Reference ranges for tissue Doppler measures of maternal systolic and diastolic left ventricular function

Tissue Doppler imaging (TDI) is an echocardiographic technique that evaluates longitudinal myocardial tissue velocities during left ventricular systolic and diastolic function, relatively independently of loading conditions. Limited data are available regarding maternal cardiac function using TDI. The aim of this study was to construct reference charts for TDI indices in normal pregnancy.

This was a cross-sectional study on 104 pregnant women at 11-38 weeks of gestation and 19 non-pregnant controls. Doppler echocardiography was used to assess transmitral inflow velocities during diastole (peak velocity of early (E) and late (A) atrial filling), whilst TDI at the septal and lateral margins of the mitral annulus measured diastolic velocities (peak velocity of early (E') and late (A') diastolic filling) and peak systolic velocity (S'). The left ventricular filling index (E : E' ratio) was derived. The Tei index (ratio of isovolumetric time to ejection time) was measured.

Systolic function assessed by TDI S' velocity was unaltered at the septal and lateral margins, although S' velocity at the lateral margin was higher (12%, P = 0.028) in the first two trimesters, compared to non-pregnant controls. Diastolic function was modified as demonstrated by an increase in A velocity (P P = 0.024). Similarly, A' increased at the septal and lateral margins ( P < 0.001 and P = 0.02, respectively), resulting in a decrease in E' : A' ratios at the septal and lateral mitral margins ( P = 0.001 and P = 0.001, respectively). E : E' at both mitral margins and Tei index were unaltered.

This study gives normal ranges for TDI indices in pregnancy. TDI demonstrated modified longitudinal systolic and diastolic function. Future studies will evaluate the potential of this technique in pregnancies complicated by hypertension and cardiac disease. Published by John Wiley & Sons, Ltd.