Maternal Left Ventricular Function in Uncomplicated Twin Pregnancies: A Speckle-Tracking Imaging Longitudinal Study

Area of Science:

• Cardiovascular Physiology
• Maternal-Fetal Medicine
• Obstetrics

Background:

• Maternal cardiovascular adaptation in twin pregnancies is not fully understood.
• Twin pregnancies present unique physiological challenges compared to singletons.

Purpose of the Study:

• To longitudinally investigate maternal left ventricular (LV) function in uncomplicated twin pregnancies.
• To compare cardiovascular hemodynamic adaptation between twin and singleton pregnancies.

Main Methods:

• Prospective enrollment of 30 twin pregnant women and 30 singleton controls.
• Transthoracic echocardiography performed at three gestational periods (T1, T2, T3).
• Assessment of LV dimensions, volumes, ejection fraction, mass, diastolic parameters, and 2D strains (GLS, radial, circumferential).

Main Results:

• Maternal LV dimensions, volumes, and mass increased in both groups, with stable LV ejection fraction.
• LV remodeling/hypertrophy observed in 50% of women in both groups at T2 and T3.
• Diastolic function worsened over gestation, with higher LV filling pressures in twins at T2; 2D strains showed impairment in a significant proportion of women.

Conclusions:

• Maternal LV geometry, dimensions, and function are significantly impaired in twin pregnancies, especially in the second half of gestation.
• These impairments show no significant differences compared to singleton pregnancies.
• Findings highlight the substantial cardiovascular load imposed by twin gestation.