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Pregnant women experience adaptation of the cardiovascular system to hemodynamic changes. The aim of this study was to assess cardiovascular changes during normal pregnancy using speckle tracking echocardiography (STE).
Pregnant subjects were enrolled retrospectively if they underwent a transthoracic echocardiography (TTE) between 2011-2014. Subjects with abnormal TTE findings, hypertension, diabetes, preeclampsia, prior cardiac surgery, poor imaging quality or in the 1st trimester were excluded (due to small sample size). A total of 74 pregnant subjects were categorized into the 2nd or 3rd trimesters. STE analysis was performed at the parasternal short axis view at the papillary muscle level and apical 4, 3 and 2 chamber views using Syngo Velocity Vector Imaging software (Siemens Healthcare, Erlangen, Germany). Twenty-one healthy age-matched females were selected as a control group.
The heart undergoes extensive remodeling during pregnancy with increased left ventricular septal thickness, posterior wall thickness, cavity size and mass (p=0.045, p=0.002, p<0.001, p=0.018, respectively). However, myocardial mechanical function measured by: global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), global longitudinal strain rate (GLSR), global radial strain rate (GRSR) and global circumferential strain rate (GCSR), remained preserved (Table 1). Only time to peak strain rate corrected for heart rate for GRSR and GLSR were significantly increased in the third trimester (p=0.016 for both).
Our study showed that despite extensive heart remodeling, many STE derived parameters remain unchanged and valid for women in the 2nd and 3rd trimester. Future studies using these parameters to explore early detection of pregnancy related heart disease are warranted.