnancy related heart disease would require these parameters as reference values for each time point of a normal pregnancy.

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Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China

Cong

Wang

Jin³

et al. 2016

Cardiovasc Ultrasound

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“…In the first trimester, RWT did not change (mean difference, 0.01 (95% CI, 0.00-0.02) (% change, 3.62 (95% CI, 0.00-7.25)%)) (Table 3, Figure 4). Only one included study provided a value for RWT suitable for inclusion in the 15-21-week gestational-age interval (0.01 (95% CI, -0.03 to 0.05) (% change, 2.94 (95% CI, -8.82 to 14.71)%)) 20 . The first statistically significant increase in RWT was seen between 22 and 28 weeks, with a value Only first author of each study is given.…”

Section: Relative Wall Thicknessmentioning

confidence: 99%

Cardiac remodeling in normotensive pregnancy and in pregnancy complicated by hypertension: systematic review and meta‐analysis

Haas

Ghossein‐Doha

Geerts

et al. 2017

Ultrasound in Obstet & Gyne

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During normotensive pregnancy, most cardiac geometric indices change from the second trimester onwards. Both LVM and RWT increase, by 20% and 10%, respectively, consistent with concentric rather than eccentric remodeling. Cardiac adaptation in hypertensive pregnancy deviates from that in healthy pregnancy by a greater change in LVM (95% increase from reference) and RWT (56% increase from reference). Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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“…In order to meet the demands of gestation, significant cardiac adaptations occur in healthy pregnant women, including increased cardiac output secondary to increased preload and heart rate (HR) and reduced afterload 1 . Despite these favorable hemodynamic changes, it has previously been suggested that systolic function, as assessed by ejection fraction (EF), may decrease [2][3][4] or remain unchanged in pregnancy [5][6][7] . However, EF is insensitive to underpinning hemodynamic load, and represents an oversimplified marker of myocardial function by providing only a relative change in ventricular volume 8 .…”

Section: Introductionmentioning

confidence: 99%

Left ventricular mechanics in late second trimester of healthy pregnancy

Meah

Backx

Cockcroft

et al. 2019

Ultrasound in Obstet & Gyne

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INTRODUCTION: Healthy pregnancy causes significant changes in maternal hemodynamics that lead to structural and functional adaptation of a woman's heart. Reductions in ejection fraction have been reported in healthy pregnancy; however, this measure of cardiac contractile function is over simplistic and insensitive to the underpinning hemodynamic load. Indices of systolic myocardial deformation, such as left ventricular strain and twist ('LV mechanics') may therefore provide a more accurate assessment of cardiac function during gestation. As such, the aim of this study was to evaluate LV mechanics in the second trimester of healthy pregnancy and secondly, to determine the influence of underpinning hemodynamics (heart rate (HR), preload and afterload) on LV mechanics during gestation. METHODS: We conducted a cross-sectional study of non-pregnant (n=18), primiparous pregnant (22-26 weeks gestation; n=14) and postpartum (12-16 weeks after delivery; n=13) women. All pregnant and postpartum women had uncomplicated, singleton gestations. Cardiac structure and function were assessed using echocardiography. LV mechanics, specifically longitudinal strain, circumferential strain and twist/untwist, were measured using speckletracking echocardiography. Differences between groups were identified using ANCOVA, with age, HR, end-diastolic volume (EDV) and systolic blood pressure (SBP) as covariates. Relationships between LV mechanics and hemodynamics were examined using Pearson's correlation. RESULTS: Pregnant women had significantly greater resting longitudinal and basal circumferential strain compared to non-pregnant women (-22±2 vs.

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CRT-407 Physiological Adaptation of the Left Ventricle during Healthy Pregnancy assessed by Two-Dimensional Speckle Tracking Echocardiography

Cited by 16 publications

References 0 publications

Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China

Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China

Cardiac remodeling in normotensive pregnancy and in pregnancy complicated by hypertension: systematic review and meta‐analysis

Left ventricular mechanics in late second trimester of healthy pregnancy

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