Maternal left ventricular transverse and long-axis systolic function during pregnancy (original) (raw)
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Altered maternal left ventricular contractility and function during normal pregnancy
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To evaluate maternal left ventricular (LV) systolic and diastolic function during normal pregnancy by non-invasive measures of LV contractility incorporating loading conditions. Sixty-five women were examined using echocardiography, including tissue Doppler and two-dimensional speckle tracking, and subclavian artery pulse trace recordings at gestational weeks 14-16, 22-24 and 36, and at 6 months postpartum. The mean ± SD age of the women was 32.0 ± 4.6 years. Cardiac output and LV end-diastolic volume were on average 20% and 23% higher, respectively, during pregnancy, compared to that at 6 months postpartum (both, P < 0.01). LV ejection fraction, global peak systolic strain and rate-corrected LV velocity of circumferential fiber shortening (Vcfc) were 11%, 6% and 6% lower, respectively, at 36 weeks' gestation compared to at 6 months postpartum (all, P < 0.01). Afterload, measured as LV end-systolic wall stress (ESWS) increased by 10% between 14-16 and 36 weeks' gestati...
Maternal left ventricular diastolic and systolic long-axis function during normal pregnancy
European Journal of Echocardiography, 2007
Aims: The aim of this study was to evaluate left ventricular (LV) function during normal pregnancy and investigate the effect of maternal factors. Little information about LV diastolic and long-axis systolic function in normal pregnancy exists. Methods and results: Two hundred and twenty eight Doppler echocardiography and DTI studies of the mitral annulus were performed in 63 normal pregnant women longitudinally at 11e14, 20e24, 26e32, 33e38 weeks and 8e12 weeks postpartum. Cardiac output, stroke volume and heart rate increased during pregnancy and total vascular resistance decreased. Long-axis shortening decreased, transmitral A velocity increased (p ¼ 0.003) and the ratio of transmitral E to A velocity decreased (p ¼ 0.001). DTI early diastolic velocity (E 0 ) decreased and late diastolic velocity (A 0 ) remained unaltered. DTI systolic velocity (S 0 ) and the E/E 0 ratio did not change significantly during pregnancy. Tei index increased throughout pregnancy (p ¼ 0.03). Maternal age was related to E velocity (p ¼ 0.001) and E/A ratio (p ¼ 0.001) while ethnicity was related to cardiac output (p < 0.001), stroke volume (p < 0.02) and heart rate (p < 0.0001). Conclusion: This study gives normal ranges for Doppler tissue imaging measurements, but demonstrates that maternal characteristics may affect these and all measures of systolic and diastolic function.
Obstetrics & Gynecology, 1997
Objective: To investigate the hemodynamic changes occurring in normal pregnancy and to see if these changes were associated with an increase in myocardial contractility. Methods: In a longitudinal study, primigravidas were studied with echocardiography in early (15 + 1.8 weeks), mid (26 rt 1.2 weeks), and late (36 f 1.0 weeks) gestation, as well as at 6 weeks postpartum. Cardiac dimensions were measured with two-dimensional and M-mode echocardiography and hemodynamic indices were calculated. All measurements were made with subjects in the left lateral decubitus position. Statistical analysis was performed with repeated measures analysis of variance. Results: Seventy-six women with normal pregnancy outcomes completed all four studies. From the baseline study to late gestation, an increase in cardiac output of 27% (from [mean f standard error] 4.2 f 0.1 to 5.8 f 0.2 L/min, P = .OOl), and a decrease in total peripheral resistance of 33% (from 1356-C 69 to 941 f 37 dynes/second cmm5, P = .OOl) occurred. Over this same time period, left ventricular function, while demonstrating a small and non-significant increase in velocity of circumferential fiber shortening (from 1.25 f 0.02 to 1.27-C 0.02 cm/second), revealed a 12% decrease in wall stress (from 36.3 + 1.0 to 31.9 + 1.0 g/cm', P = .OOl) and a 13% decrease in the load-independent wall stress to velocity of circumferential fiber shortening ratio (from 30.0 f 1.2 to 26.1 f 1.0, P = .Ol), implying enhanced intrinsic myocardial contractility. Conclusion: Normal pregnancy is characterized by enhanced myocardial performance.
Maternal left ventricular mass and diastolic function during pregnancy
Ultrasound in Obstetrics and Gynecology, 2001
Objective To evaluate changes in left ventricular mass and diastolic function during normal pregnancy. Methods This was a cross-sectional study of 125 pregnant women at 9-42 weeks of gestation and 19 non-pregnant female controls. Two-dimensional and M-mode echocardiography of the maternal left ventricle and left atrium was performed. Results During pregnancy left ventricular mass increased by 52%. There was an increase in left ventricular end-diastolic and end-systolic diameters (12% and 20%, respectively), left ventricular posterior wall diameter during diastole and systole (22% and 13%, respectively) and left intraventricular septum during diastole and systole (15% and 19%, respectively). Mitral valve A-wave maximum velocity increased during pregnancy by 19%, while mitral valve E-wave maximum velocity and the ratio of E-wave/A-wave velocities increased early in pregnancy by about 14% and 6%, respectively, with a subsequent decline to 4% and 10%, respectively, below non-pregnant levels. Conclusion Left ventricular mass increases during pregnancy, while left ventricular diastolic function, as demonstrated by the changes in mitral valve flow velocities, increases in the first two trimesters but declines in the third trimester.
Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy
Journal of the American Society of Echocardiography, 2013
Background: The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy. Methods: Forty-four healthy fetuses were examined prospectively during the second-trimester and thirdtrimester ultrasound examinations (20-24 and 30-34 weeks, respectively). Clips with high frame rates (mean, 120 frames/sec) of two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses of global and regional walls and segments (basal, mid, and apical) of myocardial strain and strain rate as well as T2P global strain in the longitudinal direction. Results: There were statistically significant decreases in global and regional strain of the right ventricle between the second and third trimesters. No statistically significant changes were observed in global and regional strain of the left ventricle. Global and regional strain rates of both ventricles decreased in a similar way during pregnancy. The mean T2P longitudinal left ventricular global strain (adjusted for heart rate) increased mildly during fetal life. Whereas T2P longitudinal strain of the left ventricle at 20 to 24 weeks was statistically significantly shorter than that of the right ventricle, no difference in T2P longitudinal strain was found at 30 to 34 weeks of gestation between both ventricles. Conclusions: The establishment of these changes between the second-trimester and third-trimester twodimensional speckle-tracking echocardiography-derived reference values is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.
Maternal Diastolic Dysfunction and Left Ventricular Geometry in Gestational Hypertension
Hypertension, 2001
The objective of this study was to evaluate diastolic parameters and left ventricular geometry in gestational hypertension. Twenty-one consecutive pregnant women with gestational hypertension and 21 normotensive women matched for age and gestational age were enrolled in the third trimester of gestation. Echocardiographic and uterine color Doppler evaluations were performed. Systolic, diastolic, and mean blood pressure, total vascular resistance (TVR), and uterine resistance index were higher in hypertensive women than in control subjects (PϽ0.01). Left atrial function and cardiac output were significantly lower in gestational hypertension (PϽ0.01). Patients with gestational hypertension had longer left ventricular isovolumetric relaxation time (IVRT) (PϽ0.0001); lower velocity-time integral of the A wave (PϽ0.05) and of the diastolic pulmonary vein flow (PϽ0.05); and higher velocity-time integral of the reverse pulmonary vein flow (PϽ0.05). Systolic fraction of the pulmonary vein flow was higher in women with gestational hypertension than in control subjects (PϽ0.01); the difference in duration of pulmonary vein flow and A wave was closer to 0 in gestational hypertension (PϽ0.0001). Altered left ventricular geometry was found in 100% of hypertensive patients and in 19.05% of normotensive patients (PϽ0.001). IVRT, left ventricular end-systolic volume, atrial function, and uterine resistance index were directly related to TVR (PϽ0.01); deceleration time of the E wave showed a quadratic correlation with TVR (PϽ0.01). Gestational hypertension is characterized by an altered cardiac geometric pattern of concentric hypertrophy. The altered geometric pattern assessed during gestational hypertension is associated, in our study, with depressed systolic function, high TVR, altered diastolic function, and left atrial dysfunction. Deceleration time of the E wave, IVRT, and left atrial fractional area change, found in concomitance with the highest TVR, may be useful in the evaluation of cardiac function and hemodynamics present in pregnancy-induced hypertension. (Hypertension. 2001;37: 1209-1215.)
Effects of gestational hypertension on left ventricular geometry
Kardiologia polska
During pregnancy heart rate, stroke volume, cardiac output and left ventricular (LV) mass increase while peripheral vascular resistance decreases. Gestational hypertension (GHT) which is noted in some pregnancies during the third trimester, is considered a temporary condition. Its effects on LV geometry are not known. To assess the effects of acute pressure overload in GHT on the LV geometry. Forty three pregnant women (mean age 28.7+/-8.9 years) with GHT were included in the study (Group A). Blood pressure levels >140/90 mmHg were considered diagnostic for GHT. Fifty six pregnant women (mean age 25.7+/-5.7 years) with normal blood pressure formed the control group (Group B). Transthoracic echocardiography was performed in all subjects before delivery. LV end-systolic (ESD) and end-diastolic (EDD) diameters, LV septal and posterior wall thickness were measured, and LV mass index (MI) as well as relative wall thickness (RWT) were calculated using Devereux and Ganau formulas. LV ge...
Cardiac structure and function in normal pregnancy
Current Opinion in Obstetrics & Gynecology, 2012
Purpose of review To review the published data on maternal cardiac adaptation to pregnancy. Recent findings Normal pregnancy is characterized by significant changes in the cardiovascular system. Studies on systemic arterial system and heart remodelling in pregnancy provide somewhat uniform results. In normal pregnancy, left ventricle mass, cardiac output and arterial compliance increase, whereas total vascular resistance decreases. In contrast, findings on left ventricular systolic and diastolic chamber and myocardial function are conflicting.
Study of the left ventricular function in pregnancy-induced hypertension
Clinical Cardiology, 1988
Left ventricular (LV) morphological and functional characteristics in 9 women suffering from pregnancy-induced hypertension (PIH) were studied by means of echocardiograms. In order to distinguish which changes depended on the pressure values and which were the result of pregnancy, 10 nonpregnant control women with no heart disease and 10 normal pregnant women (NP) were studied and the results of each of the groups compared. To evaluate the structure, left ventricular systodiastolic diameters and wall thickness were measured. The only statistically significant difference was in the diastolic diameters between the PIH (4:7 f0.3 cm) and the control group (4.4f0.2 cm) p <0.01. Left ventricular mass was significantly increased (p<O.Ol) in the PIH patients (185It53.1 g) compared to the NP patients (161f29.6 g) and the control group (125f 17.4 g). No statistically significant differences were found in the radius thickness ratio in the three groups. The systolic function assessed by the shortening percentage was significantly lower (~~0. 0 5) in the control group (32.8f4.4%) and in the NP patients (37.8f5.2%) than in the PIH group (39k6.5 %). Afterload assessed by isovolumic period stress was significantly greater (p<O.Ol) in the PIH patients (157 f 10.6 dyne/cm*) compared with the NP group (118.9f7.01 dyne/cm2). There were no significant differences between the first group and the control group (134.09f8.7 dyne/cm2). As evidence of the diastolic function, analysis was made, on the one hand, of diastolic isovolumic period length (DIP). Values in the control group were 50f8.1 ms, in NP 54f14.2 ms, and in PIH 50f 12.2 ms. There were no significant differences between the groups. On the other hand, peak velocity di
Echocardiography, 2014
Aims: During pregnancy, important hemodynamic changes occur, consistent with an increase in preload and decrease in afterload and systemic vascular resistance. The aim of the present study was to investigate the changes in left ventricular (LV) strain and rotational properties during the 3 trimesters of normal pregnancy and to examine the factors that drive these changes. Methods and Results: Twenty-seven pregnant women (29.7 AE 6.9 years) and 11 age-matched nonpregnant controls (29.9 AE 5.4 years) were evaluated. Conventional echocardiography and two-dimensional speckle tracking imaging were performed at 8-12 (1st trimester), 21-28 (2nd trimester), and 33-36 (3rd trimester) weeks of pregnancy. LV rotation, twist, untwisting rate, and circumferential strain were measured using the parasternal short-axis views at basal and apical levels. Global longitudinal strain was calculated from the LV apical views. Peak LV twist and peak untwisting rate increased significantly in the 3rd trimester of normal pregnancy (13.48 AE 2.90°, 13.12 AE 3.30°, 16.83 AE 3.61°, P < 0.001; and À111.52 AE 23.54°/sec, À107.40 AE 26.58°/sec, À144.30 AE 45.14°/sec, P < 0.001; in the 1st, 2nd, and 3rd trimester, respectively). Global longitudinal and circumferential strain of the apex decreased significantly from the 2nd trimester. An independent association was found between the change in LV twist and the change in LV end-systolic volume between the 1st and 3rd trimester. Peak untwisting rate at the 3rd trimester correlated significantly with peak twist and LV end-diastolic volume. Conclusions: During normal pregnancy, LV twist and peak untwisting rate increase in the 3rd trimester and correlate with end-systolic and end-diastolic volume, respectively. Circumferential strain of the apex and global longitudinal strain decrease from the 2nd trimester. (Echocardiography 2014;31:155-163)