Evaluation of myocardial function in pregnant women with speckle-tracking echocardiography

Abstract

Objectives: The speckle-tracking technique calculates the regional rate, the strain and the strain rate from two-dimensional gray-scale visualizations. The aim of this study was to evaluate with speckle-tracking echocardiography the effects of the first, second and third trimesters of pregnancy on cardiac functions.

Methods: One hundred five voluntary pregnant and 35 healthy women of reproductive age were included in the study. For echocardiographic evaluations, the 111 highest-quality visualizations were chosen: 24 cases in the first trimester, 31 cases in the second trimester, 32 cases in the third trimester and 24 healthy women as a control group. Global longitudinal, radial, and circumferential strain, and left ventricular (LV) rotation and twist were evaluated by two-dimensional speckle tracking echocardiography.

Results: During pregnancy, the diameter, and volume of the left atrium, LV stroke volume, and the heart rate significantly increased beginning in the first trimester (p < 0.0125). The parameters of pulse-Doppler E velocity and tissue Doppler Em velocity significantly increased in the first trimester (p < 0.0125), whereas in the second and third trimester they decreased to control levels. Global longitudinal strain was significantly decreased in the third trimester of the pregnancy (p < 0.0125). Basal and apical LV rotation and twist were significantly increased in the third trimester of pregnancy (p < 0.0125). LV apical and basal reverse rotation rate were significantly increased in the first trimester of pregnancy (p < 0.0125).

Conclusions: In the third trimester global longitudinal strain decreased whereas LV rotation and twist increased. Speckle-tracking echocardiography may be used to evaluate the effects of pregnancy and that provide further data on cardiac functions. 

Keywords

• Strain
• echocardiography
• tissue Doppler imaging
• pregnancy

References

1. 1. Clapp JF III, Capeless E. Cardiovascular function before, during and after the first and subsequent pregnancies. Am J Cardiol 1997;80:1469-73.
2. 2. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006; 47:789-93.
3. 3. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J 3rd. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960-8.
4. 4. Helle-Valle T, Crosby J, Edvardsen T, Lyseggen E, Amundsen BH, Smith HJ, et al. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 2005;112:3149-56.
5. 5. Teicholz LE, Kreulen T, Herman MW, Gorlin R. Problems in echocardiographic–angiographic correlations in the presence or absence of asynergy. Am J Cardiol 1976;37:7-11.
6. 6. Moran AM, Colan SD, Mauer MB, Geva T. Adaptive mechanisms of left ventricular diastolic function to the physiologic load of pregnancy. Clin Cardiol 2002;25:124-31.
7. 7. Tasar O, Kocabay G, Karagoz A, Kalayci Karabay A, Karabay CY, Kalkan S, et al. Evaluation of left atrial functions by 2-dimensional speckle-tracking echocardiography during healthy pregnancy. J Ultrasound Med 2019;38:2981-8.
8. 8. Kametas NA, McAuliffe F, Hancock J, Chambers J, Nicolaides KH. Maternal left ventricular mass and diastolic function during pregnancy. Ultrasound Obstet Gynecol 2001;18:460-6.

9. 9. Mesa A, Jessurun C, Hernandez A, Adam K, Brown D, Vaughn WK, et al. Left ventricular diastolic function in normal human pregnancy. Circulation 1999;99:511-7.
10. 10. Fok WY, Chan IY, Wong JT, Yu CM, Lau TK. Left ventricular diastolic function during normal pregnancy: assessment by spectral tissue Doppler imaging. Ultrasound Obstet Gynecol 2006;28:789-93.
11. 11. Schannwell CM, Zimmermann T, Schneppenheim M, Plehn G, Marx R, Strauer BE. Left ventricular hypertrophy and diastolic dysfunction in healthy pregnant women. Cardiology 2002;97:73-8.
12. 12. Bamfo JE, Kametas NA, Nicolaides KH, Chambers JB. Reference ranges for tissue Doppler measures of maternal systolic and diastolic left ventricular function. Ultrasound Obstet Gynecol 2007;29:414-20.
13. 13. Savu O, Jurcuţ R, Giuşcă S, van Mieghem T, Gussi I, Popescu BA, et al. Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging 2012;5:289-97.
14. 14. Cong J, Wang Z, Jin H, Wang W, Gong K, Meng Y, et al. Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China. Cardiovasc Ultrasound 2016;14:45.
15. 15. Kim HK, Sohn DW, Lee SE, Choi SY, Park JS, Kim YJ, et al. Assessment of left ventricular rotation and torsion with two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr 2007;20:45-53.
16. 16. Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T. Concentric left ventricular hypertrophy brings deterioration of systolic longitudinal, circumferential, and radial myocardial deformation in hypertensive patients with preserved left ventricular pump function. J Cardiol 2010;55:23-33.